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Although the results of stereotactic radiosurgery are similar to the percutaneous needle-based surgeries, the primary difference is the time required to achieve pain relief. With the percutaneous operations, most patients respond within the first few hours. After radiosurgery, pain relief is generally not noticed until 3-4 weeks after the procedure has been completed. As a result, patients with severe facial pain are generally not considered good candidates for stereotactic radiosurgery.

Retrogasserian Neurotomy

This surgical procedure involves sectioning the trigeminal nerve between the Gasserian ganglion and the pons. It was performed frequently during the first half of the 20th century but is done now performed only in very limited cases (e.g., patients who have undergone MVD surgery without pain relief or if no compression of the trigeminal nerve is discovered during surgery). Anesthesia dolorosa is the most dreaded complication of this procedure.

Peripheral Neurectomy

Peripheral neurectomy involves the excision of a segment of the trigeminal nerve. It is used only under limited circumstances such as patients who have failed to achieve pain relief from percutaneous rhizotomy procedures or patients who cannot tolerate undergoing MVD surgery due to advanced age or other underlying health problems. Rarely does peripheral neurectomy for trigeminal neuralgia achieve pain control beyond one year.

Trigeminal Tractotomy

In trigeminal tractotomy, the surgeon sections the descending fibers of the trigeminal tract in the medulla. It is carried out through a small suboccipital craniectomy and laminectomy of C1 and C2. This leads to a loss of pain and temperature sensation on one side of the face and in the larynx. It is not performed frequently and only if all other measures fail. It is critical that the surgeon be highly experienced in this procedure since there is a high complication and morbidity rate associated with inexperienced surgeons.