Posterior Nerve Research Articles

Posterior Nasal Nerve Section versus Surface Coblation for Treatment of Intractable Rhinorrhea

Posterior Nasal Nerve Section versus Surface Coblation for Treatment of Intractable Rhinorrhea

Patient Questions Surrounding Posterior Nasal Nerve Ablation for Chronic Rhinitis

AbstractObjectiveIn‐office ablation of the posterior nasal nerve (PNN) has emerged as an effective treatment option for chronic rhinitis patients. This study explored questions patients commonly search online regarding this therapy and the quality of content available.Study DesignA retrospective analysis of online search criteria and sources was performed with subsequent analysis of results.SettingSearch and data acquisition was in September of 2023.MethodsMost common search terms related to cryotherapy and radiofrequency neurolysis of the PNN were identified with associated People Also Ask (PAA) questions. Questions were categorized and organized into subtopics and sources evaluated using readability and quality metrics.ResultsA total of 255 unique PAA questions and 175 unique websites were identified. The most common subtopics were related to facts about chronic rhinitis (26.7%) and rhinitis treatment options (25.1%). Nearly a quarter (24.3%) of websites were from commercial sources. Quality metrics indicate difficult‐to‐read and low‐quality materials.ConclusionExisting online resources need improvement to provide patients material that is easier to read. Physicians counseling patients should be aware of these areas for adequate shared decision making.

The Gluteus Deep Investing Fascia Compartment Block: A Novel Technique for Posterior Femoral Cutaneous Nerve Block.

The posterior femoral cutaneous nerve (PFCN) block is used in regional anesthesia for lower extremity surgery. This study introduces a new ultrasound-guided technique called the "Gluteus-Deep Investing Fascia compartment Block (GDIF block)"for blocking the PFCN. This approach involves injecting local anesthetic into the potential space between the gluteus maximus muscle and the deep investing fascia, named the 'Gluteus Deep Investing Fascia Compartment'. The study discusses the anatomical and sonographic features crucial for identifying this compartment and explores the potential benefits of this approach for achieving effective PFCN block. Additionally, it examines the clinical application of the GDIF block for PFCN block as part of the Complete Lower Extremity Fascia Tri-compartment Block technique, named"CLEFT Block." This technique combines the suprainguinal fascia iliaca block with GDIF compartment block for PFCN and a sciatic nerve block as exclusive anesthesia technique. Nine patients with weapon-related lower limb injuries underwent surgery at district hospitals supported by the International Committee of the Red Cross. Between October and December 2023, seventeen above-knee procedures were performed for the nine patients using the GDIF block as part of a CLEFT block technique. Anesthesia was performed with a CLEFT block technique using a volume ratio of 1:1 of 1% lidocaine and 0.5% levobupivacaine. The GDIF block technique for PFCN blockade was performed successfully in all patients without complications, achieving complete PFCN blockade. The CLEFT block technique proved effective as the sole anesthetic technique for seventeen above-knee procedures. All surgeries were completed successfully without additional pain medication or conversion to general anesthesia. The GDIF block appears to be a promising technique for anesthetic management, alone or as part of the CLEFT block. Further research with a larger patient population is necessary to validate these findings.

Comparison Between the Effect of Turbinoplasty With and Without Posterior Nasal Nerve Neuroectomy in Patients of Allergic Rhinitis Not Responding to Medical Treatment

Comparison Between the Effect of Turbinoplasty With and Without Posterior Nasal Nerve Neuroectomy in Patients of Allergic Rhinitis Not Responding to Medical Treatment

Combined Decompression of Pudendal and Inferior Cluneal Nerves for Entrapment Neuralgias Using Transperitoneal Robotic Laparoscopy: Feasibility and Our Four-Step Technique

Objective: To demonstrate the feasibility of a combined decompression of pudendal and inferior cluneal nerves for entrapment syndrome using a transperitoneal robotic laparoscopy. DesignDemonstration of our 4 steps technique with narrated video footage. SettingPudendal and inferior cluneal neuralgias caused by an entrapment syndrome are both responsible for perineal pain (1). Although more precise data are lacking, these two neuralgias are frequently associated. Failure of surgical pudendal nerve decompression in the early 2000 has driven to discover the entity of a potential entrapment syndrome of the posterior cutaneous nerve of the tight and its inferior cluneal branches between the ischium bone and the sacrotuberous ligament (2). The corresponding neuralgia is responsible for a neuropathic pain to a more posterior part of the perineum and the thigh, without any neuro-vegetative symptom. In case of failure of medical treatment, surgery can be proposed using an invasive open trans-gluteal approach as a standard treatment (3-5). InterventionsTransperitoneal robotic laparoscopy for a mini-invasive releasing of both pudendal and inferior cluneal nerves, following a 4 steps technique:1. Opening of the peritoneum between external iliac vessels and umbilical ligament2. Dissection of the internal iliac and pudendal arteries up to the pudendal nerve3. Section of sacrospinous ligament and release of pudendal nerve4. Section of sacrotuberous ligament and release of inferior cluneal nerve. ConclusionPreviously, pudendal and inferior cluneal neuralgias have been managed with an invasive open trans-gluteal surgery. Here, we demonstrate the feasibility of a mini-invasive transperitoneal robotic laparoscopy, with a standardized 4 steps surgical technique.

Modified technique improves efficacy for in-office posterior nasal nerve ablation.

Posterior nasal nerve (PNN) ablation is a minimally invasive treatment option for patients with chronic rhinitis. Recent evidence shows that parasympathetic innervation of the nasal cavity is more extensive and there are many fibers posterior to the lateral attachment of the middle turbinate. We describe a modified ablative technique that targets the extensive innervation of the posterior nasal nerves. Description of the technique and retrospective cohort analysis. In addition to the traditional radiofrequency and cryoablation targets, three additional treatment sites posterior to the middle turbinate were targeted using radiofrequency ablation, as well as one focused treatment posteroinferior to the middle turbinate attachment using cryotherapy ablation. The primary outcome collected was a 30% improvement in overall rhinitis symptoms. Forty-five patients received treatment and completed 3-month follow-up using the modified technique for radiofrequency and cryotherapy PNN ablation. Previously, our institution documented a 64.5% responder rate at 3 months. After introducing the modified technique, the response rate at 3 months significantly improved (64.5% vs. 91.1%, p = .004). This report suggests improved efficacy with implementation of the modified technique for in-office PNN ablation. Given the extensive nature of the post-ganglionic parasympathetic fibers of the nasal cavity which often emerge posterior to the middle turbinate attachment, a modified technique to target these branches should be considered. Prospective randomized studies comparing this modified technique to the traditional technique are needed. III.

Comparison of the Efficacy of Different Radiofrequency Techniques for the Treatment of Lumbar Facet Joint Pain: Combined with Anatomy.

Lumbar facet pain is generally considered to be one of the major causes of chronic low back pain. Each lumbar facet joint is innervated by the medial branch of the posterior spinal nerve from its own level and above. Radiofrequency (RF) of the medial branch of the posterior branch of the spinal nerve is an effective method for the treatment of lumbar facet pain. RF technology is diverse, including traditional radiofrequency (TRF), pulsed radiofrequency (PRF), cooled radiofrequency (CRF), low-temperature plasma radiofrequency ablation (CA), and other treatment methods. The purpose of this paper is to compare the efficacy of different radiofrequency techniques and to analyze the reasons for this in the context of anatomy. There have been studies confirming the differences in efficacy of different RF techniques. However, most of the studies only compared two RF techniques, not four techniques, TRF, CRF, PRF, and CA, and did not analyze the reasons for the differences in efficacy. This article reviews the differences in the efficacy of the above four RF techniques, clarifies that the differences are mainly due to the inability to precisely localize the medial branch of the posterior branch of the spinal nerve, analyzes the reasons for the inability to precisely localize the posterior branch of the spinal nerve in conjunction with anatomy, and proposes that the development of RF technology for lumbar facet pain requires more in-depth anatomical, imaging, and clinical studies.

Severe epistaxis after posterior nasal nerve ablation requiring surgical intervention: A multi-center case series.

Severe epistaxis occurs in 2% of PNN ablation cases, independent of method or device type. Major epistaxis requiring intervention after PNN ablation can occur on average 20 days post-procedure.

Letter Regarding "Improvement in Nasal Symptoms of Chronic Rhinitis after Cryoablation of the Posterior Nasal Nerve":Towarda Unified Airway Approach.

Letter Regarding "Improvement in Nasal Symptoms of Chronic Rhinitis after Cryoablation of the Posterior Nasal Nerve":Towarda Unified Airway Approach.

Macrophages enhance regeneration of lateral line neuromast derived from interneuromast cells through TGF-β in zebrafish.

Macrophages play a pivotal role in the response to injury, contributing significantly to the repair and regrowth of damaged tissues. The external lateral line system in aquatic organisms offers a practical model for studying regeneration, featuring interneuromast cells connecting sensory neuromasts. Under normal conditions, these cells remain dormant, but their transformation into neuromasts occurs when overcoming inhibitory signals from Schwann cells and posterior lateral line nerves. The mechanism enabling interneuromast cells to evade inhibition by Schwann cells remains unclear. Previous observations suggest that macrophages physically interact with neuromasts, nerves, and Schwann cells during regeneration. This interaction leads to the regeneration of neuromasts in a subset of zebrafish with ablated neuromasts. To explore whether macrophages achieve this effect through secreted cytokines, we conducted experiments involving tail amputation in zebrafish larvae and tested the impact of cytokine inhibitors on neuromast regeneration. Most injured larvae remarkably regenerated a neuromast within 4 days post-amputation. Intriguingly, removal of macrophages and inhibition of the anti-inflammatory cytokine transforming growth factor-beta (TGF-β) significantly delayed neuromast regeneration. Conversely, inhibition of the pro-inflammatory cytokines interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) had minor effects on the regeneration process. This study provides insights into how macrophages activate interneuromast cells, elucidating the pathways underlying neuromast regeneration.

Periosteal Lipoma Compressing Peripheral Nerves

Introduction: Lipoma is a common benign, slow-growing soft tissue neoplasm. Periosteal lipomas of the proximal radius causing posterior interosseus nerve (PIN) palsy are the rarest. 
 Due to specific anatomical relationships, proximal antebrachial lipomas can easily compress PIN. We present a case report and report on the related literature.
 Material and Methods: A 55-year-old female was admitted complaining of a progressively growing lump in the anterior-lateral antebrachial region near the left elbow. The recent onset of weakness in finger extension was more evident during manual work. 
 MRI showed a well-defined oval lesion in the dorsal aspect of the proximal radius bone with inter-muscular laying between m. supinator et extensor carpi radialis brevis of 7x5x3 cm in diameter. EMG study confirmed PIN compression syndrome.
 An en-block extirpation was performed through extensor muscles. PIN and its muscular branches were well preserved. Histological examination confirmed lipoma. The postoperative course was uneventful, and a good recovery was seen within 12 days. 
 We revised three other similar cases operated for the same Clinical diagnosis by our team. 
 Pertinent literature was reported. 
 Discussion: Periosteal radius lipoma related to compression of PIN has rarely been reported in the literature. We say our operative series and the surgical technique. MRI and EMG are the standard diagnostic methods. The intermuscular approach is safe for total tumor removal in experienced hands.
 Conclusion: Periosteal lipoma compressing PIN is a rare clinical finding. Total removal may be obtained through an intermuscular approach. Intraoperative monitoring can assist in preserving tiny PIN branches

Wrist extensor pathomechanics: implications for tendon and nerve transfer.

Central and peripheral nervous system lesions may disrupt the intricate balance of the prime movers of the wrist. In spasticity, hyperactive wrist flexors create a flexion moment and, if untreated, can lead to flexion contractures. In patients with C6 spinal cord injury and tetraplegia, the posterior interosseus nerve is typically affected by a complex pattern of upper and/or lower motoneuron lesions causing radial deviation of the wrist due to loss of ulnar deviation actuators. In this report, we illustrate severe pathomechanics that may occur even with relatively modest changes in wrist balance. These results illustrate how thorough understanding of muscle-tendon-joint interaction aids in designing tendon and nerve reconstructive surgeries to normalize wrist positions and balance in neuromuscular conditions.

Three Subtypes of Cutaneous Nerve Entrapment Syndrome: A Narrative Review.

Anterior, lateral, and posterior cutaneous nerve entrapment syndromes have been proposed as etiologies of trunk pain. However, while these syndromes are analogous, comprehensive reports contrasting the three subtypes are lacking. We therefore reviewed the literature on anterior, lateral, and posterior cutaneous nerve entrapment syndrome. We searched the PubMed and Cochrane Library databases twice for relevant articles published between March and September 2022. In addition to 16 letters, technical reports, and review articles, a further 62, 6, and 3 articles concerning anterior, lateral, and posterior cutaneous nerve entrapment syndromes, respectively, were included. These syndromes are usually diagnosed based solely on unique history and examination findings; however, the diagnostic process may be prolonged, and multiple re-evaluations are required. The most common first-line treatment is trigger point injection; however, the management of refractory cases remains unclear. Awareness of this disease should be expanded to medical departments other than general medicine.

Resolution of PIN syndrome following Physiotherapy: A case report

This case report highlights the use of physiotherapy as monotherapy for non-traumatic posterior interosseus nerve palsy, which is a rare compression neuropathy that usually gets referred to a surgeon and for which the patient may undergo surgical decompression. However, in a resource limited setting, patients are often not able to afford advanced radiographic modalities like high resolution ultrasound and MRI scans. Hence the standard pathway to surgery is uncertain and they often get referred to physiotherapy while awaiting surgery. In this case, the patient was referred for Physiotherapy and the palsy improved. This suggests there was no defined surgical lesion, as has been found in many patients who have undergone ultrasound. This case highlights the need for robust research on the role of physiotherapy for PIN palsy in resource limited settings and a possible treatment algorithm that reserves investigations and surgery for patients whose PIN palsy does not improve with physiotherapy and for whom surgery is not clearly indicated from the outset.

Sub-Gluteus Maximus Fascial Plane and Perineural Hydrodissection as Novel Treatment for Posterior Femoral Cutaneous Nerve Entrapment.

Posterior femoral cutaneous nerve (PFCN) entrapment due to overuse is rarely reported in the literature, and treatment is limited. Conventional treatment includes focused rehabilitation exercises, computed tomography-guided or magnetic resonance (MR)-guided nerve blocks, MR-guided cryoablation, and surgical decompression, but data for treatment validation and efficacy are lacking. Sub-gluteus maximus fascial plane and perineural hydrodissection may offer an effective alternative treatment for PFCN entrapment, especially given reports of successful cases with similar procedural techniques in other anatomical locations and structures.

Anatomical variations of interest for posterior nasal nerve cryotherapy in the treatment of chronic rhinitis: A radioanatomic study.

An unfavorable insertion of the middle turbinate for cryotherapy was present in 74.2% of cases. Placing cryoprobe 15-30mm above the nasal floor targets the nerves in 95.8% of cases. Centering the cryoprobe 38mm behind the inferior turbinate axilla targets the nerves in 94.6% of cases.

Effectiveness of the Posterior Nasal Nerve Cryoablation in Allergic and Non-Allergic Rhinitis.

This study assessed the impact of cryoablation of the posterior nasal nerve on symptoms of rhinitis in individuals with allergic rhinitis (AR) and non-allergic rhinitis (NAR). PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases for studies published up to June 2023. Studies that evaluated the quality of life and rhinitis-related symptom scores before and after cryotherapy treatment, as well as sham-controlled studies, were included. In total, 368 patients from seven studies were analyzed. Patients who underwent cryoablation showed a significant improvement in rhinitis-related symptoms in both NAR and AR. In particular, the most significant improvement was observed in symptoms of rhinorrhea and congestion. Furthermore, cryoablation improved the disease-specific quality of life evaluated using the Rhinoconjunctivitis Quality of Life Questionnaire. The rate of clinical improvement in the total nasal symptom score (total nasal symptom score [TNSS]; >30% reduction from baseline) after cryotherapy was 74%. The change in TNSS score significantly increased over time in NAR patients (p = 0.0041). Therefore, changes in the TNSS score after 12 months of cryotherapy treatment were greater in the NAR group than in the AR group (p = 0.0020), indicating that cryoablation is effective for both types of rhinitis and has better long-term efficacy in NAR than in AR. Subjective symptom scores related to rhinitis, particularly for rhinorrhea and congestion, decrease after cryoablation of the posterior nasal nerve. Furthermore, the symptom improvement was greater in NAR than AR. Laryngoscope, 134:2502-2512, 2024.

Two-Year Outcomes After Radiofrequency Neurolysis of Posterior Nasal Nerve in Chronic Rhinitis.

To assess the long-term safety and effectiveness of temperature-controlled radiofrequency (TCRF) neurolysis of the posterior nasal nerve (PNN), a minimally invasive treatment for chronic rhinitis. A prospective, single-arm study of 129 patients at 16 centers (United States, Germany) was conducted. Patient-reported outcome measures were the 24-h reflective total nasal symptom score (rTNSS) and mini rhinoconjunctivitis quality of life questionnaire (MiniRQLQ). Postnasal drip and cough symptoms were assessed using a 4-point scale. The mean pretreatment rTNSS was 7.8 (95% CI, 7.5-8.1). The significant rTNSS treatment effect at 3 months (-4.2 [95% CI, -4.6 to -3.8]; p < 0.001) was sustained through 2 years (-4.5 [95% CI, -5.0 to -3.9]; p < 0.001), a 57.7% improvement. At 2 years, the proportion of patients with a minimal clinically important difference (MCID) of ≥30% improvement in rTNSS from baseline was 80.0% (95% CI, 71.4%-86.5%). Individual postnasal drip and cough symptom scores were significantly improved from baseline through 2 years. The proportion of patients who reached the MCID for the MiniRQLQ (≥0.4-point improvement) at 2 years was 77.4% (95% CI, 68.5%-84.3%). Of 81 patients using chronic rhinitis medications at baseline, 61.7% either stopped all medication use (28.4%) or stopped or decreased (33.3%) use of ≥1 medication class at 2 years. No device/procedure-related serious adverse events were reported throughout 2 years. TCRF neurolysis of the PNN resulted in sustained improvements in chronic rhinitis symptom burden and quality of life through 2 years, accompanied by a substantial decrease in medication burden. 4 Laryngoscope, 134:2077-2084, 2024.

SorCS2 binds progranulin to regulate motor neuron development

Motor neuron (MN) development and nerve regeneration requires orchestrated action of a vast number of molecules. Here, we identify SorCS2 as a progranulin (PGRN) receptor that is required for MN diversification and axon outgrowth in zebrafish and mice. In zebrafish, SorCS2 knockdown also affects neuromuscular junction morphology and fish motility. In mice, SorCS2 and PGRN are co-expressed by newborn MNs from embryonic day 9.5 until adulthood. Using cell-fate tracing and nerve segmentation, we find that SorCS2 deficiency perturbs cell-fate decisions of brachial MNs accompanied by innervation deficits of posterior nerves. Additionally, adult SorCS2 knockout mice display slower motor nerve regeneration. Interestingly, primitive macrophages express high levels of PGRN, and their interaction with SorCS2-positive motor axon is required during axon pathfinding. We further show that SorCS2 binds PGRN to control its secretion, signaling, and conversion into granulins. We propose that PGRN-SorCS2 signaling controls MN development and regeneration in vertebrates.

Mechanical differences of anterior and posterior spinal nerve roots revealed by tensile testing

Cervical spondylotic myelopathy can damage the nerves and structures of the subarachnoidal canal. The spinal cord is attached to the subarachnoidal canal via structures such as nerve roots (NR), which play an important role in its positioning and can be affected by cervical spondylotic myelopathy Understanding the tensile mechanical properties of nerve roots is therefore crucial.A total of 37 swine nerve samples (15 bundles, 12 posterior roots, and 10 anterior roots) were mechanically tested within 12 h of sacrifice by a tensile test on a Mach 1 system (Biomomentum, Montreal, Canada) equipped with a 17 N load cell. Bi-linear piecewise fitting was performed to determine the elastic modulus, maximal strain and stress at failure, as well as the coefficients of the 1st- and 3rd-order Ogden models. Additionally, a sensitivity analysis on the Ogden coefficients was performed.The elastic modulus for the bundles, posterior roots, and anterior roots were 3.7 ± 3.1 MPa, 0.23 ± 0.18 MPa, and 0.31 ± 0.27 MPa, respectively. Significant differences (P < 0.05) were found between the bundles and the anterior/posterior roots. Coefficients for the 1st-, 2nd- and 3rd-order Ogden models were provided for each type of sample.Nerve roots have different properties depending on their types. The 1st-order Ogden model may be used to model the mechanical properties of NR using constitutive laws.