Peripheral neurectomy as treatment for incipient trigeminal neuralgia

Abstract

1. 1. Neurectomy is the excision of a section of a nerve for the relief of the intractable neuralgia, especially that of the fifth nerve. 2. 2. It succeeds only when the neuralgia is of incipient or peripheral form and involves only one branch of the nerve. 3. 3. After neurectomy the affected nerve has a very strong tendency to regeneration causing recurrence of the neuralgic pain. This particular character, in a way, resembles that of a tumor. 4. 4. To prevent this recurrence of the pain, a considerable section of the nerve, 4 cm. at least, should be excised. When the nerve happens to occupy a bone canal, the canal should be plugged tightly with sterile gold foil. 5. 5. In the advanced cases, recurrence of pain after neurectomy may occur without reunion of the sectioned nerve, being caused by the intact collateral branches or from the ascending lesion of the remaining part of the nerve trunk. 6. 6. Neurectomy can be done either extraorally or intraorally. The extraoral approach, however, is much superior to the intraoral operation. (1) It gives ready access to the nerve enabling the excision of a large section; (2) the bony canal in which the nerve lies can be plugged tightly; (3) the operative field can be kept free from contamination of saliva and oral bacteria. 7. 7. With proper selection of cases and thorough excision of the nerve, neurectomy may give relief of pain for at least four years or longer. A few fortunate cases of permanent cure can be found in records. 8. 8. It is a simple and safe procedure, compared to that of the intracranial operation. It can be repeated easily when the pain recurs. 9. 9. It should be tried in most incipient cases of trigeminal neuralgia. The division of the sensory root should be saved for the recurrent cases or the more advanced cases. 10. 10. The use of alcohol injections should be limited, because they are invariably followed by recurrence of the pain. When they are used in the peripheral nerve area repeatedly, the primary peripheral lesion often becomes central and no longer can be controlled by extracranial neurectomy. When they are used in the central nerve area they may produce grave complications. 11. 11. While there may be many reasons for us to spurn the idea of peripheral neurectomy, we must realize the fact that none of our present treatments of trigeminal neuralgia is ideal or specific; all of them are crude and symptomatic, since the exact etiology of the disease is still unknown. 12. 12. The investigation of a satisfactory treatment should therefore be directed toward research to find the cause of the disease