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

Holste, Katherine; Hardaway, Frances; Raslan, Ahmed M.; Burchiel, Kim J.

doi:10.3171/2018.3.jns172495

Cited by 23 publications

(27 citation statements)

References 17 publications

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“…88 Of note, some rarer conditions such as glossopharyngeal neuralgia and intermedius (geniculate) neuralgia may also respond well to destructive procedures. 42,109 The Future of Pain Surgery…”

Section: Trigeminal Neuralgiamentioning

confidence: 99%

Contemporary concepts of pain surgery

Burchiel

Raslan

2019

Journal of Neurosurgery

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Pain surgery is one of the historic foundations of neurological surgery. The authors present a review of contemporary concepts in surgical pain management, with reference to past successes and failures, what has been learned as a subspecialty over the past 50 years, as well as a vision for current and future practice. This subspecialty confronts problems of cancer pain, nociceptive pain, and neuropathic pain. For noncancer pain, ablative procedures such as dorsal root entry zone lesions and rhizolysis for trigeminal neuralgia (TN) should continue to be practiced. Other procedures, such as medial thalamotomy, have not been proven effective and require continued study. Dorsal rhizotomy, dorsal root ganglionectomy, and neurotomy should probably be abandoned. For cancer pain, cordotomy is an important and underutilized method for pain control. Intrathecal opiate administration via an implantable system remains an important option for cancer pain management. While there are encouraging results in small case series, cingulotomy, hypophysectomy, and mesencephalotomy deserve further detailed analysis. Electrical neuromodulation is a rapidly changing discipline, and new methods such as high-frequency spinal cord stimulation (SCS), burst SCS, and dorsal root ganglion stimulation may or may not prove to be more effective than conventional SCS. Despite a history of failure, deep brain stimulation for pain may yet prove to be an effective therapy for specific pain conditions. Peripheral nerve stimulation for conditions such as occipital neuralgia and trigeminal neuropathic pain remains an option, although the quality of outcomes data is a challenge to these applications. Based on the evidence, motor cortex stimulation should be abandoned. TN is a mainstay of the surgical treatment of pain, particularly as new evidence and insights into TN emerge. Pain surgery will continue to build on this heritage, and restorative procedures will likely find a role in the armamentarium. The challenge for the future will be to acquire higher-level evidence to support the practice of surgical pain management.

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Section: Trigeminal Neuralgiamentioning

confidence: 99%

Contemporary concepts of pain surgery

Burchiel

Raslan

2019

Journal of Neurosurgery

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“…Given the preponderance of surgical reports, focused information on medical treatment was vague and often limited. [8][9][10]13,[15][16][17][19][20][21][22][23][24][25][26][27]29,30,32,33,[35][36][37]…”

Section: Treatments Reported For Ninmentioning

confidence: 99%

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

Robblee

2021

Headache

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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.

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“…The facial nerve's sensory fibers that travel in the NI project to the spinal trigeminal nerve nucleus together with the glossopharyngeal and vagus nerves. It is not uncommon for patients with subacute or chronic GN to have referred pain to these nerves' cutaneous distributions, which thus leads to misdiagnosis of neuralgia with a different source (Holste, Hardaway, Raslan, & Burchiel, ). This is why early diagnosis, as well as classification of otalgia's initial symptom, is paramount to localize the disease correctly.…”

Section: Diagnosis Based On Anatomymentioning

confidence: 99%

“…The variability in each of these treatments' results reflects the variability in the NIs anatomy directly (Bentley & Sagher, ). Postoperative deficits in taste and lacrimation vary between surgical techniques, and often are spared in cases of nerve sectioning, but not in direct geniculate ganglion destruction (Holste et al, ; Rupa, Weider, Glasner, & Saunders, ). Hearing loss is also a dreaded complication from excessive seventh–eighth nerve complex manipulation or vascular insult, and hearing outcomes after surgical intervention are underreported in the current literature (Holste et al, ; Peris‐Celda et al, ).…”

Section: Anatomically Guided Surgerymentioning

confidence: 99%

“…Postoperative deficits in taste and lacrimation vary between surgical techniques, and often are spared in cases of nerve sectioning, but not in direct geniculate ganglion destruction (Holste et al, ; Rupa, Weider, Glasner, & Saunders, ). Hearing loss is also a dreaded complication from excessive seventh–eighth nerve complex manipulation or vascular insult, and hearing outcomes after surgical intervention are underreported in the current literature (Holste et al, ; Peris‐Celda et al, ). In our experience, when identifying the NI, gentle depression of the superior vestibular nerve or elevation of the facial nerve will reveal the cisternal location in most cases.…”

Section: Anatomically Guided Surgerymentioning

confidence: 99%

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

et al. 2019

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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.

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

Cited by 23 publications

References 17 publications

Contemporary concepts of pain surgery

Contemporary concepts of pain surgery

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

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

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