Nervus intermedius sectioning for the treatment of geniculate neuralgia.

IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY
Alexander L Ren, Amirreza Ehsani, David J Park, Amit R Persad, Janet Y Wu, Jennifer C Hall, Michael Zhang, John Choi, Lily H Kim, Risheng Xu, Steven D Chang, Michael Lim
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引用次数: 0

Abstract

Objective: Geniculate neuralgia (GN) is a rare facial pain syndrome characterized by severe stabbing pain in the ear canal. The exact cause of GN remains unclear; however, it is thought that the nervus intermedius (NI) is the primary implicated structure. When medical management fails, surgical interventions are offered to treat the pain. This study aimed to present a consecutive series of patients with GN who underwent craniotomy with NI sectioning, to offer insights into the safety and efficacy of the surgical approach.

Methods: A retrospective review of consecutive institutional medical records from January 2000 to February 2024 identified patients diagnosed with GN who underwent surgical treatment. Patient records were manually reviewed for information regarding patient demographics, comorbidities, medication history, surgical techniques, and outcomes.

Results: The study included 47 NI sectioning procedures in 45 patients with GN (mean age 45.5 years). Most patients had concurrent trigeminal neuralgia (TN) and approximately one-third of patients had concurrent TN and glossopharyngeal neuralgia. Surgical procedures involved NI sectioning, often alongside microvascular decompression (MVD) for cranial nerves (CNs) V or IX/X/XI, with favorable early postoperative pain relief. Of 47 procedures, 38 (80.9%) improved pain (Barrow Neurological Institute [BNI] pain intensity score < IV) and 32 (68.1%) resolved pain (BNI score I) by the latest follow-up visit. There was a low incidence of complications, with 2 cases of unexpected hearing loss among all patients, no instances of permanent facial paralysis, and 1 case of permanent vestibular dysfunction. Additionally, 3 patients reported experiencing loss of taste following surgery.

Conclusions: This case series suggests that NI sectioning is safe and likely efficacious in relieving the primary deep ear pain of GN, with a potential additive benefit when performed with MVD on CNs V or IX/X/XI, as needed. Further research is needed to refine treatment guidelines and clarify NI-specific otalgia given the overlapping innervation of the inner ear with other CNs.

中间神经切开术治疗膝状神经痛。
目的:膝状神经痛(GN)是一种罕见的面部疼痛综合征,其特征是剧烈的耳道刺痛。GN的确切病因尚不清楚;然而,人们认为中间神经(NI)是主要的牵连结构。当医疗管理失败,手术干预提供治疗疼痛。本研究旨在介绍连续系列的GN患者,他们接受了NI切开术,以深入了解手术方法的安全性和有效性。方法:回顾性分析2000年1月至2024年2月连续的医疗记录,确定诊断为GN并接受手术治疗的患者。通过人工检查患者记录,了解患者人口统计学、合并症、用药史、手术技术和结果等信息。结果:该研究包括45例GN患者(平均年龄45.5岁)的47例NI切片手术。大多数患者并发三叉神经痛(TN),约三分之一的患者并发三叉神经痛和舌咽神经痛。手术包括NI切片,通常与颅神经(CNs) V或IX/X/XI的微血管减压(MVD)一起进行,有利于术后早期疼痛缓解。47例手术中,38例(80.9%)疼痛得到改善(Barrow Neurological Institute [BNI]疼痛强度评分< IV), 32例(68.1%)疼痛得到缓解(BNI评分为I)。并发症发生率低,所有患者中有2例意外听力损失,无永久性面瘫,1例永久性前庭功能障碍。此外,3名患者报告术后味觉丧失。结论:这个病例系列表明,NI切片是安全的,并且可能有效地缓解GN的原发性深耳痛,如果需要的话,在CNs V或IX/X/XI上进行MVD,可能会有潜在的附加益处。考虑到内耳与其他中枢神经的神经支配重叠,需要进一步的研究来完善治疗指南,并澄清ni特异性耳痛。
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来源期刊
Journal of neurosurgery
Journal of neurosurgery 医学-临床神经学
CiteScore
7.20
自引率
7.30%
发文量
1003
审稿时长
1 months
期刊介绍: The Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, and Neurosurgical Focus are devoted to the publication of original works relating primarily to neurosurgery, including studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology. The Editors and Editorial Boards encourage submission of clinical and laboratory studies. Other manuscripts accepted for review include technical notes on instruments or equipment that are innovative or useful to clinicians and researchers in the field of neuroscience; papers describing unusual cases; manuscripts on historical persons or events related to neurosurgery; and in Neurosurgical Focus, occasional reviews. Letters to the Editor commenting on articles recently published in the Journal of Neurosurgery, Journal of Neurosurgery: Spine, and Journal of Neurosurgery: Pediatrics are welcome.
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