Efficacy of Internal Neurolysis for Trigeminal Neuralgia without Vascular Compression

Abstract

Background and Objective Trigeminal neuralgia is a common neurologic disease that seriously impacts a patient's quality of life. We retrospectively investigated the efficacy and safety of internal neurolysis (nerve combing) for trigeminal neuralgia without vascular compression. Patients and Methods This study was a retrospective review of all patients with trigeminal neuralgia who were admitted between January 2014 and February 2019. A subgroup of 36 patients had no vascular compression at surgery and underwent internal neurolysis. Chart review and postoperative follow-up were performed to assess the overall outcomes of internal neurolysis. Results Thirty-six patients were identified, with a mean age of 44.89 ± 7.90 (rang: 31–65) years and a disease duration of 5.19 ± 2.61 years. The immediate postoperative pain relief (Barrow Neurological Institute [BNI] pain score of I or II) rate was 100%. The medium- to long-term pain relief rate was 91.7%. Three patients experienced recurrence. Facial numbness was the primary postoperative complication. Four patients with a score of III on the BNI numbness scale immediately after surgery had marked improvement at 6 months. No serious complications occurred. Conclusion Internal neurolysis is a safe and effective treatment for trigeminal neuralgia without vascular compression or clear responsible vessels.

Trigeminal Nerve Isolation Application in Microvascular Decompression for Treating Trigeminal Neuralgia: A Retrospective Study

“…It was reported that 83% of cases achieved significant pain relief and 63% of cases reduced the drug dosage by at least 50% 12 . Our results showed that the rate of initial pain relief and outcomes at the 1-year follow-up was 94.5%, which is in line or better than previously reported rates (60%–91.7%) for long-term relief in different centers 13–16 …”

“…12 Our results showed that the rate of initial pain relief and outcomes at the 1-year follow-up was 94.5%, which is in line or better than previously reported rates (60%-91.7%) for long-term relief in different centers. [13][14][15][16] In the conventional operation, neurosurgeons identify the responsible vessel that is conflicted with the trigeminal nerve root from the MRI images before the procedure, then probe the REZ to find the vessel that is compressing the nerve root. Subsequently, neurosurgeons transport the vessels from the nerve to over the nerve and insert a small prosthesis, Teflon, to maintain the pulsating artery separated from the trigeminal nerve root.…”

Development of a neural network model to establish a surgical paradigm for trigeminal neuralgia patients difficult to classify

“…Alternatively, if there is no vascular compression upon any part of the trigeminus, TN is usually classi ed as [8][9][10], and internal neurolysis (IN) surgery is usually performed with satisfactory treatment e cacy. Internal neurolysis (IN) involves longitudinal incision of the intracranial nerve root to achieve nerve micro destruction and is highly effective at curing ITN and signi cantly reducing the incidence of facial sensory disorders and the degree of numbness [11,12]; therefore, IN has been gradually accepted by an increasing number of scholars [13][14][15]. Our research team also used IN to treat ITN and came to similar conclusions [16].…”

The Molecular Basis and Pathophysiology of Trigeminal Neuralgia

“…For those without neurovascular compressions, particularly when MVD is initially intended but compression is not observed intraoperatively, open interfascicular neurolysis can be considered [ 127 ]. This technique aims to induce micro-trauma in the hyperactive trigeminal nerve by dividing the nerve longitudinally into multiple fascicles, which is thought to interrupt abnormal nociceptive transmissions and induce remyelination in the trigeminal system [ 127 , 128 , 129 ]. Although multiple retrospective studies have shown long-term symptom relief in 70–90% of the patients by this technique, the broad application of open neurolysis is limited by its invasive nature, along with the retrospective design and the small sample size of the supporting clinical studies [ 127 , 129 , 130 , 131 ].…”