Neurectomy In Patients Research Articles

Functional Level and Dynamic Posturography Results Two Years after Vestibular Neurectomy in Patients with Severe Meniere's Disease.

Objectives: The aim of this study was to evaluate the functional outcomes and balance compensation in patients with severe Meniere's disease after vestibular neurectomy. Methods: Pre- and postoperative results were analyzed in twenty patients with unilateral Meniere's disease before and two years after vestibular neurectomy. Clinical evaluation was performed using a subjective grading scale proposed by the American Academy of Otolaryngology-Head and Neck Surgery and the Dizziness Handicap Inventory. Sensory organization test results were analyzed to assess the balance system before and after the surgery. Results: All patients reported a complete resolution of vertigo attacks after the vestibular neurectomy; 95% of patients reported functional level improvement according to a scale proposed by the American Academy of Otolaryngology-Head and Neck Surgery, and the average score decreased from 4.5 to 1.6. Clinical improvement, evaluated with the Dizziness Handicap Inventory, was present in all patients, with the average result decreasing from 81.7 to 16.4. Analyzing both grading systems, differences between pre- and postoperative results were statistically significant. No statistically significant differences were found between the sensory organization test results before and after vestibular neurectomy. Significant correlations were found between a patient's age and postoperative results of the Dizziness Handicap Inventory and posturography. Conclusions: Vestibular neurectomy is an effective vertigo treatment in patients with severe Meniere's disease with no clinical improvement despite conservative treatment. It results in subjective physical, functional, and emotional improvement, enabling patients to return to daily activities and work. An appropriate qualification of patients and comprehensive preoperative evaluation are essential to obtaining satisfactory clinical outcomes.

Mental Nerve Neurectomy: A Comparison of Titanium Screw Versus Gutta-Percha Oburation of the Mental Foramen.

This study aims to compare the two mental foramen obturating techniques in parameters like operator's ease, postoperative displacement of obturation material, and remission of pain after peripheral neurectomy in patients with trigeminal neuralgia. This study adopts a single-centered comparative analytical approach. This study was performed in the Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry (AFID), from October 1, 2023, to February 10, 2024. Sixty patients fulfilling the inclusion criteria were included and divided into two groups (30 each), and peripheral neurectomy was performed under local anesthesia. In one group, gutta-percha sticks were used to obturate the foramina, and in the other group, titanium screws were used. Postoperatively, the operator's ease, postoperative displacement, and relapse of pain were recorded. Titanium screws were easy to handle, and there was no relapse of pain because of no displacement postoperatively when compared with gutta-percha sticks, which were hard to manipulate and showed a relapse of pain. Titanium screws have better postoperative outcomes when compared with gutta-percha sticks in terms of the operator's ease, relapse of pain, and postoperative displacement.

Outcomes of Patellar Replacement Vs Patellar Neurectomy in Total Knee Replacement

Objectives: To compare the outcomes of patellar replacement and patellar neurectomy in Patients undergoing Total Knee Replacement . Materials & Methods: The design of this study was a cross sectional study design and this study was conducted in DHQ Teaching Hospital Gujranwala. Total 30 Patients were enrolled in this study and they were divided into two groups. Group A constitutes of 15 Patients underwent Post tibial neurectomy. And Group B consisting of 15 Patients went through Tibial Resection. All the patients have been assessed through the Tinel test on the painful area and self-administered Patient-Reported Outcome Measurements (PROMs): Patellar replacement also known as patellofemoral arthroplasty, is a surgical procedure that is performed in conjunction with total knee replacement (TKR) to relieve pain in the knee joint caused by patellofemoral arthritis or other conditions affecting the patella. All the patients of Group B were given anesthesia to numb the area. An incision was made in front of the knee to expose the patella and surrounding structures. Removal of the patella: The patella was carefully removed from the knee joint. The underside of the patella was reshaped to fit a prosthetic component that was implanted in its place. The patellar component was attached to the reshaped surface of the patella using bone cement. The patella was repositioned in the knee joint and attached to the femur using sutures. The incision was closed using sutures or staples. The goal of patellar replacement is to reduce pain and improve function in the knee joint. All the group A participants went through Patellar neurectomy. Patellar neurectomy is a surgical procedure that involves cutting or removing the nerve endings that supply sensation to the patella. Results: Total 30 Patients participated in this study. In Group A =15 Patients who underwent patellar Neurectomy and 15 Patients in Group B who experienced Tibia Resection. Total 5 months follow up was done. Group B participants showed excellent Results. NRS score decreased to 0 in Group B. While in patellar Neurectomy group A two patients experienced still moderate pain, Remaining 13 patients although did not experienced pain but felt numbness on limbs. Practical Implication: Patellar neurectomy involves cutting or removing the nerve endings that supply sensation to the patella, interrupting the transmission of pain signals from the patella to the brain. Although it is less time consuming but can cause numbness or altered sensation in the skin over the patella, which may affect the patient's quality of life Does not address underlying patellar instability or misalignment, which can still cause pain and functional limitations Can be associated with a risk of complications such as neuroma, infection, stiffness. Conclusion: Patellar Resection with TKA has better outcomes than Patellar Neurectomy. Patellar denervation with electrocautery is effective in reducing pain and opioid consumption after total knee replacement. Postoperative range of motion is significantly better in patellar denervation group, which means that patellar denervation significantly improves clinical outcome Keywords: Total Knee Replacement, Patellar Replacement, Neurectomy, Neurectomy, Tibia Resection, Pain, Prosthesis

Operative treatment options for Morton’s neuroma other than neurectomy − a systematic review

BackgroundThe effectiveness of operative treatments other than neurectomy for Morton’s neuroma remains debatable despite several reported studies. This review aimed to evaluate the effects of operative treatments for Morton’s neuroma other than neurectomy using an algorithmic approach and a structured critical framework to assess the methodological quality of reported studies. MethodsSeveral electronic databases were searched for articles published until August 2021 that evaluated the outcomes of operative treatments other than neurectomy in patients diagnosed with Morton’s neuroma. Data searches, extraction, analysis, and quality assessments were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the clinical outcomes were evaluated using objective, subjective, and negative outcomes; complications; and reoperation rate and type. ResultsAfter reviewing 11,213 studies, 22 studies were finally included. Although a number of studies with high level of evidence are limited, we divided them according to four categories: (1) neurolysis with or without nerve transposition, (2) minimally invasive nerve decompression, (3) metatarsal osteotomy, and (4) additional procedures after nerve transection or neurectomy. All categories showed reliable outcomes except minimally invasive nerve decompression. The proportion of postoperative neurogenic symptoms was lower with neurolysis than with neurectomy. ConclusionWhether the alternative procedures were superior to neurectomy remains unclear as the number of good quality studies was limited. The proportion of postoperative neurogenic symptoms was lower with neurolysis than with neurectomy. Furthermore, performing simultaneous dorsal transposition of the nerve along with neurolysis is more recommended than neurolysis alone. Surgeons should be more careful with minimally invasive deep transverse intermetatarsal ligament release and metatarsal shortening osteotomy as their effectiveness remains inconclusive. Finally, we strongly recommend performing intramuscular embedding or intermuscular transposition of the nerve cutting end if neurectomy or nerve transection is inevitable. Level of evidenceLevel III, systematic review

Pain Control and Quality of Life after Peripheral Neurectomy in Patients with Refractory Trigeminal Neuralgia

Pain Control and Quality of Life after Peripheral Neurectomy in Patients with Refractory Trigeminal Neuralgia

The long-term outcomes of posterior nasal neurectomy with or without pharyngeal neurectomy in patients with allergic rhinitis: a randomized controlled trial

IntroductionAllergic rhinitis is a form of IgE mediated inflammation of the nasal mucosa in response to specific allergens, resulting in typical symptoms. ObjectivesThis study was designed with the primary goal of comparing the clinical efficacy of posterior nasal neurectomy with or without pharyngeal neurectomy for the treatment of moderate-to-severe perennial allergic rhinitis. Secondary study aims included a comparison of the severity of comorbidities, including chronic cough and asthma, between patients in these two surgical treatment groups. MethodsA total of 52 patients were enrolled in this randomized controlled trial and were assigned to either the control group (posterior nasal neurectomy) or the experimental group (posterior nasal neurectomy + pharyngeal neurectomy). The visual analog scale and rhinoconjunctivitis quality of life questionnaire were used to compare the differences in patient symptoms between baseline and 6-, 12-, and 24-months post-treatment. In addition, patient cough and asthma symptoms were monitored during follow-up via visual analog scale and asthma control test respectively. ResultsNo significant differences in preoperative scores were evident between groups (p > 0.05). At 6-months post-treatment, there were significant differences in visual analog scale, rhinoconjunctivitis quality of life questionnaire, and asthma control test scores relative to baseline values in experimental group and control group patients (p < 0.05), and this remained true upon 12- and 24-month follow-up. No significant differences in visual analog scale, rhinoconjunctivitis quality of life questionnaire, or asthma control test scores were observed between the two treatment groups at any postoperative follow-up time point (p > 0.05), while coughing severity was found to be significantly reduced in the experimental group relative to the control group (p < 0.05). Conclusionposterior nasal neurectomy can be safely implemented with or without pharyngeal neurectomy in order to effectively treat allergic rhinitis. Combined posterior nasal neurectomy and pharyngeal neurectomy treatment may offer greater value than posterior nasal neurectomy alone for the treatment of allergic rhinitis patients with chronic cough.

957 Comparison of Inguinodynia In Patients Undergoing Prophylactic Ilioinguinal Neurectomy vs No Neurectomy In Lichtenstein Mesh Hernioplasty

Abstract Objective The objective of this study is to compare the frequency of inguinodynia in ilioinguinal neurectomy VS no neurectomy in patients undergoing Lichtenstein mesh hernioplasty. Method 200 male patients with unilateral, primary, reducible inguinal hernia were randomly distributed in to two groups by using lottery method to undergo Lichtenstein’s hernia repair i.e., with and without ilioinguinal neurectomy. All the operation were carried out under local anesthesia. Pain score was calculated using the VAS system at 3rd month and inguinodynia was labelled if it is more than 1 on VAS scale. Results 200 male patients with mean age of 53.25 ± 6.768 were included. 42 (21%) had Inguinodynia after surgery. When we cross tabulated both groups with inguinodynia, results came up significant (p = 0.001). In neurectomy group 10 patients had inguinodynia while in no neurectomy group, 32 patients were having Inguinodynia. There was no effect of malnutrition on outcome. Younger age group benefitted more from procedure. Conclusions It is concluded that there is difference in frequency of inguinodynia in ilioinguinal neurectomy versus no neurectomy in patients undergoing Lichtenstein hernia repair. Patients with ilioinguinal neurectomy had reduced incidence of inguinodynia.

Long-Term Effects of Combined Submucous Turbinectomy and Posterior Nasal Neurectomy in Patients with Allergic Rhinitis

Submucous inferior turbinectomy (ST) can be combined with posterior nasal neurectomy (PNN) to treat intractable allergic rhinitis (AR) and vasomotor rhinitis (VR). This study assessed the long-term effects and complications of this surgical intervention. We enrolled 127 patients who had undergone combined ST and PNN. We mailed these patients card questionnaires. Of these questionnaires, we excluded the 5 patients with VR and 26 patients who had undergone concomitant endoscopic sinus surgery (ESS), because they had both AR or VR and sinusitis. Then, we assessed the questionnaire score of 31 patients with AR who had undergone combined ST and PNN. Postoperative bleeding was investigated in 127 subjects by medical records. Moreover, we compared the incidence of numbness in the palate, cheeks, or teeth between patients who had undergone PNN and those who had not. We found that 77.4% of the AR patients were satisfied with the improvement of their nasal symptoms after the operation. Although seven patients had been receiving medical treatment from an otolaryngology clinic every month before the operation, none needed any such treatment after the operation. One year postoperatively, all symptom scores were statistically decreased. However, the scores increased over time, although there was a significant improvement in nasal obstruction more than 3 years after the operation (P < 0.01). Five patients (3.9%) among 127 patients who had undergone PNN were treated for postoperative bleeding. Patients who had undergone PNN did not differ significantly from those who had not in terms of postoperative numbness in the palate, cheeks, or teeth. Endoscopic ST combined with PNN is an effective treatment for intractable AR. Further studies are required to elucidate the efficacy of this intervention.

Dermatome mapping test (DMT) and it’s place on triple and selective neurectomy in patients with post-operative chronic inguinal pain

Dermatome mapping test (DMT) and it’s place on triple and selective neurectomy in patients with post-operative chronic inguinal pain

Factors predicting outcome after anterior neurectomy in patients with chronic abdominal pain due to anterior cutaneous nerve entrapment syndrome (ACNES)

BackgroundChronic abdominal pain due to anterior cutaneous nerve entrapment syndrome may require surgery to provide long-term pain relief in up to 70% of patients. Factors predicting outcome after an anterior neurectomy are unknown. The aim of the study is to identify factors associated with treatment failure to possibly allow for optimizing patient counselling and selection. MethodsCharacteristics of anterior cutaneous nerve entrapment syndrome patients who were unresponsive to nonsurgical therapies and underwent an anterior neurectomy in a tertiary referral center from 2011 to 2016 were analyzed. Treatment failure was defined as <50% pain reduction using a numeric pain rating scale (numeric pain rating score 0–10) approximately 2 months postoperatively. A prediction model based on a multivariate regression analysis was tested for its discriminative value. ResultsA total of 495 patients (78% female, median age 40 years, range 8–83) undergoing an anterior neurectomy were eligible for analysis. Pain medication use (odds ratio 1.84, P = .027, confidence interval 1.07–3.17), abdominal surgery in the past (odds ratio 1.85, P = .026, confidence interval 1.08–3.18), the presence of paravertebral tender points at exit points of intercostal nerves (odds ratio 2.58, P = .003, confidence interval 1.39–4.80), and failure to favorably respond to a diagnostic rectus sheath block (odds ratio 3.74, P = .000, confidence interval 3.74 – 7.10) were identified as factors predicting surgical failure. However, a prediction model including these 4 factors had poor accuracy with an area under the curve of 0.64 (confidence interval 0.58–0.70). ConclusionThe present study identified risk factors associated with treatment failure that are useful in counseling anterior cutaneous nerve entrapment syndrome patients prior to a surgical intervention.

NEMISIS neuropathic minimally invasive surgeries for diabetic foot pathology

The effectiveness of operative treatments other than neurectomy for Morton’s neuroma remains debatable despite several reported studies. This review aimed to evaluate the effects of operative treatments for Morton’s neuroma other than neurectomy using an algorithmic approach and a structured critical framework to assess the methodological quality of reported studies.Several electronic databases were searched for articles published until August 2021 that evaluated the outcomes of operative treatments other than neurectomy in patients diagnosed with Morton’s neuroma. Data searches, extraction, analysis, and quality assessments were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the clinical outcomes were evaluated using objective, subjective, and negative outcomes; complications; and reoperation rate and type.After reviewing 11,213 studies, 22 studies were finally included. Although a number of studies with high level of evidence are limited, we divided them according to four categories: (1) neurolysis with or without nerve transposition, (2) minimally invasive nerve decompression, (3) metatarsal osteotomy, and (4) additional procedures after nerve transection or neurectomy. All categories showed reliable outcomes except minimally invasive nerve decompression. The proportion of postoperative neurogenic symptoms was lower with neurolysis than with neurectomy.Whether the alternative procedures were superior to neurectomy remains unclear as the number of good quality studies was limited. The proportion of postoperative neurogenic symptoms was lower with neurolysis than with neurectomy. Furthermore, performing simultaneous dorsal transposition of the nerve along with neurolysis is more recommended than neurolysis alone. Surgeons should be more careful with minimally invasive deep transverse intermetatarsal ligament release and metatarsal shortening osteotomy as their effectiveness remains inconclusive. Finally, we strongly recommend performing intramuscular embedding or intermuscular transposition of the nerve cutting end if neurectomy or nerve transection is inevitable.Level III, systematic review

Pulsed radiofrequency or anterior neurectomy for anterior cutaneous nerve entrapment syndrome (ACNES) (the PULSE trial): study protocol of a randomized controlled trial

BackgroundSome patients with chronic abdominal pain suffer from an anterior cutaneous nerve entrapment syndrome (ACNES). This somewhat illusive syndrome is thought to be caused by the entrapment of end branches of the intercostal nerves residing in the abdominal wall. If ACNES is suspected, a local injection of an anesthetic agent may offer relief. If pain is recurrent following multiple-injection therapy, an anterior neurectomy entailing removal of the entrapped nerve endings may be considered. After 1 year, a 70% success rate has been reported. Research on minimally invasive alternative treatments is scarce. Pulsed radiofrequency (PRF) treatment is a relatively new treatment for chronic pain syndromes. An electromagnetic field is applied around the nerve in the hope of leading to pain relief. This randomized controlled trial compares the effect of PRF treatment and neurectomy in patients with ACNES.MethodsAdult ACNES patients having short-lived success following injections are randomized to PRF or neurectomy. At the 8-week follow-up visit, unsuccessful PRF patients are allowed to cross over to a neurectomy. Primary outcome is pain relief after either therapy. Secondary outcomes include patient satisfaction, quality of life, use of analgesics and unanticipated adverse events. The study is terminated 6 months after receiving the final procedure.DiscussionSince academic literature on minimally invasive techniques is lacking, well-designed trials are needed to optimize results of treatment for ACNES. This is the first large, randomized controlled, proof-of-concept trial comparing two therapy techniques in ACNES patients. The first patient was included in October 2015. The expected trial deadline is December 2017. If effective, PRF may be incorporated into the ACNES treatment algorithm, thus minimizing the number of patients requiring surgery.Trial registrationNederlands Trial Register (Dutch Trial Register), NTR5131 (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5131). Registered on 15 April 2015.

Neurophysiological and Clinical Effects of Laparoscopic Retroperitoneal Triple Neurectomy in Patients with Refractory Postherniorrhaphy Neuropathic Inguinodynia.

Chronic postherniorrhaphy inguinal pain (CPIP) is a complex, major health problem. In the absence of recurrence or meshoma, laparoscopic retroperitoneal triple neurectomy (LRTN) has emerged as an effective surgical treatment of CPIP. This prospective pilot study evaluated the neurophysiological and clinical effects of LRTN. Ten consecutive adult CPIP patients with unilateral predominantly neuropathic inguinodynia underwent three comprehensive quantitative sensory testing (QST) assessments (preoperative, immediate postoperative, and late postoperative). Pain severity, health-related function, and sleep quality were assessed over the course of a 6-month follow-up period. QST revealed marked increases in mechanical, pressure, thermal, and pain thresholds in the areas with maximum pain prior to LRTN surgery for the immediate (P < 0.01; mean 160.9 minutes, range 103 to 255 minutes after extubation) and late postoperative (P < 0.05; mean 27.9 days, range 14 to 78 days after surgery) assessments compared to baseline. Wind-up phenomena were eliminated postoperatively. LRTN provided robust group-level improvements of all clinical measures. No preoperative QST variables were found to be predictive of surgical outcomes. The positive change in heat pain threshold (preoperative compared to late postoperative) showed significant positive correlations with improvements of pain scores and function. LRTN may produce immediate, profound, and consistent positive effects across multiple mechanical, pressure, and thermal QST variables, and marked improvements of clinical outcomes in selected CPIP patients. These data contribute to the understanding of mechanisms involved in the success of LRTN. Large, high-powered studies are warranted to determine whether preoperative or repeated longitudinal QST may guide patient selection and predict effectiveness of LRTN.

Topic: Abdominal Wall and Inguino Femoral Hernia Repair as a Super Specialization.

Background: Injection treatment followed by an anterior neurectomy in patients insufficiently responding to an injection regimen is successful long tenn in three-quarters of patients with anterior cutaneous nerve entrapment syndrome (ACNES). The efficacy of secondary surgery, including re-exploration or a posterior neurectomy in patients reporting recurrent pain after initially successful surgery or following an immediately failed anterior neurectomy is unknown.

Long-term success rates after an anterior neurectomy in patients with an abdominal cutaneous nerve entrapment syndrome

Surgery occasionally is proposed in patients with chronic abdominal wall pain caused by an anterior cutaneous nerve entrapment syndrome (ACNES) who are refractory to injection therapy. An anterior neurectomy may seem successful, but follow-up is usually short and populations are small. The primary aim of this study was to determine the long-term success rate of surgery in a large ACNES population. In this retrospective observational study, patients with ACNES ≥18 years who underwent a primary anterior neurectomy between January 2004 and February 2012 in one single center were studied. Pain scores were obtained before surgery, after surgery, and at the moment of questioning using a pain intensity numeric rating scale (PI-NRS 0-10) and a 6-point verbal category rating scale. Success was defined as a ≥50% PI-NRS reduction or ≥2 point verbal rating scale reduction. Data of 181 neurectomies in 154 individuals were available for analysis (female, n = 127, 82.5%; age 47 ± 17 years, range, 20-83). Pain before operation was severe (mean PI-NRS 8.08, SD 1.43). Short-term (1-3 months postoperative) success was 70% (127/181 procedures). Three subjects showed spontaneous remission of complaints after ≥3 months. After a mean 32 months (range, 3-93) follow-up, a success rate of 61% (109/180) on the long-term was found. A 70% short-term success rate and a 61% long-term success rate after a primary anterior neurectomy in patients with chronic abdominal pain due to ACNES were attained. Surgery is the method of choice in ACNES patients who are refractory to a conservative regimen.

Surgical options after a failed neurectomy in anterior cutaneous nerve entrapment syndrome.

Injection treatment followed by an anterior neurectomy in patients insufficiently responding to an injection regimen is successful long term in three-quarters of patients with anterior cutaneous nerve entrapment syndrome (ACNES). The efficacy of secondary surgery, including re-exploration or a posterior neurectomy in patients reporting recurrent pain after initially successful surgery or following an immediately failed anterior neurectomy is unknown. A database of ACNES patients receiving surgery between 2004 and 2012 in the SolviMáx institution was analysed. Adult patients with residual pain after an anterior neurectomy (failures) or with recurrent pain after initially successful surgery (recurrences) were selected. Following a re-exploration or a posterior neurectomy, pain was scored using a pain intensity numeric rating scale (PI-NRS 0-10) and a six-point verbal category rating scale (VRS). Success was defined as a ≥50 % PI-NRS reduction and/or ≥2 point VRS reduction. ACNES patients undergoing an anterior neurectomy (n = 181) were analysed during the 8-year study period. At follow-up, 51 patients reported unacceptable pain levels following an anterior neurectomy, whereas 20 developed recurrent abdominal wall pain. Of these 71 unsuccessful patients, 41 underwent secondary surgery, including a re-exploration (n = 10), or a posterior neurectomy (n = 31). After a 25-month median follow-up, secondary surgical treatment regimens proved successful in 66 % (27/41). Patients with recurrent pain did better (14/15) than patients who were immediate failures after the anterior neurectomy (13/26, p = 0.01). Secondary surgery including re-explorations and posterior neurectomies are successful in two-thirds of ACNES patients with persistent pain or recurrence of pain after an anterior neurectomy.

Long-term follow-up after mesh removal and selective neurectomy for persistent inguinal postherniorrhaphy pain

Persistent inguinal pain, influencing daily activities, is seen in about 5 % of patients following inguinal herniorrhaphy. Surgical treatment of patients with persistent postherniorrhaphy pain has been associated with pain relief and improvement in functional status. However, the detailed long-term outcome effects remain to be clarified. The aim of this study was to determine the long-term effects of mesh removal and selective neurectomy in patients with persistent postherniorrhaphy pain after previous open repair. The study consecutively included 54 inguinal postherniorrhaphy pain patients treated with mesh removal and aimed neurectomy. Patients completed questionnaires evaluating pain intensity with a numerical rating scale (NRS) and pain-related functional impairment preoperatively, and, 3, 6, 12, 24, and 36 months postoperatively. Endpoints were changes in pain intensity and functional ability when comparing preoperative and postoperative assessments. Pain intensities (average, maximum, and during activity) were significantly lower at all time points during follow-up compared to preoperative values (p < 0.01 for all) with a reduction in median (IQR) average pain intensity from 6.0 (5.0-7.0) preoperatively to 3.0 (1.0-5.5) at 36-month follow-up. There was no association between positive pain outcome and intraoperative nerve identification (p = 0.47). The number of patients who reported a long-term negative effect of the operation (≥ 25 % increase in average pain intensity at 36-month follow-up) was 1 of 8. The functional ability was improved at 3 months after the operation (p < 0.01), but the improvement was not statistically significant in the follow-up period. Preoperative signs of depression, anxiety, and catastrophizing had no influence on outcome. Mesh removal and attempted neurectomy may provide long-lasting analgesic effects in most patients and with a small proportion being worse, without relation to pain history and operative findings. Detailed multicenter collaboration is required to define preoperative diagnostics and the indication for mesh removal and neurectomy, the exact surgical procedure (type of neurectomy) and with detailed follow-up.

Functional Results and Quality of Life After Retrosigmoid Vestibular Neurectomy in Patients With Ménière’s Disease

Severe Ménière's disease (MD) may be debilitating and compromising, despite intensive medical treatment. Vestibular neurectomy (VN) is considered an effective surgical treatment for disabling MD. Our aim was to analyse the medium- to long-term outcome after retrosigmoid VN with special regard to vertigo, quality of life (American Academy of Otolaryngology-Head and Neck Surgery criteria), and pure tone average (PTA). Retrospective evaluation of patients with disabling MD treated with retrosigmoid VN at the university hospital of Bern (1992-2009), after unsuccessful attempts at medical treatment. Demographics, clinical signs and symptoms, quality of life, thresholds of hearing, and adverse events were documented at baseline, 1 week, 12 months, and 24 months after surgery. Medium to long-term follow-up data were available from 44 of 78 patients, who had undergone retrosigmoid VN (19 men; mean age, 50.3 ± 11.0 yr). Vertigo disappeared in 34 (77.3%) of 44 patients and improved in 6 (13.6%) of 44 patients. Quality of life significantly improved postoperatively (mean American Academy of Otolaryngology-Head and Neck Surgery, 0.68 ± 1.14 [1 yr] and 0.57 ± 1.19 [2 yr] versus 5.11 ± 0.66). Mean PTA decreased (52.3 ± 19.2 dB versus 56.2 ± 21.6 dB [1 wk] and 60.4 ± 20.5 dB [1 yr]; p < 0.001). Ten (22.7%) of 44 patients showed improved PTA after VN. These patients had significantly higher baseline PTA (69.4 dB versus 47.9 dB; p = 0.001). Retrosigmoid VN is a valuable and safe surgical option to treat disabling MD that has proved resistant to medical treatments. It may also be indicated for patients with preoperative severely impaired thresholds of hearing, in whom a certain hearing gain may be observed.

Functional Results and Quality of Life after Retrosigmoidal Vestibular Neurectomy in Patients with Menière's Disease

Background: Severe Ménière's disease (MD) may be debilitating and compromising despite intensive medical treatment. Vestibular neurectomy (VN) is considered an effective surgical treatment for disabling MD. Our aim was to analyze the medium to long-term outcome after retrosigmoidal VN with special regard to vertigo, quality of life (AAO criteria), and pure tone average (PTA).

Surgical Management of Inguinal Neuralgia After a Low Transverse Pfannenstiel Incision

The authors assessed the long-term pain relief after local nerve blocks or neurectomy in patients suffering from chronic pain because of Pfannenstiel-induced nerve entrapment. The low transverse Pfannenstiel incision has been associated with chronic lower abdominal pain because of nerve entrapment (2%-4%). Treatment options include peripheral nerve blocks or a neurectomy of neighboring nerves. Knowledge on adequate (surgical) management is scarce. Patients treated for iliohypogastric and/or ilioinguinal neuralgia after a Pfannenstiel incision received a questionnaire assessing current pain intensity (by 5-point verbal rating scale), complications, and overall satisfaction. Twenty-seven women with Pfannenstiel-related neuralgia were identified between 2000 and 2007. A single diagnostic nerve block provided long-term pain relief in 5 patients. Satisfaction in women undergoing neurectomy (n = 22) was good to excellent in 73%, moderate in 14%, and poor in 13% (median follow-up, 2 years). Complications were rare. Successful treatment improved intercourse-related pain in most patients. Comorbidities (endometriosis, lumbosacral radicular syndrome) and earlier pain treatment were identified as risk factors for surgical failure. Peripheral nerve blocking provides long-term pain reduction in some individuals. An iliohypogastric or ilioinguinal nerve neurectomy is a safe and effective procedure in most remaining patients.