I thank Dr. Foye for his comments and his interest in my report.1I adopted a computed tomography–guided approach to the ganglion impar to allow us to accurately localize the target and find the shortest and  least traumatic pathway to the target for injection of neurolytic agent.

The risks of infection, bleeding, and needle breakage are potentially lower because needles pass through low-resistance soft tissues and may therefore be less traumatic. I agree with Dr. Foye that a single needle injection may be just as effective as bilateral needle injection because the ganglion impar is a solitary ganglion.

Duke University Medical Center, Durham, North Carolina. hokokyuen@yahoo.com.sg

Ho KY, Nagi PA, Gray L, Huh BK: An alternative approach to ganglion impar neurolysis under computed tomography guidance for recurrent vulva cancer. Anesthesiology 2006; 105:861–2