Nerve Decompression Surgery Research Articles

Predictive Reliability of the Phoenix Sign for the Outcome of Common Fibular (Peroneal) Nerve Decompression Surgery

A positive Phoenix sign occurs when a patient, with a suspected focal nerve entrapment of the Common Fibular (Peroneal) Nerve (CFN) at the level of the fibular neck, demonstrates an improvement in dorsifexion after an ultrasound guided infiltration of a sub-anesthetic dose of lidocaine. Less than 5 cc’s of 1% or 2% lidocaine is utilized and the effect is seen within minutes after the infiltration, but usually lasts only 10 minutes. This effect may be due to the vasodilatory action of lidocaine on the microcirculation in the area of infiltration. This nerve block has significant diagnostic utility as it is highly specific in the confirmation of true focal entrapment of the CFN, has high predictive value for a patient who may undergo surgical nerve decompression if they have demonstrated a positive Phoenix Sign, and may help in the surgical decision-making process in patients who have had a drop foot for many years but still may regain some motor function after decompression. In this retrospective review, 26 patients were tested, and 25 of this cohort demonstrated a Positive Phoenix Sign (an increase in dorsiflexion strength of the Extensor Hallucis Longus muscle (EHL)). One patient had no response to the peripheral nerve block. Of the 25 patients who demonstrated a positive “Phoenix Sign” and underwent nerve decompression of the CFN, and 25 (100%) showed an increase in dorsiflexion strength of the EHL after nerve decompression surgery of the CFN. The one patient in this cohort who did not demonstrate any improvement in dorsiflexion of the EHL after the nerve block did not have any improvement after surgery.

The Cutting Edge of Headache Surgery: A Systematic Review on the Value of Extracranial Surgery in the Treatment of Chronic Headache.

Migraine is a debilitating neurologic condition, with a large socioeconomic impact. There is a subgroup of patients that does not adequately respond to pharmacologic management and may have underlying neuralgia. Surgical decompression of extracranial sensory nerves has been proposed as an alternative therapy. The aim of this article is to review the evidence for the surgical treatment of neuralgias. A systematic review was conducted to study the efficacy of decompression of extracranial sensory nerves as a treatment for neuralgia. Clinical studies were included that studied patients, aged 18 years or older, diagnosed with any definition of headache and were treated with extracranial nerve decompression surgery. Outcome parameters included intensity (on a 10-point scale), duration (in days), and frequency (of headaches per month). Thirty-eight articles were found describing extracranial nerve decompression in patients with headaches. Postoperative decrease in headache intensity ranged from 2 to 8.2, reduction of duration ranged from 0.04 to 1.04 days, and reduction in frequency ranged between 4 and 14.8 headaches per month. Total elimination of symptoms was achieved in 8.3 to 83 percent of cases. A detailed summary of the outcome of single-site decompression is described. Statistical pooling and therefore meta-analysis was not possible, because of articles having the same surgeon and an overlapping patient database. Nerve decompression surgery is an effective way of treating headaches in a specific population of patients with neuralgia. Although a meta-analysis of the current data was not possible, the extracranial decompression of peripheral head and neck sensory nerves has a high success rate.

Successful Treatment of Penile Numbness and Erectile Dysfunction Resulting From Pudendal Nerve Entrapment

Pudendal nerve decompression surgery has not been studied or reported for the treatment of penile numbness in the absence of pain. Herein, we report a case of a male patient with chronic numbness of the penis and erectile dysfunction in the absence of pelvic pain who was found to have pudendal nerve entrapment. This patient was treated with surgical decompression of the pudendal nerves that resulted in the return of genital sensation and erections. Thus, we propose that pudendal nerve entrapment may be considered as a cause of penile numbness and that pudendal nerve decompression surgery in these patients may be effective.

Advancing Our Understandings of Healthcare Team Dynamics From the Simulation Room to the Operating Room: A Neurodynamic Perspective.

The initial models of team and team member dynamics using biometric data in healthcare will likely come from simulations. But how confident are we that the simulation-derived high-resolution dynamics will reflect those of teams working with live patients? We have developed neurodynamic models of a neurosurgery team while they performed a peroneal nerve decompression surgery on a patient to approach this question. The models were constructed from EEG-derived measures that provided second-by-second estimates of the neurodynamic responses of the team and team members to task uncertainty. The anesthesiologist and two neurosurgeons developed peaks, often coordinated, of elevated neurodynamic organization during the patient preparation and surgery which were similar to those seen during simulation training, and which occurred near important episodes of the patient preparation and surgery. As the analyses moved down the neurodynamic hierarchy, and the simulation and live patient neurodynamics occurring during the intubation procedure were compared at progressively smaller time scales, differences emerged across scalp locations and EEG frequencies. The most significant was the pronounced suppression of gamma rhythms detected by the frontal scalp sensors during the live patient intubation which was absent in simulation trials of the intubation procedure. These results indicate that while profiles of the second-by-second neurodynamics of teams were similar in both the simulation and live patient environments, a deeper analysis revealed differences in the EEG frequencies and scalp locations of the signals responsible for those team dynamics. As measures of individual and team performance become more micro-scale and dynamic, and simulations become extended into virtual environments, these results argue for the need for parallel studies in live environments to validate the dynamics of cognition being observed.

Cost-Effectiveness of Long-term, Targeted Onabotulinumtoxina Versus Peripheral Nerve Decompression Surgery for the Treatment of Migraine Headaches

BACKGROUND: Chronic migraines affect approximately 2% of the US population and cost an estimated $17 billion per year. OnabotulinumtoxinA (botulinum toxin type A [BoNTA]) is an Food and Drug Administration-approved prophylactic medication for chronic migraine headaches and is best injected in a targeted fashion into specific trigger sites. The purpose of this study is to determine the cost-effectiveness of long-term, targeted BoNTA versus peripheral nerve decompression surgery for the treatment of migraine headaches. METHODS: A Markov model was constructed to examine long-term, targeted BoNTA versus peripheral nerve decompression surgery. Costs, utilities, and other model inputs were identified from the literature. One-way and probabilistic sensitivity analyses were performed. An incremental cost-effectiveness ratio under $50,000 per quality adjusted life year was considered cost-effective. RESULTS: The mean cost of peripheral nerve decompression surgery was $10,303 with an effectiveness of 7.06, whereas the mean cost of long-term, targeted BoNTA was $36,071 with an effectiveness of 6.34. Decompression surgery is more effective and less costly over the time horizon of the model. One-way sensitivity analysis revealed that surgery is the most cost-effective treatment in patients requiring treatment for >6.75 years. CONCLUSION: Based on this model, peripheral nerve decompression surgery is the more cost-effective option for treating refractory migraine headaches requiring treatment beyond 6.75 years. The model reveals that peripheral nerve decompression surgery is more effective and less costly than long-term, targeted BoNTA over the course of a patient’s lifetime.

The Effectiveness and Safety of 42°C Pulsed Radiofrequency Combined with 60°C Continuous Radiofrequency for Refractory Infraorbital Neuralgia: A Prospective Study

Background: Infraorbital neuralgia, one of the rare causes of facial pain, lacks systematic treatment guidelines because few studies on the topic have been published. We previously found that 42°C percutaneous nondestructive pulsed radiofrequency (PRF) treatment could achieve satisfactory pain relief for infraorbital neuralgia patients. However, patients who responded poorly to PRF had no other ideal treatment options until now. Recently, standard PRF combined with 60°C continuous radiofrequency (CRF) was successfully performed on trigeminal neuralgia patients and achieved a promising effective rate with mild complications. However, the efficacy of the combined therapy in the treatment of infraorbital neuralgia has not yet been reported. Objectives: To evaluate the effectiveness and safety of 42°C PRF combined with 60°C CRF in infraorbital neuralgia patients who responded poorly to 42°C PRF and were reluctant to receive destructive therapies or nerve decompression surgery. Study Design: Prospective, single-center, observational clinical trial. Setting: The interventional pain management center in Beijing Tiantan Hospital. Methods: We prospectively investigated the effects of 10 minutes of 3-dimensional computer tomography-guided 42°C PRF combined with 270 seconds of 60°C CRF in the treatment of 28 patients with refractory infraorbital neuralgia. The response criterion was a postoperative verbal pain numeric rating scale score reduction of > 50%. The response rates at different time points during a 2-year follow-up were calculated. Results: The effective rates of combined PRF and CRF treatment were 95.5%, 86.4%, 81.8%, 72.7%, 72.7%, and 72.7% postoperative at 1 month, 3 months, 6 months, 1 year, 18 months, and 2 years, respectively. Except for 16 patients (72.7%) experiencing mild numbness that gradually disappeared within 1 week to 2 months after the operation, no obvious complications were observed. Limitations: This study examined the therapeutic effectiveness over a period of only 2 years; no further follow-up was conducted. In addition, this study is a single-center observational clinical study with small sample sizes. Conclusions: For patients with intractable infraorbital neuralgia, 42°C PRF combined with 60°C CRF is an effective and safe treatment. Prospective, double-blind randomized controlled trials with longer follow-up periods are needed to evaluate whether the combined treatment could become an alternative option for those who do not respond to conservative treatment, sparing those patients from destructive therapies or more invasive nerve decompression surgery. Key words: Infraorbital neuralgia, effectiveness, safety, pulsed radiofrequency, continuous radiofrequency, combined therapy

Progressive Radial Nerve Entrapment Resulted in Finger Drop: A Case Report

Introduction: Posterior interosseous nerve (PIN) palsy gives rise to various symptoms. The PIN due to lipoma is rare. Here, we report a case of progressive loss of finger extension due to a giant painless parosteal lipoma. Case Presentation: A 52-year-old patient with progressive weakness of finger extension with diagnosis of posterior interosseous nerve (PIN) palsy was referred to our clinic. Electrophysiological studies showed a right PIN neuropathy at the level of the forearm. The patient had no history of trauma of the hand. The patient underwent surgery for tumor removal and nerve decompression. The loss of finger extension due to PIN palsy gradually recovered after tumor removal and the nerve recovered from the motor deficits. The patient showed no recurrence of motor deficit after the surgery in the follow-up. Conclusions: Since PIN palsy may arise from lipoma early surgical exploration and the excision of deep-seated lipoma in the proximal forearm is recommended in order to avoid permanent damage to PIN or other branches of the radial nerve.

Histological Evidence of Intrinsic Muscle Degeneration in Compression Ulnar Neuropathy.

We investigated the histological characteristics of the tissues in the intrinsic hand muscles of patients with compressive ulnar neuropathy (CUN) to determine how the compromised nerve influences the target muscle. In total, 83 patients underwent surgery for CUN in our institution between March 2015 and August 2017. Of these, 45 patients who met our inclusion/exclusion criteria were initially included in this study. Basic demographic data including age, sex, hand dominance, duration of symptoms, bone mineral density, and clinical stage were evaluated. During the ulnar nerve decompression surgery, a biopsy of the ipsilateral adductor pollicis was performed. Using the biopsy samples, we analyzed the tissue composition and degree of degeneration, and investigated the association with demographic factors and clinical status. The ratio of muscle/connective tissue/fat was 62.62 ± 8.27%/23.44 ± 4.10%/14.16 ± 6.68% in the affected muscle. The ratio was different than that of samples taken from control groups. In samples containing muscle fibers, although the total fat content remained low, fat was consistently concentrated at the fascicular borders, between fascicles (perifascicular fat, 62.3 ± 18.2% of fascicles), and within fascicles (intrafascicular fat, 35.6 ± 11.8% of fascicles). The proportion of centrally nucleated muscle fibers was also significantly elevated (5.58 ± 4.25%; P < 0.001) compared with that of both controls (1.09 ± 1.26%) and the clinical threshold for abnormal central nuclei (3%). Preoperative scores assessed using Gabel and Amadio criteria were positively correlated with the muscle composition (r = 0.89, P < 0.001). In addition, the clinical status was negatively correlated with the degree of fat accumulation and the proportion of centrally nucleated muscle fibers (r = -0.94, P < 0.001, r = -0.82, P < 0.001). We demonstrated that target muscle in CUN underwent degeneration, which was potentially exacerbated by inflammation, and that the degree of degeneration was correlated with the patient's clinical status. Histologically, reversible recovery of the hand muscles may be possible if decompression of the ulnar nerve is performed at earlier stages.

Contrast-enhanced magnetic resonance imaging of facial nerve swelling in patients with severe Ramsay Hunt syndrome

ObjectiveIn Ramsay Hunt syndrome, contrast enhancement of magnetic resonance (MR) imaging seen in the affected facial nerve in the majority of cases, but its clinical significance has not been well investigated to date. The aim of this study was to elucidate the clinical significance of this imaging sign by quantitively investigating the correlation between the signal increase and swelling of the facial nerve. We also investigated the temporal change in this sign and its correlation with recovery. MethodsWe retrospectively evaluated swelling of the facial nerve in 16 patients with severe Ramsay Hunt syndrome who underwent both contrast-enhanced magnetic resonance imaging and facial nerve decompression surgery via a transmastoid approach alone or in combination with a middle cranial approach. All the patients had a Yanagihara score of ≤8 points and facial nerve degeneration of ≥90% confirmed by either a nerve excitability test or electroneurography. Swelling of the facial nerve was evaluated intraoperatively using a 4-point grading system. ResultsA significant correlation was observed between contrast enhancement on T1-weighted images and facial nerve swelling in the labyrinthine segment, geniculate ganglion, and pyramidal segment (P = 0.030, P = 0.018, and P = 0.037, respectively). Furthermore, the contrast enhancement increased significantly as more time elapsed after the onset of facial palsy (mean ± standard error, 14.7 ± 2.3 days, range, 5–42 days) in the geniculate ganglion and pyramidal segment (correlation coefficient, 0.546 and 0.689, P = 0.022 and P = 0.002, respectively). Patients with good recovery (Yanagihara score of ≥36) showed significantly lower contrast enhancement in the tympanic and mastoid segments (P = 0.021 and 0.020, respectively) than those who with poor recovery. ConclusionIn particular segments of the facial nerve, contrast enhancement on T1-weighted image correlated with facial nerve swelling and recovery. These observations underscore the clinical significance of contrast enhancement on T1-weighted images in patients with Ramsay Hunt syndrome.

Surgical Management of Migraine Headaches: A Systematic Review and Meta-analysis.

The aim of the present study was to systematically review and analyze the available evidence on the role of surgery in improving outcomes in patients with migraine headaches. An electronic search of PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar databases was performed for English-language articles reporting results of peripheral nerve surgery for migraine headaches. The search strategy revealed a total of 1528 records, of which 23 studies were included in the review. A total of 1151 headache patients were treated in the included studies. The trigger site of migraine addressed varied across studies. Meta-analysis of data of 616 patients revealed that migraine surgery significantly reduces migraine headache frequency (random: mean, 9.52; 95% confidence interval, 7.14-11.9; P < 0.00001; I = 94%). Similarly, when data of 797 patients were analyzed, there was statistically significant reduction in migraine headache intensity in patients undergoing migraine headache surgery (random: mean, 3.97; 95% confidence interval, 3.31-4.62; P < 0.00001; I = 94%). On pooling of data of all 23 studies, 8.3% to 76.4% of patients reported complete elimination of headache after surgery, whereas 3.9% to 33.3% had no relief. Peripheral nerve decompression surgery is highly effective in reducing migraine headache frequency and migraine headache intensity. However, not all patients benefit from the surgical procedure, with a small subset showing no improvement. Further clinical and anatomical studies are needed to define the exact mechanism of nerve compression in migraine patients and as to why a subset of patients does not respond to surgical treatment.

Alteration of Sciatic Nerve Histology and Electrical Function After Compression and After Neurolysis in a Diabetic Rat Model.

Diabetic rats are more sensitive to nerve entrapment. This study was conducted to evaluate nerve function and histological changes in diabetic rats after nerve compression and subsequent decompression. A total of 35 Wistar rats were included. The experimental group was divided into diabetic sciatic nerve compression group (DSNC, n = 5) and diabetic sciatic nerve decompression group (DSND, n = 20). The DSNC model was created by wrapping a silicone tube circumferentially around the nerve for 4 weeks, and then the DSND group accepted nerve decompression and was followed up to 12 weeks. The DSND group was equally divided into DSND 3 weeks (DSND3), 6 weeks (DSND6), 9 weeks (DSND9), and 12 weeks (DSND12) groups. Five rats were taken as normoglycemic control group (CR, n = 5), and another 5 rats as diabetic control group (DM, n = 5). The mechanical hyperalgesia of rats was detected by Semmes-Weinstein nylon monofilaments (SWMs) and by motor nerve conduction velocity (MNCV). These 2 physiological indicators and histology of sciatic nerves were compared among different groups. The SWM measurements improved toward normal values after decompression. The SWM value was significantly lower (more normal) in the DSNC groups than in the DSND group (P < 0.05). The MNCV was 53.7 ± 0.8 m/s in the CR group, whereas it was 28.4 ± 1.0 m/s in the DSNC group (P < 0.001). Six weeks after decompression, the MNCV was significantly faster than that in the DSNC group (P < 0.001). Histological examination demonstrated chronic nerve compression, which responded toward normal after decompression, but with degree of myelination never recovering to normal. Chronic compression of the diabetic sciatic nerve has measureable negative effects on sciatic nerve motor nerve function, associated with a decline of touch/pressure threshold and degeneration of myelin sheath and axon. Nerve decompression surgery can reverse these effects and partially restore nerve function.

Effectiveness of Endoscopic Optic Nerve Decompression Surgery for Traumatic Optic Neuropathy with Optic Nerve Canal Fracture

Effectiveness of Endoscopic Optic Nerve Decompression Surgery for Traumatic Optic Neuropathy with Optic Nerve Canal Fracture

Piezosurgical management of sealer extrusion‐associated mental nerve anaesthesia: A case report

The present report describes a case where sealer extrusion (Sealapex) occurred during root canal obturation of a left lower second premolar tooth, and the patient experienced sudden pain and followed by complete anaesthesia of the lower lip. After 3weeks of conservative therapy and an unaltered anaesthesia period, piezosurgical removal of the extruded sealer and root-end resection was performed despite the direct contact with the mental neurovascular bundle. At suture removal, 1week after surgery, there was no improvement in sensation. Two weeks after the operation, the patient reported some changes, including a short paraesthesia period alternating with anaesthesia. At the fourth post-operative week, neurosensory function recovered completely. This case represents successful use of the piezoelectric technique for mental nerve decompression and periapical surgery of a lower second premolar with close contact of the mental nerve.

Delayed transmastoid facial nerve decompression surgery in patients with Ramsay-Hunt syndrome presenting with neurophysiologically complete paralysis

Objectives: To determine the efficacy of delayed transmastoid facial nerve decompression in patients with Ramsay Hunt Syndrome (RHS) presenting with complete facial paralysis.Methods: Twenty-five RHS patients with complete facial nerve paralysis presenting electroneuronographic (ENoG) degeneration ≥90% underwent transmastoid facial nerve decompression more than 3 weeks after the onset of paralysis. The principal features measured were 12 months pre- and post-operative House-Brackmann (HB) grades and the presence of a direct intraoperative neural response (INR) prior to decompression procedure. Correlations between these parameters, and the time between symptom onset and surgery (within or later than 30 and 50 d) were statistically analyzed.Results: Of the 25 patients 13 (52%) exhibited good recovery (HB grade I or II) at 12 months-post-operatively. The timing of decompression generally did not significantly influence outcome but patients treated within 50 d of symptom onset enjoyed better outcomes than those treated later (p = .047). The presence of an INR significantly influenced outcomes (p = .0003).Conclusions: The success of delayed transmastoid facial nerve decompression in RHS patients was not affected between 25–30 and 30–40 d from symptom onset but was compromised when the delay was >50 d. The presence or absence of an INR was a good predictor of post-operative prognosis.

Two-Point Discrimination Predicts Pain Relief after Lower Limb Nerve Decompression for Painful Diabetic Peripheral Neuropathy.

Peripheral nerve decompression surgery has been reported to be effective for pain reduction in patients with painful diabetic peripheral neuropathy. The aim of this study was to characterize which patients may have more pain relief benefits in the lower limbs after nerve decompression surgery. A retrospective study was conducted. Pain levels were measured with the Numerical Rating Scale. Treatment effects were classified by either substantial relief (at least 50 percent reduction in Numerical Rating Scale score compared with preoperative Numerical Rating Scale score) or nonsubstantial relief (<50 percent reduction or worse in Numerical Rating Scale score) at 12 months based on established criteria. Sex, age, body mass index, duration of diabetes mellitus, duration of diabetic peripheral neuropathy pain, preoperative Numerical Rating Scale score, and two-point discrimination were evaluated using univariate and logistic regression analysis. The mean preoperative Numerical Rating Scale score (8.65 ± 1.29) decreased significantly 6 days (3.56 ± 2.22; p < 0.01), 6 months (3.03 ± 2.11; p < 0.01), and 12 months (3.44 ± 2.36; p < 0.01) after surgery; 64.7 percent of patients had substantial pain relief at 12 months. According to univariate and logistic regression analysis, better two-point discrimination was associated with substantial pain relief (OR, 3.700; p = 0.046, logistic regression analysis). Nerve decompression surgery was able to alleviate pain in patients with painful diabetic peripheral neuropathy. Two-point discrimination may be a predictive factor for the prognosis of painful diabetic peripheral neuropathy after nerve decompression surgery. Risk, III.

Optimization of Surgical Outcome in Lower Extremity Nerve Decompression Surgery.

There is still debate regarding whether the surgical release of entrapped lower extremity nerves reduces complaints of associated neuropathy and results in gain of sensory function. The aim of this study was to investigate which factors are associated with a favorable surgical outcome, by follow-up of patients previously participating in a randomized controlled trial. The authors evaluated the 5-year follow-up of diabetic patients previously participating in the Lower Extremity Nerve Entrapment Study (LENS). Visual analogue pain scores, satisfaction, complaints, quality of life (i.e., 36-Question Short-Form Health Survey and EuroQol 5 Dimensions instrument), sensory function, and incident ulceration and amputation were assessed. Differences between patients who underwent unilateral versus bilateral decompressions were investigated. Thirty-one of the original 42 LENS participants were measured, of which eight patients underwent additional decompression of the contralateral leg, after 12-month LENS follow-up. At 5 years, bilateral surgical patients (n = 8) had significantly lower pain scores and higher quality of life compared with unilateral surgical patients (n = 23), were younger, had a lower age when diagnosed with diabetes, and had a lower body mass index at baseline. Pain scores of the additional decompressed leg decreased in a manner similar to that of the initial decompressed leg during follow-up. Patients with severe preoperative sensory loss did worse; 41.2 percent of the LENS Follow-Up Study subjects underwent or considered undergoing contralateral surgery. The authors' results suggest that the beneficial effects of lower extremity nerve decompression surgery are reserved for a select group of patients, of which preoperative nerve damage, age, duration of diabetes, and body mass index are important effect modifiers. Therapeutic, III.

Ultra-Early Optic Nerve Decompression for the Resection of Anterior Clinoidal Meningioma.

Improvement in vision is one of the main goals of surgery for anterior clinoidal meningiomas with visual deficits. Early optic nerve decompression surgery has been advocated in previous studies to achieve the best visual outcome. Through this video, the authors describe their surgical techniques to decompress the optic nerve at the very early stage of surgery.A 35-year-old patient presented with subjective blurry vision in the right eye over the last 8 months. Magnetic resonance images showed a 3.2-cm meningioma arising at the right anterior clinoid. Preoperative ophthalmological test was within the normal range, but the patient wished to have surgical resection after a detailed discussion of benefits and risks related to surgical resection. The surgical strategy consisted of the right lateral subfrontal approach that includes a standard right frontotemporal craniotomy, extradural anterior clinoidectomy, and early optic nerve decompression prior to tumor resection. The tumor was divided into compartments defined by the arteries and resected. Simpson grade II resection was achieved without complications. The patient's symptoms disappeared.In anterior clinoidal meningiomas that cause visual deficits, the optic nerve is assumed very vulnerable to any further injuries related to the operative maneuver. Ultra-early optic nerve decompression can be performed in anterior clinoidal meningiomas regardless of their size by extradural unroofing of the optic canal and sectioning of the optic canal sheath, which we believe contributes to better visual improvement. The link to the video can be found at: https://youtu.be/RIFi4ecWAhQ .

Facial nerve neuroma in the geniculate ganglion extending into the internal auditory canal: A case report

Facial nerve schwannoma is a very rare benign tumor representing less than 1% of intrapetrous lesions. Our patient is a forty-one year old female who has suffered from recurrent right facial palsy for the last six years. She was first misdiagnosed as having Bell’s palsy and received corticosteroids which resulted in little improvement. She then had facial nerve decompression surgery which resulted in a partial improvement. Since then, she has suffered from recurrent attacks of facial palsy. Two years ago, she came to our hospital seeking further treatment options. The final diagnosis made by MRI was a possible facial nerve tumor. To obtain a better facial outcome, total tumor removal was performed through the middle cranial fossa approach along with facial-hypoglossal nerve end-to-side anastomosis through transmastoid approach. Her hearing was preserved, and she obtained a better facial outcome than that of her preoperative level. In conclusion, facial nerve schwannoma has the potential to be misdiagnosed as Bell’s palsy which might lead to a delay in diagnosis, and end-to-side neurorrhaphy may be an effective alternative in a selected case.

Nerve Decompression and Restless Legs Syndrome: A Retrospective Analysis.

Restless legs syndrome (RLS) is a prevalent sleep disorder affecting quality of life and is often comorbid with other neurological diseases, including peripheral neuropathy. The mechanisms related to RLS symptoms remain unclear, and treatment options are often aimed at symptom relief rather than etiology. RLS may present in distinct phenotypes often described as "primary" vs. "secondary" RLS. Secondary RLS is often associated with peripheral neuropathy. Nerve decompression surgery of the common and superficial fibular nerves is used to treat peripheral neuropathy. Anecdotally, surgeons sometimes report improved RLS symptoms following nerve decompression for peripheral neuropathy. The purpose of this retrospective analysis was to quantify the change in symptoms commonly associated with RLS using visual analog scales (VAS). Forty-two patients completed VAS scales (0-10) for pain, burning, numbness, tingling, weakness, balance, tightness, aching, pulling, cramping, twitchy/jumpy, uneasy, creepy/crawly, and throbbing, both before and 15 weeks after surgical decompression. Subjects reported significant improvement among all VAS categories, except for "pulling" (P = 0.14). The change in VAS following surgery was negatively correlated with the pre-surgery VAS for both the summed VAS (r = -0.58, P < 0.001) and the individual VAS scores (all P < 0.01), such that patients who reported the worst symptoms before surgery exhibited relatively greater reductions in symptoms after surgery. This is the first study to suggest improvement in RLS symptoms following surgical decompression of the common and superficial fibular nerves. Further investigation is needed to quantify improvement using RLS-specific metrics and sleep quality assessments.

Reduction in Chronic Migraine following Occipital Nerve Decompression Surgery: Further Implications for Extracranial Origin of Headache (P2.170)

Reduction in Chronic Migraine following Occipital Nerve Decompression Surgery: Further Implications for Extracranial Origin of Headache (P2.170)