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This operation requires a small craniectomy, just behind the ear. It is typically used to treat refractory trigeminal neuralgia or Tic Doloreaux. The hole in the back of the skull is used to access the cranial nerves. In the case of Tic pain, a small Teflon sponge is used to separate the fifth cranial nerve from an artery compressing it. This operation is effective, but should only be used after medical treatments have failed.