In Reply: Comparison of Surgical Treatments for Trigeminal Neuralgia: Reevaluation of Radio frequency Rhizotomy

In reply: We appreciate the comments of Håkanson who pioneered the technique of glycerol rhizotomy in the treatment of trigeminal neuralgia. We agree that attention to detail during glycerol rhizotomy is crucial for success. This principle of technique to achieve optimal results is applicable for all of the surgical procedures described in our article, including radiofrequency rhizotomy, balloon compression, and microvascular decompression. Concerns similar to those raised by Håkanson apply to all of them. All of the procedures reviewed in our article were performed by "experts" in the field who rationalize and have valid reasons for considering their individual techniques. We emphasize that every surgeon should compare his or her results with the results reported in the literature to justify continuation or discontinuation of a specific surgical procedure for any disorder. For no situation is this more true than for the surgical treatment of trigeminal neuralgia. That there are so many treatments for this disorder suggests that none are perfect. Jamal M. Taha John M. Tew, Jr. Cincinnati, Ohio