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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2021; 40(01): 059-070
DOI: 10.1055/s-0040-1721334
Original Article | Artigo Original

Internal Neurolysis (Nerve Combing) for Trigeminal Neuralgia without Neurovascular Compression

Neurólise interna (nerve combing) para neuralgia do trigêmeo sem compressão neurovascular
Marco Gonzales-Portillo 
1   Instituto Neurociencias de Lima, Universidad Peruana Cayetano Heredia, Lima, Perú
,
Luis Adrián Huamán 
2   Servicio de Neurocirugía, Hospital Nacional Dos de Mayo, Lima, Perú
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Abstract

Objective The aim of the present study was to describe and evaluate the initial and the long-term clinical outcome of internal neurolysis (IN) for trigeminal neuralgia (TN) without neurovascular compression (NVC).

Methods A total of 170 patients diagnosed with TN were treated by posterior fossa exploration, during the period between April 2012 and October 2019. The patients were divided into two groups: Group A (50 patients) was treated by IN and Group B (120 patients) received microvascular decompression (MVD). Surgical outcomes and postoperative complications were compared between the two groups. Pain intensity was assessed by the Barrow Neurological Institute (BNI) pain intensity score and BNI facial numbness score. Pain recurrence was statistically evaluated with Kaplan-Meier analysis.

Results Pain was completely relieved in 44 patients (88%) who underwent IN (group A); 3 (6%) experienced occasional pain but did not require medication (BNI 2). In group B, 113 (94%) experienced immediate pain relief after MVD. The median duration of follow-ups was 4 years (6 months to 7.5 years). In Group A, there was a meantime recurrence of 27 months in 3 patients (6%). The recurrence in Group B was of 5.8% during the follow-up period. There were no statistically significant differences in the surgical outcomes between the two groups. All patients with IN experienced some degree of numbness, 88% of the cases resolved in 6 months, on average.

Conclusion Internal neurolysis is an effective, safe and durable treatment option for trigeminal neuralgia when NVC is absent.

Resumo

Objetivo O propósito do presente estudo foi descrever e avaliar o resultado clínico inicial e a longo prazo da neurólise interna (IN, na sigla em inglês) para neuralgia do trigêmeo (TN, na sigla em inglês) sem compressão neurovascular (NVC, na sigla em inglês).

Métodos. Um total de 170 pacientes diagnosticados com TN foram tratados pela exploração da fossa posterior, durante o período entre abril de 2012 e outubro de 2019. Os pacientes foram divididos em dois grupos: o grupo A foi tratado com IN (50 pacientes) e o grupo B recebeu descompressão microvascular (DMV) (120 pacientes). Resultados cirúrgicos e complicações pós-operatórias foram comparados entre os dois grupos. A intensidade da dor foi avaliada pelo escore de intensidade de dor do Barrow Neurological Institute (BNI, na sigla em inglês) e pelo escore de dormência facial do BNI. A recorrência da dor foi avaliada estatisticamente com a análise de Kaplan-Meier.

Resultados A dor foi completamente aliviada em 44 pacientes (88%) submetidos a IN (grupo A); em 3 (6%) houve dor ocasional, mas não necessitaram de medicação (BNI 2). No grupo B, 113 (94%) experimentaram alívio imediato da dor após DMV. A duração média do acompanhamento foi de 4 anos (6 meses a 7,5 anos). No grupo A, houve recorrência em três pacientes (6%). O tempo médio de recorrência foi de 27 meses. A recorrência no grupo B foi de 5,8% nesse período de acompanhamento. Não houve diferenças estatisticamente significativas nos resultados cirúrgicos entre os dois grupos. Todos os pacientes com IN experimentaram algum grau de dormência, em 88% dos casos, resolvidos em 6 meses, em média.

Conclusões A IN é uma opção de tratamento atraente, eficaz, segura e durável para a neuralgia do trigêmeo quando a NVC está ausente.

Keywords

internal neurolysis - nerve combing - trigeminal neuralgia - root entry zone - neurovascular compression - microvascular decompression

Palavras-chave

neurólise interna - nerve combing - neuralgia do trigêmeo - zona de entrada da raiz - compressão neurovascular - descompressão microvascular


Publikationsverlauf

Eingereicht: 01. August 2020

Angenommen: 25. September 2020

Artikel online veröffentlicht:
18. Januar 2021

© 2021. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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