Clinical implications of nervus intermedius variants in patients with geniculate neuralgia: Let anatomy be the guide

Clifton, William; Grewal, Sanjeet S.; Lundy, Larry; Cheshire, William P.; Tubbs, R. Shane; Wharen, Robert E.

doi:10.1002/ca.23536

Cited by 7 publications

(5 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There is also a nervus intermedius that can be confused with a split in the facial nerve. The nervus intermedius was first identified in 1563; it was first named "portio media intercommunicantem faciei et nervum auditorium" in 1777 by Heinrich August Wrisberg [36,37]. The nervus intermedius is thus named because it is located between the facial nerve and the superior portion of the vestibular cochlear nerve [37,38].…”

Section: Discussionmentioning

confidence: 99%

Penetrating Offenders in Hemifacial Spasm: Surgical Tactics and Prognosis

Lee,

Park

2023

Life

View full text Add to dashboard Cite

(1) Background: In cases of hemifacial spasm (HFS), there are various patterns related to the vascular compression of the facial nerve, including a very rare form that is seen when the offending vessel penetrates the facial nerve. However, there have been few reports in the literature regarding the associated surgical techniques and postoperative prognosis. (2) Methods: A retrospective review was conducted of 4755 patients who underwent microvascular decompression (MVD) surgery from April 1997 to June 2023. In total, 8 out of the 4755 patients (0.2%) exhibited a penetrating offending vessel; the medical and surgical records of these 8 patients were then analyzed. Surgery was then attempted to maximally decompress the penetrating offender. (3) Results: Seven out of the eight patients (87.5%) were spasm-free immediately after surgery, and one had only 10% residual spasm compared to their preoperative condition. That patient was also spasm-free one year later. Postoperative facial palsy occurred in one patient (12.5%) who was assessed as grade II in the House–Brackmann grading system. In another patient, the resection of a small facial nerve bundle did not result in facial palsy. There were no cases of hearing loss or other complications. (4) Conclusions: Decompressing the penetrating offender did not increase the incidence of facial palsy, and the prognosis for hemifacial spasms was good. Therefore, when a penetrating pattern was encountered during MVD surgery, decompression between the penetrating offender and the facial nerve may offer good results.

show abstract

Section: Discussionmentioning

confidence: 99%

Penetrating Offenders in Hemifacial Spasm: Surgical Tactics and Prognosis

Lee,

Park

2023

Life

View full text Add to dashboard Cite

show abstract

“…Note that the included cases are diagnosed as NIN, but this diagnosis may not have been confirmed and may not have even formally met ICHD‐3 criteria. As a result of this review, 61 papers were reviewed in full for inclusion, from which data on 127 cases were compiled from 33 publications, 2,6,8–38 with 30 of these publications discussing treatments 6,8–13,15–37,39 …”

Section: Methodsmentioning

confidence: 99%

“…The most common effective treatments reported in the literature were surgical procedures, 6,[8][9][10][11][12][13]15,16,18,[20][21][22]24,27,28,[30][31][32][33][34][35][36] including microvascular decompression, nerve sectioning, rhizotomy, and tractotomy. None of the surgical cases reported a poor response, although some did report requiring two to three procedures for a good response.…”

Section: Treatments Reported For Ninmentioning

confidence: 99%

See 1 more Smart Citation

A pain in the ear: Two case reports of nervus intermedius neuralgia and narrative review

Robblee

2021

Headache

View full text Add to dashboard Cite

Objective: Present two cases of nervus intermedius neuralgia (NIN) in which patients described unilateral deep ear pain as their primary complaint and present a summary of NIN cases reported in the literature. Background: The nervus intermedius is a tiny branch of the facial nerve that, with neuralgia, can present as a deep ear pain (NIN). The International Classification of Headache Disorders, 3rd edition, (ICHD-3) criteria for an NIN diagnosis include a unilateral deep ear pain with possible radiation that occurs in paroxysms with sharp pain and a tactile trigger. Methods: A PubMed search was conducted for NIN and geniculate neuralgia. Two patients recently diagnosed with NIN at a single clinic were selected for case reports to highlight the variability of symptom presentation. Results: The two cases reported here and the 127 cases reported in the literature show a wider range of presentations than included in the ICHD-3 criteria, including variable pain radiation sometimes diagnosed as concurrent trigeminal, glossopharyngeal, or occipital neuralgia. Pain was reported as constant or paroxysmal, as well as dull, sharp, or neuralgiform with inconsistent presence of triggers. While ICHD-3 does mention reported taste change, lacrimation, and salivation, the literature reports a much wider range of potential features associated with NIN. Optimal medical treatment is unclear given the predominance of surgical reporting of positive response to microvascular decompression, nerve sectioning, or other procedures. The two cases described here were successfully managed medically. Conclusion: NIN can present as described in the ICHD-3, but a more variable presentation may be possible. More studies are needed to clarify presentation, optimal medical treatment, and surgical indications for patients with NIN, especially when patients have no clear neurovascular conflict on neuroimaging. K E Y W O R D S ear pain, geniculate, nervus intermedius, neuralgia, otalgia | 415 HEADACHE How to cite this article: Robblee J. A pain in the ear: Two case reports of nervus intermedius neuralgia and narrative review.

show abstract

“…Such authoritative findings have been taken as the anatomical basis for the subsequent surgical procedure. Some surgeons have tried various strategies to treat NIN, such as the previously proposed NI transection and the recently advocated MVD ( 11 , 12 ). Despite this fact, there are limited guidelines on different surgical approaches in specific scenarios, and this motivates our interest in sharing our experience with treating NIN by MVD.…”

Section: Introductionmentioning

confidence: 99%

Case Report: Direct Visualization of the Nervus Intermedius During the Microvascular Decompression Procedure: Should We Take It Seriously?

Zheng

Zhao

et al. 2021

Front. Neurol.

View full text Add to dashboard Cite

Background: Nervus intermedius neuralgia (NIN), known as geniculate neuralgia (GN), is an uncommon cranial nerve disease caused by an offending vessel compressing the nervus intermedius (NI). Microvascular decompression (MVD) has now become a valued treatment approach for NIN because it can resolve neurovascular conflict (NVC) at the root entry zone of the NI. In the era of continuously optimizing and improving the surgical technique of MVD, further minimization of all possible postoperative complications is not only welcome but also necessary.Objective: The aim of this work is to assess the postoperative outcome of direct visualization of the NI during the MVD procedure.Methods: This study retrospectively reviewed the clinical records of a group of seven consecutive patients with NIN who underwent MVD in the period of 2013–2020 in our clinic and 16 studies reported NIN patients who underwent MVD in the period of 2007–2020.Results: In total, 91.3% of all patients experienced immediate and complete relief of cranial neuralgia after MVD. Six of 23 patients have experienced direct visualization of the NI intraoperatively, and 66.7% of those patients had complications such as facial paralysis, dysacousia, or a combination of these conditions postoperatively. Slight surgical approach-related complications such as complaints associated with excessive drainage of cerebrospinal fluid (CSF), nausea and vertigo, and delayed wound union were observed in 80% of the remaining 15 patients, and these symptoms are totally relieved in the telephone and outpatient follow-up after 6 months.Conclusion: Our case series shows that MVD produced immediate pain relief in the majority of NIN patients. MVD carries surgical risk, especially in patients who experience direct visualization of the NI after mechanical stretch and blunt dissection in surgical procedures. Attempts to avoid mechanical stretch and blunt dissection of the compressed nerve were important for intraoperative neuroprotection, especially facial nerve protection

show abstract

Clinical implications of nervus intermedius variants in patients with geniculate neuralgia: Let anatomy be the guide

Cited by 7 publications

References 23 publications

Penetrating Offenders in Hemifacial Spasm: Surgical Tactics and Prognosis

Penetrating Offenders in Hemifacial Spasm: Surgical Tactics and Prognosis

A pain in the ear: Two case reports of nervus intermedius neuralgia and narrative review

Case Report: Direct Visualization of the Nervus Intermedius During the Microvascular Decompression Procedure: Should We Take It Seriously?

Contact Info

Product

Resources

About