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The neurosurgical treatment of craniofacial pain syndromes: current surgical indications and techniques


Craniofacial pain syndromes are comprised of multiple pathological entities resulting in pain referred to the scalp, face, or deeper cranial structures. In a small subset of patients affected by those syndromes, pharmacological and physical therapies fail in alleviating pain. In some of those refractory patients surgical procedures aimed at relieving pain are indicated and have been adopted with variable results and safety profiles. In this review, the authors describe craniofacial pain syndromes that most commonly fail to respond to pharmacological therapies and may be amenable to tailored surgical procedures. In particular, trigeminal, glossopharyngeal, and occipital neuralgias are considered, as well as some primary headache syndromes such as cluster headache, short unilateral neuralgiform headache with conjunctival injection and tearing/short unilateral neuralgiform headache with autonomic symptoms, and migraine. Surgical techniques, including the implantation of deep brain or peripheral nerve electrodes with subsequent chronic stimulation, microvascular decompression of neurovascular conflicts, and percutaneous lesioning of neural structures are described. Finally, surgical indications, outcomes, and safety of these procedures are presented.

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Trigeminal neuralgia


Glossopharyngeal neuralgia


Occipital neuralgia


Root entry zone


Microvascular decompression


Cerebellopontine angle


Stereotactic radiosurgery


Linear accelerators


Magnetic resonance imaging


Occipital nerve stimulation


Greater occipital nerve


Cluster headache


Deep brain stimulation


Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing


Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms


Chronic migraine


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This work was supported by IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy.

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Correspondence to Andrea Franzini.

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Franzini, A., Moosa, S., D’Ammando, A. et al. The neurosurgical treatment of craniofacial pain syndromes: current surgical indications and techniques. Neurol Sci 40, 159–168 (2019).

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  • Trigeminal neuralgia
  • Glossopharyngeal neuralgia
  • Occipital neuralgia
  • Cluster headache
  • Migraine
  • SUNA
  • Microvascular decompression
  • Deep brain stimulation
  • Occipital nerve stimulation