The Taarnhoj* Operation: Relief of Trigeminal Neuralgia Without Numbness

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TAARNHOJ1 in 1952 reported ten consecutive patients with trigeminal neuralgia who were treated by dividing the dural sheath enclosing the sensory root of the gasserian ganglion without dividing the nerve itself. This procedure afforded these patients relief of their tic douloureux without resultant anesthesia of the face. The reasoning which led Taarnhoj to attempt this procedure was suggested by the following case.

In April 1951 Taarnhoj observed a 31 year old man with typical trigeminal neuralgia of the third division. Because of the patient's age and the location of his pain, he suspected that the neuralgia was caused by an epidermoid in the right cerebellopontine angle, as had been previously reported by Olivecrona.2 At operation an epidermoid about the size of a hazelnut was found which was compressing the trigeminal root. The epidermoid was removed and the trigeminal root was left intact. When last seen seven months after operation, the patient had no pain and had normal sensation in the face.

This experience led Taarnhoj to suspect that idiopathic trigeminal neuralgia might also be due to compression of the root of the nerve. In studying the anatomy of the nerve it appeared to him that the most likely spot where compression might occur was in the narrow channel formed by the dura as it passes over the upper margin of the petrous bone. Therefore, he decided to treat patients with trigeminal neuralgia by dividing the dural sheath enclosing the root and ganglion without dividing the root itself. All of his. . .



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