Alcohol Injections of the Gasserian Ganglion for Trigeminal Neuralgia

Abstract

FOLLOWING the publication in the ANNALS OF SURGERY of November, I930 (vol. 92, p. 984), of my article on a method for penetrating into the Gasserian ganglion, read before the twenty-first Russian Surgical Congress of that year, two papers, one by Hartel and a second by Kirschner, have been published in the Zentralblatt fur Chirurgie, No. 6, I93S, criticizing the procedure outlined in my paper.Defending his method, Hairtel emphasizes in his article that complications may happen if one is not sufficiently acquainted with the technics of the procedure. He simultaneously makes objection against my method, which is defended by Kirschner. The latter names the method of Hartel supramandibular, that of mine inframandibular.Hartel asserts that the method used by him during twenty years has never needed modifications, while "the method of Irger is based on a pure theoretical construction and has until the publication of the former never been verified on men." Though admitting the possibility of penetrating to the Gasserian ganglion from the angle of the lower jaw, he demands that the expediency of this method be proved on clinical material. It seems to Hiirtel, though he has not verified it, that the path of penetration of the needle after my method would be longer than after the one employed by him. But making objection to Hartel, Kirschner maintains the expediency and simplicity of my method, which he first verified on patients while I had worked it out only on cadavers. He used my method in twenty-five cases without any complications.Concerning the length of the path from the skin prick to the Gasserian ganglion Kirschner could not find any essential difference between my method and that of Hiirtel on either skulls or patients.In using the method of Hartel, verified on cadavers and patients, we could not confirm the correctness of penetrating into the ganglion; that is why we began to search for another method.Offerhaus noted in his day that the oval foramina and the articular tubercles were on a same line. Uniting, according to our researches, by direct line the angle of the lower jaw, the upper margin of the articular tubercle and the oval foramen, we get an isosceles triangle with the top at the angle of the lower jaw. Consequently, the distance from the angle of the lower jaw to the oval foramen will be equal to the distance from the former to the upper margin of the articular tubercle.The examination of fifty skulls has enabled us to affirm that these deductions are quite true. Now as it is quite easy to determine in everyone the 61