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July 22, 1983

A Method of Total Extirpation of the Gasserian Ganglion for Trigeminal Neuralgia: By a Route Through the Temporal Fossa and Beneath the Middle Meningeal Artery.

Author Affiliations

Associate in Surgery, The Johns Hopkins University. Baltimore.

JAMA. 1983;250(4):519-528. doi:10.1001/jama.1983.03340040059035

Of the many diseases which, on therapeutic grounds, are supposed to occupy a border-line position between the provinces of the physician and surgeon, perhaps no one more than intractable epileptiform neuralgia illustrates so well the dictim of that renowned Philadelphian and friend of many doctors, Benjamin Franklin, to the effect that "he is the best physician who knows the worthlessness of the most medicines."

Granting the premise in all cases of true tic douloureux, the neuralgia quinti major of Henry Head, in which all three divisions of the trigeminal nerve are affected, that surgical measures alone can with any degree of certainty be depended on to afford relief from this horrible affliction and that the removal of the Gasserian ganglion must ultimately be contemplated, it is to be regretted that this final procedure should generally be regarded as one hazardous in its performance and uncertain in its permanent effects. Two