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Sectioning of nervus
intermidus provides effective pain relief in nervus intermedius neuralgia
patients without any significant complications like deafness or permanent
facial weakness.
According
to the Department of Neurological Surgery, Oregon Health & Science
University, the sectioning of nervus intermedius to treat Nervus intermedius
neuralgia (NIN) displayed no severe complications. NIN is a rare type of
craniofacial neuralgia which includes lancinating, sharp pain deep in the ear
and alongside the trigeminal neuralgia (TN). There are decidedly fewer evidence
to associate intraoperative findings, postoperative outcomes and clinical
presentation. Therefore, this retrospective cohort study was conducted to
investigate nervus intermedius (NI) sectioning related surgical/clinical
findings. The patients who suffered from NIN and went through neurological
treatment at the same institution from 2002 to 2016 were included in the study.
A revised facial pain and quality of life questionnaire were used determine
pain-free survival that recorded via chart review and phone interviews.
Kaplan-Meier curves were used to represent these pain-free survival data.
Fifteen
patients were elected who met the study criteria. Out of 15 patients, 14 went
through NI sectioning, eight patients among these had concomitant TN. A
reduction in pain was seen among thirteen out of 14 patients after the surgery.
Five patients were found to have visible neurovascular compression (NVC) of NI
by the anterior inferior cerebellar. The patients were followed up for 6.41
years. Diplopia, tinnitus, temporary facial nerve palsy, dizziness, ear
fullness and vertigo were the common complications found after the treatment.
Six out of fourteen patients found to have pain recurrence. At the most
extended follow-up, four patients with isolated NIN and then obtained NI
sectioning alone reported worse or the same pain scores than before the
surgery. It indicates that individual NI sectioning was not adequate. The
median pain-controlled survival and median pain-free survival reported was 6.22
years ± 15.78 and 4.82 years ± 14.85 months respectively. The pathophysiology
of NIN is yet not clearly understood. Neurovascular compression does not play
an essential role in NIN pathophysiology and shows the high degree of overlap
with TN. For NIN management, NI sectioning imparts a significant role without
any significant complications like deafness or permanent facial weakness.
Journal of Neurosurgery
Pain-free and pain-controlled survival after sectioning the nervus intermedius in nervus intermedius neuralgia: a single-institution review.
Katherine G.Holste et al.
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