Reply to the Letter to the Editor: Mechanism of Efficacy of Microvascular Decompression for Trigeminal Neuralgia.

In an article published in the August 2015 issue of WORLD NEUROSURGERY, Tenser argues that the occasional reactivation of Herpes simplex virus (HSV) after surgical treatment of trigeminal neuralgia provides insights into the mechanism for efficacy of these operations. Specifically, he argues that because HSV reactivation has been observed in ablative treatments (radiofrequency lesions, glycerol injections, balloon compressions) and in nonablative treatments (microvascular decompression), then these treatments must share a common mechanism related to an alteration in trigeminal ganglion neuronal function.