Microvascular decompression may be an effective treatment for nervus intermedius neuralgia

Saers, S J F; Han, Kuo Sen; Ru, J. Alexander de

doi:10.1017/s0022215110002677

Cited by 29 publications

(27 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of the case reports advocating MVD, their patients experienced pain relief at longterm follow-up of 1-4 years, although pain recurrence is not known past 4 years, unlike our patients with NVC. 6,10 Ultimately there was no difference in the number of painfree months in those with and without NVC, indicating that patients with NVC do not respond better or worse than those without NVC to surgery.…”

Section: Figmentioning

confidence: 92%

See 1 more Smart Citation

Pain-free and pain-controlled survival after sectioning the nervus intermedius in nervus intermedius neuralgia: a single-institution review

Holste

Hardaway

Raslan³

et al. 2019

Journal of Neurosurgery

View full text Add to dashboard Cite

OBJECTIVE Nervus intermedius neuralgia (NIN) or geniculate neuralgia is a rare facial pain condition consisting of sharp, lancinating pain deep in the ear and can occur alongside trigeminal neuralgia (TN). Studies on the clinical presentation, intraoperative findings, and ultimately postoperative outcomes are extremely limited. The aim of this study was to examine the clinical presentation and surgical findings, and determine pain-free survival after sectioning of the nervus intermedius (NI). METHODS The authors conducted a retrospective chart review and survey of patients who were diagnosed with NIN at one institution and who underwent neurosurgical interventions. Pain-free survival was determined through chart review and phone interviews using a modified facial pain and quality of life questionnaire and represented as Kaplan-Meier curves. RESULTS The authors found 15 patients with NIN who underwent microsurgical intervention performed by two surgeons from 2002 to 2016 at a single institution. Fourteen of these patients underwent sectioning of the NI, and 8 of 14 had concomitant TN. Five patients had visible neurovascular compression (NVC) of the NI by the anterior inferior cerebellar artery in most cases where NVC was found. The most common postoperative complaints were dizziness and vertigo, diplopia, ear fullness, tinnitus, and temporary facial nerve palsy. Thirteen of the 14 patients reportedly experienced pain relief immediately after surgery. The mean length of follow-up was 6.41 years (range 8 months to 14.5 years). Overall recurrence of any pain was 42% (6 of 14), and 4 patients (isolated NIN that received NI sectioning alone) reported their pain was the same or worse than before surgery at longest follow-up. The median pain-free survival was 4.82 years ± 14.85 months. The median pain-controlled survival was 6.22 years ± 15.78 months. CONCLUSIONS In this retrospective review, sectioning of the NI produced no major complications, such as permanent facial weakness or deafness, and was effective for patients when performed in addition to other procedures. After sectioning of the NI, patients experienced 4.8 years pain free and experienced 6.2 years of less pain than before surgery. Alone, sectioning of the NI was not effective. The pathophysiology of NIN is not entirely understood. It appears that neurovascular compression plays only a minor role in the syndrome and there is a high degree of overlap with TN.

show abstract

Section: Figmentioning

confidence: 92%

“…6,12,14 In these case reports, MVD of the NI without sectioning was sufficient to produce pain relief. 10,11,17 Anatomically, NVC is most likely to occur proximally near the brainstem. As the NI exits the pontomedullary junction, it is in the form of 1-5 roots and travels through the cerebellopontine angle cistern, adhering to CN VIII.…”

Section: Figmentioning

confidence: 99%

Pain-free and pain-controlled survival after sectioning the nervus intermedius in nervus intermedius neuralgia: a single-institution review

Holste

Hardaway

Raslan³

et al. 2019

Journal of Neurosurgery

View full text Add to dashboard Cite

show abstract

“…Therefore, 18 papers were included in the review. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] All reports directly related to geniculate neuralgia were classified as level 4 evidence, consisting of single case reports or small case series. There were two level 1 systematic reviews, which discussed the medical therapy of neuralgia.…”

Section: Methodsmentioning

confidence: 99%

“…Saers et al 8 reported another patient with geniculate neuralgia for whom medical treatment was unsuccessful. Magnetic resonance imaging showed compression of the nervus intermedius by the anterior inferior cerebellar artery.…”

Section: Surgerymentioning

confidence: 99%

Geniculate neuralgia: a systematic review

et al. 2014

View full text Add to dashboard Cite

show abstract

“…This is why early diagnosis, as well as classification of otalgia's initial symptom, is paramount to localize the disease correctly. Patients who present with otalgia also should undergo a thorough evaluation from an otorhinolaryngology specialist to rule out non‐neurologic etiologies before considering surgical treatment for GN (Saers, Han, & de Ru, ).…”

Section: Diagnosis Based On Anatomymentioning

confidence: 99%

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

et al. 2019

View full text Add to dashboard Cite

Geniculate neuralgia (GN) is an uncommon, but severe, condition that is characterized by excruciating paroxysmal pain in the seventh cranial nerve's cutaneous distribution of general somatic afferent fibers carried through the nervus intermedius (NI). GN becomes a surgical disease in refractory cases of pain after exhaustive medical management. Surgical intervention in the form of microvascular decompression and nerve sectioning has been investigated with good patient outcomes. Despite this, there are limited guidelines on either technique's appropriateness in specific operative scenarios. In our 30‐year experience in GNs surgical management, we have found that a detailed knowledge of the NIs anatomy, variants, and intraoperative surgical anatomic findings are the key to choosing the most appropriate intervention, and may provide the answer to why some patients fail to experience pain relief after surgery. These anatomic variants also may explain why many patients commonly do not experience side effects related to the visceral efferent and special afferent fibers after nerve sectioning.

show abstract

Microvascular decompression may be an effective treatment for nervus intermedius neuralgia

Abstract: Patients with nervus intermedius neuralgia who do not respond to medical treatment may benefit from microvascular decompression.

Cited by 29 publications

References 16 publications

Pain-free and pain-controlled survival after sectioning the nervus intermedius in nervus intermedius neuralgia: a single-institution review

Pain-free and pain-controlled survival after sectioning the nervus intermedius in nervus intermedius neuralgia: a single-institution review

Geniculate neuralgia: a systematic review

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

Contact Info

Product

Resources

About