Surgical treatment of postherpetic neuralgia. Results of skin undermining and excision in 14 patients.

Abstract

The pain which may persist after an attack of herpes zoster has proved to be notoriously refractory to the neurosurgical procedures generally advocated for the control of pain. With the exception of bilateral prefrontal lobotomy, which has most frequently brought relief or rather modified the patient's response to pain, 1 procedures such as peripheral nerve section or avulsion, 2 rhizotomy, 3-6 cordotomy, 7 and sympathectomy 8,9 have failed to provide relief from pain in the great majority of patients afflicted with this disorder. However, the undesirable mental changes and impairment in intellectual function following prefrontal lobotomy make this a procedure to be considered only as a last resort. 10 A different approach to this problem was suggested by Browder and de Veer 11 in 1949. These authors obtained encouraging results in patients with postherpetic pain involving the thoracic region by excision of the involved skin and subcutaneous tissue. Abbott and