| Abstrakt: |
To the Editor.—Dr Shenkin (240:22, 1978) seems to have missed the point of Loeser's SPECIAL COMMUNICATION (239:1153, 1978). The ideal form of management of trigeminal neuralgia is the permanent relief of pain without producing neurologic deficit. The initial response to medication is usually satisfactory. However, ultimately a large percent of patients fail medical management. The problem then becomes one to be solved surgically. Dr Loeser has made a plea to use surgical therapies that are based on physiologic principles and aimed at dealing with the known neuropathologic states associated with this excruciating condition.Dandy1 clearly demonstrated compression of the fifth cranial nerve in the posterior fossa when he operated on these patients. Other investigators2-4 were able to substantiate these findings. Jannetta5 has taken us one step further in devising an operative approach to the region and in demonstrating how to achieve long-standing pain relief without producing |
