Trigeminal neuralgia (TGN) manifests with severe pain attacks along the trigeminal nerve distribution, representing one of the most common causes of facial pain. Although approximately 70–90% of affected patients experience a satisfactory pain relief after the initiation of pharmacotherapy, approximately 44% of TGN patients suffer from refractory pain attacks from a long-term point of view [
1]. Surgical techniques, including microvascular decompression (MVD), percutaneous rhizotomy or stereotactic radiosurgery, should be considered as valuable treatment options for TGN refractory to medical treatment. Refractory TGN is a challenging condition due to a limited number of effective therapeutic options. Consequently, the continuous development of neuromodulation techniques represents a promising salvage treatment option in case of refractory neuropathic pain. In the early 1990s, motor cortex stimulation (MCS) has been proven to be effective in reducing TGN attacks not sufficiently controlled by medical treatment and common surgical procedures [
6]. Since then, several case series have been published with a reported median pain reduction of 70%, based on the pre- and post-operative visual analog scale, as stated in a recently published review [
3]. The correct position of the epidural electrode above the motor cortex is the major prerequisite for successful treatment. Hence, the procedure is preferentially performed under local anesthesia in order to conduct an intraoperative test-stimulation, confirming the correct electrode position [
2,
4,
9]. Additionally, intraoperative electrophysiological monitoring and neuronavigation are being implemented for the localization of the central sulcus. Median nerve somatosensory evoked potential (SEP) is usually used to identify the position of the central sulcus by recording a N20/P20 phase reversal across the central sulcus [
5]. Unfortunately, awake surgical procedures are generally associated with discomfort for the patients. In order to address the need for a more comfortable alternative, we present an alternative surgical option to confirm the correct position of the electrode above the motor cortex by intraoperatively eliciting motor evoked potentials (MEPs) after direct cortical stimulation via the placed epidural electrode under general anesthesia.