Neurectomy In Patients Research Articles

Ilioinguinal nerve excision in open mesh repair of inguinal hernia—results of a randomized clinical trial: simple solution for a difficult problem?

Background Inguinodynia is the second most common complication occurring after inguinal hernia repair. This study was undertaken to evaluate the effect of ilioinguinal nerve excision, a concept previously proposed to be performed during open hernia mesh repair, on postsurgical pain and hyposthesia. Methods A double-blind randomized clinical trial was performed on 121 patients undergoing open anterior mesh repair of inguinal hernia in 1 center from April 2005 through June 2006. The ilioinguinal nerve was excised in half of the patients and preserved in the other half. Pain and hyposthesia at POD 1, 1 and 6 months after surgery, and 1 year after surgery was evaluated in both groups using a visual analog scale. Results were compared using chi-square analysis. Results Of the total number of 121 patients who entered the study, with an age range of 18 to 86 years (mean ± SD 45 ± 18), 115 (95%) were male. Sixty-one were in the nerve-excision group, and 60 were in the nerve-preservation group. One hundred patients were followed-up until the end of the first year. Using the visual analog scale to detect pain severity on postsurgical day 1, mean scores in the nerve-excision and nerve-preservation groups were 2.2 ± .8 (range 1 to 4) versus 2.8 ± .7 (range 2 to 4.5), respectively ( P < .001). At 1 month after surgery, these scores were .7 ± .7 (range 0 to 3) versus 1.5 ± .7 (range 0 to 3.5), respectively ( P < .001). Between 6 months and 1 year after surgery, median scores of zero were detected in both groups. After postsurgical day 1, the median score of hyposthesia was near zero in both groups. Thirteen patients developed chronic inguinodynia (13%), 10 of whom were in the nerve-preservation group. Chronic postsurgical inguinodynia was seen in 6% of patients in the ilioinguinal nerve-excision and 21% of the patients in the ilioinguinal nerve-preservation group ( P = .033). Comments Neurectomy decreases postsurgical pain after elective inguinal hernia repair. Although chronic inguinodynia was less frequent in our study than reported by many previous studies, it is still wise to recommend ilioinguinal neurectomy in patients undergoing anterior inguinal hernia mesh repair.

Meniett therapy may avoid vestibular neurectomy in disabling Meniere's disease

Conclusion. In those patients for whom vestibular neurectomy has been selected due to the disabling recurrence of vertigo spells, Meniett® therapy has been shown to allow avoidance of this surgical procedure in a fairly high percentage of patients with Meniere's disease (MD). Our data would also support a better result when pressure treatment is acting on MD of short duration. Objective. To test the possibility that low pressure treatment (Meniett®) could avoid vestibular neurectomy in patients with MD that was refractory to medical treatment. Patients and methods. The setting was a tertiary referral centre in a university hospital. Thirty-six MD patients, for whom vestibular neurectomy was indicated, underwent Meniett® treatment and composed a group in which a long-term (>2 years) follow-up was achieved. Additionally, different durations of MD (‘young’ and ‘old’ MD) were distinguished and analysed separately. Results. Twenty-five patients (69.4%) were treated satisfactorily by using Meniett® treatment and therefore avoided vestibular neurectomy. In half of them only one cycle of treatment was necessary.

Intratympanic gentamicin therapy for persistent vertigo after endolymphatic sac surgery

Objectives: To evaluate the role of intratympanic gentamycin therapy (ITGM) in controlling vertigo in patients with refractory Meniere's who have recurrent or persistent vertigo after endolymphatic sac surgery. Study Design and Setting: A retrospective review of 491 patients seen in a university balance clinic between July 1999 and July 2000. Of these, 68 patients had Meniere's disease; 4 patients had recurrent vertigo after endolymphatic sac surgery and were followed for at least 1 year. These 4 patients received a series of ITGM injections. Outcome measures included control of vertigo and audiometric results. Results: Three of 4 (75%) patients had control of their vertigo with ITGM therapy. The 1 patient who failed ITGM therapy underwent a successful vestibular neurectomy with ultimate control of his vertigo. No patients had progression of their sensorineural hearing loss. Conclusion: ITGM therapy can be used to control vertigo in selected patients with Meniere's disease who have persistent vertigo after unsuccessful endolymphatic sac surgery. Significance: ITGM therapy may reduce the need for vestibular neurectomy in patients with refractory Meniere's disease after endolymphatic sac surgery. (Otolaryngol Head Neck Surg 2002;126: 31-3.)

Are peripheral neurectomies of value in the treatment of trigeminal neuralgia? An analysis of new cases and cases involving previous radiofrequency gasserian thermocoagulation.

The indications, advantages, complications, and benefits of peripheral neurectomy in patients with trigeminal neuralgia were studied in detail in 40 patients treated between 1982 and 1991. Twenty-eight patients had previously received radiofrequency thermocoagulation: peripheral neurectomy was performed for pain recurrence. These patients had excellent or good pain relief for at least 5 years postsurgery. Of the 12 patients who had peripheral neurectomy as their only procedure, seven had an excellent result and five had a good result. Five of the patients had recurrence of pain after 2 years but responded well to a second neurectomy. Elderly patients who experienced pain in the first and second divisions of the trigeminal distributions were the best candidates. Peripheral neurectomy is an effective, safe procedure for elderly patients who suffer from trigeminal neuralgia and have a limited life span.

Time-effect relationship after a single dose of 1000 MG of efferverscent aspirin or placebo in postoperative oro-facial pain

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.

Cochlear nerve monitoring during cerebellopontine angle operations.

The authors present their experience with intraoperative monitoring of cochlear nerve action potentials (AP) in 30 adult patients. Operative procedures were acoustic neuroma excision with attempted hearing preservation and selective vestibular neurectomy in patients with incapacitating Meniere's disease and serviceable hearing (SRT less than 50 db, discrimination greater than 60%). Loss of AP is detected rapidly and has been demonstrated after manipulation of the cochlear nerve and after coagulation of small arteries on the tumour capsule. Presence of an AP at the end of the procedure usually correlates with postoperative preservation of hearing. AP monitoring appears to be a reliable means of detecting potentially reversible changes in cochlear nerve function intraoperatively.

Licht- Und Elektronenmikroskopische Befunde Am Nervus Vestibularis Und Ganglion Scarpae Beim Morbus Menière

Degenerative changes in both the nervus vestibularis and in Scarpa's ganglion depending on the duration of Meniére's disease are visualized by light and electron microscopy. The specimens were obtained by transtemporal neurectomy in patients with Meniére's disease and were fixed quickly. On the thick nerve fibres (pars superior) a splintering of the myelin lamellae, an increase in the nerve fibre diameter and the formation of myelin globes were found. On the thin nerve fibres (pars inferior) protrusion and introversion of whole parts of the myelin sheath had been observed. In the later stages of the disease, losses of axons and decay of myelin sheath were evident. In Scarpa's ganglion, different stages of ganglion cell degeneration were found. The degenerative morphological changes in the nerve and ganglion were more obvious in later stages of the disease.