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. 2021 May 28;16(2):281-287.
doi: 10.4103/ajns.AJNS_361_20. eCollection 2021 Apr-Jun.

Peripheral Neurectomy for Trigeminal Neuralgia: A Report of Seventeen Cases and Review of the Literature

Mohamed Ragab Nagy  1 , Bokhary Mahmoud  2
Affiliations

Peripheral Neurectomy for Trigeminal Neuralgia: A Report of Seventeen Cases and Review of the Literature

Mohamed Ragab Nagy et al. Asian J Neurosurg. .

Abstract

Background: Surgical intervention for trigeminal neuralgia (TN) is indicated if there is a failure of the medical treatment. Peripheral neurectomy is one of the oldest surgical procedures for TN.

Objective: The aim is to evaluate the clinical outcome and the recurrence rate following peripheral neurectomy for the management of TN.

Patients and methods: This was a retrospective cohort study of 17 patients with classical TN treated by peripheral neurectomy. The visual analogue scale (VAS) was used for pain assessment preoperatively and during the follow-up period. The outcome of surgery was graded as a marked, moderate, or mild improvement. Kaplan-Meier analysis was used for the time to recurrence to predict the probability of recurrence at any given time following the procedure.

Results: The mean pain-free interval was 29.3 ± 16.3 months. At 2 and 5 years of the follow-up period, the mean VAS improved significantly (P < 0.001 and P = 0.042 respectively). Thirteen patients had marked improvement of pain. There was recurrence of pain in 4 patients (23.5%). By Kaplan-Meier analysis, the survival rate without recurrence at 2, 3, 4, and 5 years following the procedure were 92.9%, 79.6%, 59.7%, and 29.8%, respectively. The mean preoperative Hospital Anxiety and Depression Scale-Anxiety and Depression scores significantly improved on the last follow-up visit following the procedure (P < 0.001 for both).

Conclusion: Peripheral neurectomy provides short to medium-term good pain control for patients with TN. The preoperative severity of pain, anxiety, and depression levels improved markedly after the procedure.

Keywords: Inferior alveolar; infraorbital nerve; peripheral neurectomy; trigeminal neuralgia.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Supraorbital neurectomy in a 31-year-old male patient who had all the three divisions involved on the right side and refused more invasive neurosurgical procedures: (a) Sterilization of the skin, (b) Exposure of the supraorbital nerve before avulsion, and (c) Closure of skin at the conclusion of surgery
Figure 2
Figure 2
Right infraorbital neurectomy in the same patient illustrated in (a) Exposure of the infraorbital nerve branches through a vestibular incision, (b) The infraorbital nerve stump, and (c) The avulsed branches of the infraorbital nerve
Figure 3
Figure 3
Right inferior alveolar neurectomy in a 52-year-old female patient who had only V3 involvement: (a) Exposure of the angle of the mandible and preparation for the burr hole, (b) Exposure of the mental nerve, and (c) The avulsed nerve specimen
Figure 4
Figure 4
Mean visual analog scale score over the time in the study sample. (PROP – Preoperative)
Figure 5
Figure 5
Kaplan–Meier curve for the recurrence over the time in the study sample
See this image and copyright information in PMC

References

    1. Okeson JP. The classification of orofacial pains. Oral Maxillofacial Surg Clin N Am. 2008;20:133–44. - PubMed
    1. Jeyaraj P. Efficacy of peripheral neurectomy in the management of refractory cases of trigeminal neuralgia. Otolaryngology. 2019;8:178.
    1. Koopman JS, Dieleman JP, Huygen FJ, de Mos M, Martin CG, Sturkenboom MC. Incidence of facial pain in the general population. Pain. 2009;147:122–7. - PubMed
    1. Scrivani SJ, Mathews ES, Maciewicz RJ. Trigeminal neuralgia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100:527–38. - PubMed
    1. Yuvaraj V, Krishnan B, Therese BA, Balaji TS. Efficacy of neurectomy of peripheral branches of the trigeminal nerve in trigeminal neuralgia: A critical review of the literature. J Maxillofac Oral Surg. 2019;18:15–22. - PMC - PubMed