Surgical Treatment of Trigeminal Neuralgia: A History of Early Strides Toward Curing a “Cancerous Acrimony”

The pain of trigeminal neuralgia is considered one of the worst in human experience. Therefore, its treatment has been of special importance in the history of medicine and surgery. Long after physicians began prescribing various herbs and medication for trigeminal neuralgia, surgeons attempted to relieve it by cutting out parts of the nervous system they deemed responsible for the pain. Between the mid-19th and early 20th centuries, several surgeons pioneered surgical procedures aimed at the peripheral and central nervous system. Harvey Cushing contributed the most to increase the safety of these neurosurgical techniques. Due to Dr Cushing's meticulous clinical observation and operative record keeping, we are able to selectively review his newly discovered patient records at Johns Hopkins and Peter Bent Brigham Hospitals and provide insight into the early history and evolution of trigeminal neuralgia surgery. We also review the contributions of other surgeons from the same period.