Neurosurgery for Tic Douloureux

Contemporary treatment of tic douloureux required initial medical management. When this fails the patient should be offered several options, gangliolysis, Gamma Knife, or suboccipital cramiectomy with microvascular decompression. There are additiional surgival procedures to consider when all of these have failed. Tic rarely can occur in the distriburtion of the nervus intermdius or glossopharyngeal nerves requiring therapy targeting the involved nerve. Unrelieved tie douloureux does not meet a reasonable standard of care.