Peripheral Neurectomy for Treatment of Trigeminal Neuralgia

Roychoudhury, Priodarshi; Rocha-Romero, Andrés; Raslan, Ahmed M.; Abd‐Elsayed, Alaa

doi:10.1007/978-3-030-60687-9_20

Cited by 2 publications

(4 citation statements)

References 10 publications

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“…Peripheral neurectomy for TNP is a safe and minimally invasive procedure that has historically been limited by the recurrence of neuropathic pain postprocedure. 5,10 Among surgical interventions for TNP, peripheral neurectomy without nerve reconstruction or obturation of the neural foramina has the highest rates of recurrence due to spontaneous nerve regeneration and the development of painful neuromas. 5,6 Several studies have found that obturation of the neural foramina can increase the duration of postoperative pain relief, [11][12][13] but nerve reconstruction with a nerve connector or PNA has not yet been studied in combination with peripheral neurectomy for trigeminal neuralgia.…”

Section: Discussionmentioning

confidence: 99%

“…5,10 Among surgical interventions for TNP, peripheral neurectomy without nerve reconstruction or obturation of the neural foramina has the highest rates of recurrence due to spontaneous nerve regeneration and the development of painful neuromas. 5,6 Several studies have found that obturation of the neural foramina can increase the duration of postoperative pain relief, [11][12][13] but nerve reconstruction with a nerve connector or PNA has not yet been studied in combination with peripheral neurectomy for trigeminal neuralgia. This study describes a novel strategy for peripheral neurectomy that utilizes nerve conduits or PNAs for organized regeneration of proximal nerve stumps and reports the initial outcomes in 5 patients with TNP of various etiologies.…”

Section: Discussionmentioning

confidence: 99%

“…4 Peripheral neurectomy, or the transection of affected distal sensory nerves, has also been described for the treatment of refractory TNP, with variable success. 5,6 As with other surgical interventions for TNP, peripheral neurectomy is limited by recurrence, especially when the risks of disorganized nerve growth and neuroma formation after nerve transection are not adequately addressed. 6 However, peripheral neurectomy is less invasive and carries a lower risk profile than neurosurgical procedures for TNP, and it can also be repeated with good response and does not affect corneal sensation.…”

mentioning

confidence: 99%

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Peripheral Neurectomy With Customized Nerve Reconstruction for Periorbital Neuropathic Pain: Initial Experience and Clinical Outcomes

Kim

Tian

Gross

et al. 2022

Ophthalmic Plastic &Amp; Reconstructive Surgery

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To describe a novel, minimally invasive surgical technique to treat severe, intractable periorbital neuropathic pain.Methods: A retrospective analysis of patients with severe, treatment-refractory periorbital pain who underwent transection of affected sensory trigeminal branches with nerve repair was performed. Collected data included etiology and duration of neuropathic pain, comorbidities, prior treatment history, surgical technique including site of transected sensory nerves and type of nerve repair, preoperative and postoperative pain scores as well as follow-up duration. Differences between preoperative and postoperative values were analyzed by the Wilcoxon signed-rank test.Results: A total of 5 patients with severe periorbital neuropathic pain underwent transection of affected supraorbital, supratrochlear, infratrochlear, infraorbital, zygomaticotemporal, and zygomaticofacial nerves with customized nerve reconstruction. All 5 had improvement of periorbital pain after surgery, with 3 (60%) noting complete resolution of pain and 2 (40%) experiencing partial pain relief over a median follow-up period of 9 months (interquartile range [IQR], 6-19 months). Of the 3 patients who had complete resolution of pain, all reported continued pain relief. Median McGill pain scores significantly decreased from 8.4 (IQR, 8.2-10.0) preoperatively to 0.0 (IQR, 0.0-4.8; p < 0.001) postoperatively. All patients reported satisfaction with the surgical procedure and stated that they would undergo the procedure again if given the option. One patient with history of postherpetic neuralgia (PHN) had reactivation of herpes zoster at postoperative month 3, which was self-limited, without worsening of her neuropathic pain. Another patient with PHN required a staged procedure to achieve complete pain relief.Conclusion: Peripheral neurectomy with customized reconstruction of involved sensory nerves can successfully reduce and even eradicate periorbital neuropathic pain that was previously recalcitrant to combination pharmacotherapy and prior neurolysis procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Peripheral Neurectomy With Customized Nerve Reconstruction for Periorbital Neuropathic Pain: Initial Experience and Clinical Outcomes

Kim

Tian

Gross

et al. 2022

Ophthalmic Plastic &Amp; Reconstructive Surgery

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“…For patients with cancer, the literature supports the use of neurolytic agents [ 6 ]. Furthermore, some studies have included peripheral approaches to distal branches [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Computed tomography-guided Gasserian ganglion interventions for cancer-related facial pain in patients with complex anatomy: Insights and recommendations

et al. 2023

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Background: The Gasserian ganglion is a well-known target for facial pain management, and patients with cancer present an anatomical challenge owing to tumor progression or treatment itself. Computed tomography (CT) is an alternative method for guiding these procedures.Methods: This was an observational retrospective analysis of patients with cancer-related facial pain who underwent CT-guided Gasserian ganglion interventions using local anesthetics, local anesthetics with steroids, phenol, and radiofrequency. Demographic, clinical, and procedure-related variables were collected from January 1, 2015, to December 30, 2018, at the National Cancer Institute. Data distribution was determined using the Kolmogorov–Smirnov test. A paired sample t-test (with a cut-off of P < 0.05 for statistical significance) was used for comparing outcome.Results: We observed a significant reduction in numerical rating scale (NRS) and douleur neuropathique 4 (DN4) scores from 7.6 ± 1.4 and 4.4 ± 1.4 to 3.2 ± 2.0 and 2.2 ± 1.4 points, respectively (P < 0.001). After the procedure, 70.8% of the patients were satisfied; 16.7% were very satisfied, and 12.5% were unsatisfied. No intra- or postoperative complications were observed. The most common neoplasms were head and neck tumors (83.3%).Conclusions: Our data suggest that CT guidance is an effective and safe option for managing cancer-related facial pain in patients with complex anatomy, resulting in a significant reduction in pain, high satisfaction rates, and no mechanical complications. Future research should aim to refine the role of CT guidance in multimodal pain management in this population.

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Peripheral Neurectomy for Treatment of Trigeminal Neuralgia

Cited by 2 publications

References 10 publications

Peripheral Neurectomy With Customized Nerve Reconstruction for Periorbital Neuropathic Pain: Initial Experience and Clinical Outcomes

Peripheral Neurectomy With Customized Nerve Reconstruction for Periorbital Neuropathic Pain: Initial Experience and Clinical Outcomes

Computed tomography-guided Gasserian ganglion interventions for cancer-related facial pain in patients with complex anatomy: Insights and recommendations

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