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Several innovative surgical options for the management of trigeminal neuralgia have emerged over the past 40 years. In addition to microvascular decompression, other techniques have been introduced for the treatment of trigeminal neuralgia and facial nerve pain. This chapter describes the following novel therapeutic modalities: endoscopic microvascular decompression, radiosurgery, radiofrequency, thermocoagulation, glycerol rhizotomoy, balloon compression, Gasserian ganglion stimulation, and subcutaneous trigeminal nerve stimulation. For each of these techniques, this chapter provides a description of the procedure, criteria for patient selection, and discusses published data regarding patient outcomes.

Trigeminal neuralgia is a rare syndrome classically described as brief paroxysms of severe, lancinating facial pain along a unilateral trigeminal nerve distribution. Numerous clinical presentations of trigeminal neuralgia exist, with various distinct etiologies. Several classification schemes have been designed for clinical and research purposes. However, varying terminology and inconsistent utilization of these systems can lead to diagnostic confusion and ungeneralizable research findings. Similarly, multiple pain scales have been used for trigeminal neuralgia with differing degrees of granularity, validity, and reliability. This chapter provides an overview of the commonly used classification systems and pain scales in the context of their evolution and utilization. Furthermore, the authors provide recommendations for application of these systems to clinical and research practice.