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August 2003

Affected Side and Risk of Pain Recurrence After Surgery for Trigeminal Neuralgia

Arch Neurol. 2003;60(8):1169-1170. doi:10.1001/archneur.60.8.1169-a

We read with interest the recent article by Theodosopoulos et al1 describing a predictive model for recurrent pain following posterior fossa surgery for trigeminal neuralgia. The authors noted that left-sided pain was a strong predictor of eventual pain recurrence after surgery but provided no speculation regarding why this might be the case. Prior studies of carotid endarterectomy (CEA) have found a greater complication rate with surgery on the left internal carotid artery compared with the right.2,3 This difference has been shown to occur with CEA performed by right-handed but not left-handed surgeons, suggesting that it results from issues of surgical technique and approach to the operative site.4 A recent report also demonstrated an increase in microembolic signals detected by transcranial Doppler monitoring during left compared with right CEA performed by right-handed surgeons, further supporting this hypothesis.5 Could Theodosopoulos and colleagues remark whether difficulties with surgical technique between the right vs left trigeminal nerve exist, and if so, whether this might have reduced the success of the operation on the group of patients with left-sided symptoms? In addition, because all operations were performed by the same surgeon, is this person right- or left-handed?

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