A Modification of the Tiffany Operation for Tic Douloureux

T HE purpose of this paper is to revive and propose a modification of the operative procedure of subtotal removal of the ganglion of Gasser for the treatment of tic douloureux as proposed and executed by Tiffany 19 in 1894. Early surgical t reatment for this disease comprised division or avulsion of the peripheral branches of the 5th cranial nerve. These neurectomies resulted in only temporary relief of pain and consequently were abandoned except in special circumstances. After many years of trial and failure with peripheral neurectomies, partial to complete removal of the Gasserian ganglion was practised. During the latter part of the nineteenth century and the first half of this century major contributions dealing with the surgical t reatment of tic douloureux were made by Mears, 12 Rose, I4 Horsley et al. s Hartley, 7 Krause, 11 Tiffany, 2~ Spiller and Frazier, TM Keen, ~~ Cushing, 2 Hutchinson, 9 Dandy, 3 Stookey, 17 SjSqvist, ~5 and Taarnh0j. is In 1884 Mears 12 suggested the removal of the Gasscrian ganglion. Rose 14 is accorded the distinction of being the first to carry out this procedure (1890). Horsley et al. s in 1891 described avulsion of the dorsal root of the Gasserian ganglion through a temporal, intradural approach. In 189~ Hart ley 7 reported alleviation of the pain of tic douloureux by removal of the s and 3rd divisions of the trigeminus and a portion of the Gasserian ganglion. He did not suggest or practise avoiding the fibers in the ganglion that supply the cornea and his drawings of the face after operation indicate that there were sensory alterations of part of the cutaneous