Peripheral Neurectomy: Minimally Invasive Surgical Modality for Trigeminal Neuralgia in Indian Population: A Retrospective Analysis of 20 Cases

Abstract

Peripheral neurectomy is one of the minimally invasive and expeditious forms of surgical modality for the treatment of trigeminal neuralgia. This treatment option is cost effective and provides long term relief from neuralgic pain.

Peripheral Neurectomy for Management of Trigeminal Neuralgia Refractory to Multiple Surgical Procedures

“… 8 Most of the studies done for peripheral neurectomy were published 20–50 years ago, demonstrating an average pain relief period of 24–33 months after surgery, with follow-up periods up to 9 years. 9 …”

“…The immediate outcomes of peripheral neurectomies are usually excellent, but long-term efficacy in classic TN is variable. 10 Regarding the follow-up after peripheral neurectomy, Chandan et al 9 suggest postoperative day 2, 7, 30, and then every 6 months for up to 3 years.…”

Obliterating foramina following peripheral neurectomies can prolong remission of neuralgia up to 10 years

“…24 There have been some revivals in the last 5 years as more oral surgeons in the Indian subcontinent reported their use for treating patients who were living in the rural area and were deprived socio-economically of modern neurosurgical facilities. 7,25,40,41 Proponents of peripheral neurectomy think that this procedure still has a role to play with the elderly, medically compromised patients or those not keen to be subjected to extensive neurosurgery. 18,24,39 The surgical techniques employed in this case were essentially the same as described by Hong-Sai.…”

“…10 The average pain free period achieved has been reported to be longer than that accorded by cryotherapy and lasted between 24-36 months similar to that reported by many authors. 12,25,30 Grantham and Segerberg 30 who electrocauterized the remaining nerve stump after performing nerve avulsion, reported to have achieved a wide range, from no improvement to pain relief up to 8 years. Yadav et al 7 however, recently reported that 25% of their Indian patients who underwent peripheral neurectomy suffered from recurrence of neuralgia within 6 months post surgery.…”

“…9 , 10, 18, 19, 21-23 Bone wax was among the more popular material used as reported by several authors. [23][24][25] Hong-Sai found that titanium screws were useful to obliterate various maxillofacial foramina as they are biocompatible and were technically easy to use 10 Obliteration of the foramen has been shown to prevent nerve regeneration in an animal study 19 and was confirmed to be useful in reducing the failure rate after peripheral neurectomy 17 Hong-Sai reported cases of pain relief that lasted least 4 years, namely the 4 cases where titanium screw insertion was performed 10 The following case reports the outcome of multiple neurectomies followed by the insertion of multiple titanium screws into the infraorbital, greater palatine, incisive and mental foramina, which prolonged the duration of pain remission without any adverse complication.…”