Percutaneous trigeminal tractotomy was carried out in 12 patients suffering from intractable facial pain of benign and malignant etiologies. The technique requires placement of an electrode under local anesthesia into the ipsilateral descending trigeminal tract by percutaneous insertion of the guide-needle through the foramen magnum. Following coagulation of this pathway in the brainstem, facial analgesia was effected in every patient. In seven patients with head and neck neoplasms, pain relief occurred. In some of the benign pain problems, such as postherpetic neuralgia, pain relief was only transient in spite of effective analgesia.