Stereotactic radiosurgery for craniofacial pain disorders: current clinical applications and future perspectives

INTRODUCTION: Stereotactic radiosurgery (SRS) has emerged as a less invasive treatment for various medically refractory craniofacial pain disorders. Advances in neuroimaging, radiosurgical technology, and treatment planning have expanded its application beyond trigeminal neuralgia (TN) to glossopharyngeal neuralgia (GN), trigeminal autonomic cephalalgias (TACs), and neuropathic facial pain (NFP). AREAS COVERED: This review summarizes the current clinical indications, radiosurgical techniques, efficacy, safety, and limitations of SRS for medically refractory craniofacial pain disorders. The available literature on TN, GN, TACs, and NFP is reviewed, with particular emphasis on patient selection, target definition, treatment outcomes, repeat radiosurgery, and treatment-related adverse effects. EXPERT OPINION: SRS is an established treatment for classical, idiopathic, and multiple sclerosis-related TN. In contrast, its application to GN, tumor-related TN, TACs, and NFP remains investigational because of limited and heterogeneous evidence. Future advances in neuroimaging, target localization, and understanding of craniofacial pain pathophysiology, together with well-designed studies, are expected to optimize patient selection and better define the role of SRS for those disorders.