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Neurol Sci. 2019 Mar 5. doi: 10.1007/s10072-019-03789-4. [Epub ahead of print]

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

Author information

1
Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy. andrea.franzini1@hotmail.it.
2
Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, VA, USA. andrea.franzini1@hotmail.it.
3
Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, VA, USA.
4
Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.
5
Department of Neurosurgery, Humanitas Research Hospital, Milan, Italy.
6
University of Missouri School of medicine, Columbia, MO, USA.
7
Focused Ultrasound Foundation, Charlottesville, VA, USA.

Abstract

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.

KEYWORDS:

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

PMID:
30835002
DOI:
10.1007/s10072-019-03789-4

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