Jonathan White, M.D. - When to switch from medication management to a surgical procedure?
	Linda Mitchell, R.N. - When a facial pain patient goes to see a neurosurgeon for the first time (a nurse's perspective)
	Jonathan White, M.D. - How to select a neurosurgeon and hospital?
	Tony Whitworth, M.D. - What surgical procedure do you recommend first?
	John G. Golfinos, M.D., A.B. - Surgical treatments for classic trigeminal neuralgia & other facial pain syndromes
	Konstantin Slavin, M.D. - Selection of patients for treatment of facial pain surgery
	David A. Sirois, D.M.D., Ph.D. - Cosmetic plastic surgery considerations for trigeminal neuralgia & chronic facial pain patients

Surgical Considerations - Introduction

Many things can influence a patient’s decision to have surgery.  Some include the medication is no longer managing the pain, the medication side effects are no longer tolerable, age of the patient, health condition of the patient, information obtained from health care providers, the fear of  potential surgical complications, availability of an experienced neurosurgeon nearby, whether or not an insurance plan will approve an experienced out-of-network neurosurgeon for a procedure, assistance available for recuperating after a procedure, financial considerations if no insurance or from loss of hours on the job, work related issues, family situation (children or adult dependents), research, and hearing from other facial pain patients who underwent a procedure.

The more a patient learns about their surgical options, the easier it is to select the surgical procedure best for them.  Learning about all of your options, consulting with an experienced neurosurgeon who can discuss each procedure with you, and talking to patients who have already undergone surgery is much easier to do when you are not in pain or in a crisis situation.  Developing a game plan for how to handle your pain down the road and communicating it to family members or close friends is immensely valuable.

Before selecting a surgery, it is important to think about as a result of undergoing your first procedure, what outcome do you want.  This answer will vary from person to person usually depending on their age, health, and severity of pain.

When comparing surgical procedures, weigh the pros and cons of each procedure carefully to determine what risks you are willing to take or which potential complication you could best live with in selecting the best procedure for you.  If you have questions after a neurosurgeon consult, call the doctor or schedule another appointment to go back in and meet with the neurosurgeon for clarification.  It will be easiest to select a procedure once you have established what outcome you want from surgery and know all your options.

Current algorithm for the surgical treatment of facial pain
http://www.head-face-med.com/content/3/1/30#

Electrophysiologic Monitoring in Neurosurgery

Treatment of Trigeminal Neuralgia, Glossopharyngeal Neuralgia, and Hemifacial Spasm
http://neurosurgery.mgh.harvard.edu/TNHFS/mvd.htm

Organizations

American Association of Neurological Surgeons
http://www.aans.org/

Congress of Neurological Surgeons
http://www.neurosurgeon.org/