Microvascular Decompression of the VII/VIII Cranial Nerve Complex for the Treatment of Intermediate Nerve Neuralgia: A Retrospective Case Series

Fernandes, Eric Goulin Lippi; Doormaal, Tristan van; Ru, Sander de; Miller, Kai J.; Han, Kuo Sen

doi:10.1093/ons/opx271

Cited by 11 publications

(20 citation statements)

References 22 publications

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“…Optimistic results have been reported with isolated MVD, as Goulin Lippi Fernandes et al demonstrated in a recently published series of 8 GN patients, 7 of whom had persistently favorable outcomes at a median of 35 months after surgery. 4 In the present series, all patients except two underwent NI sectioning, with none reporting subsequent dry eye or loss of taste. In the majority of patients, additional cranial nerve-directed treatments, including MVD or rhizotomy of CN V or IX-X, were also included in the operative procedure, typically due to clinical concern for an alternative or additional underlying or comorbid craniofacial pain syndrome.…”

Section: Discussionmentioning

confidence: 64%

“…The possible benefit of an isolated MVD is again supported by the encouraging recent results from Goulin Lip-pi Fernandes et al, which confirmed durable symptomatic relief after MVD of the NI in 7 of 8 patients a median 35 months after primary surgery for uncomplicated GN. 4 Taking these results together with our own experience, we recommend addressing all possible sources of neuralgia pain identified by the clinical history with MVD, where appropriate, or considering rhizotomy if symptoms indicate probable TN/GPN but obvious neurovascular compression is not encountered intraoperatively. Furthermore, even in patients who are taken to surgery with a history of unambiguous GN (e.g., isolated deep ear pain), we recommend exploration of CNs V and IX-X, given the minimal risk of morbidity, and MVD if there is clear microvascular compression.…”

Section: Discussionmentioning

confidence: 94%

“…Understanding of the natural history and optimal management of GN is incomplete, and prior outcome studies after surgical treatment have been small and heterogeneously described. 4,7,11,13,14,18 We report a series of 11 patients treated surgically for GN, including 9 primary surgeries and 2 reoperations, which is among the largest single-institution cohorts describing this rare entity, accompanied by the first true systematic review.…”

Section: Discussionmentioning

confidence: 99%

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Nervus intermedius and the surgical management of geniculate neuralgia

Peris-Celda¹,

Oushy²,

Perry³

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Geniculate neuralgia (GN) is an uncommon craniofacial pain syndrome attributable to nervus intermedius (NI) dysfunction. Diagnosis and treatment can be challenging, due to the complex nature of ear sensory innervation, resulting in clinical overlap with trigeminal neuralgia (TN) and glossopharyngeal neuralgia (GPN). METHODS A retrospective review of a prospective neurosurgical database at our institution was performed, 2000-2017, with a corresponding systematic literature review. Pain outcomes were dichotomized as unfavorable for unchanged/worsened symptoms versus favorable if improved/resolved. Eight formalin-fixed brains were examined to describe NI at the brainstem. RESULTS Eleven patients were surgically treated for GN-9 primary, 2 reoperations. The median age was 48, 7 patients were female, and the median follow-up was 11 months (range 3-143). Seven had ≥ 2 probable cranial neuralgias. NI was sectioned in 9 and treated via microvascular decompression (MVD) in 2. Five patients underwent simultaneous treatment for TN (4 MVD; 1 rhizotomy) and 5 for GPN (3 MVD; 2 rhizotomy). Eleven reported symptomatic improvement (100%); 8 initially reported complete resolution (73%). Pain outcomes at last contact were favorable in 8 (73%)-all among the 9 primary operations (89% vs 0%, p = 0.054). Six prior series reported outcomes in 111 patients. CONCLUSIONS GN is rare, and diagnosis is confounded by symptomatic overlap with TN/GPN. Directed treatment of all possible neuralgias improved pain control in almost all primary operations. Repeat surgery seems a risk factor for an unfavorable outcome. NI is adherent to superomedial VIII at the brainstem; the intermediate/cisternal portion is optimal for visualization and sectioning.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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Nervus intermedius and the surgical management of geniculate neuralgia

Peris-Celda¹,

Oushy²,

Perry³

et al. 2019

Journal of Neurosurgery

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“…(3) preganglionic parasympathetic fibers, which originate from the superior salivary nucleus and project to the pterygopalatine and submandibular ganglions, supplying lacrimal, sublingual, submandibular, and accessory salivary glands and glands of the nose and palate, respectively (2)(3)(4)(5). To our knowledge, cutaneous sensory fibers play an important role in primary otalgia (6).…”

Section: Introductionmentioning

confidence: 99%

“…To date, no consensus has been reached on the precise pathophysiology of such disease [entities such as viral infection (herpes) and Ramsay Hunt syndrome] (8-10). However, the most widely accepted opinion is that NIN is caused by vascular compression of the NI in the entry zone of the brainstem, which is a mechanism similar to that of other cranial nerve neuralgias (2). At this point, microvascular decompression (MVD) seems to be a beneficial surgical choice for the management of NIN.…”

Section: Introductionmentioning

confidence: 99%

Case Report: Direct Visualization of the Nervus Intermedius During the Microvascular Decompression Procedure: Should We Take It Seriously?

Zheng

Zhao

et al. 2021

Front. Neurol.

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Background: Nervus intermedius neuralgia (NIN), known as geniculate neuralgia (GN), is an uncommon cranial nerve disease caused by an offending vessel compressing the nervus intermedius (NI). Microvascular decompression (MVD) has now become a valued treatment approach for NIN because it can resolve neurovascular conflict (NVC) at the root entry zone of the NI. In the era of continuously optimizing and improving the surgical technique of MVD, further minimization of all possible postoperative complications is not only welcome but also necessary.Objective: The aim of this work is to assess the postoperative outcome of direct visualization of the NI during the MVD procedure.Methods: This study retrospectively reviewed the clinical records of a group of seven consecutive patients with NIN who underwent MVD in the period of 2013–2020 in our clinic and 16 studies reported NIN patients who underwent MVD in the period of 2007–2020.Results: In total, 91.3% of all patients experienced immediate and complete relief of cranial neuralgia after MVD. Six of 23 patients have experienced direct visualization of the NI intraoperatively, and 66.7% of those patients had complications such as facial paralysis, dysacousia, or a combination of these conditions postoperatively. Slight surgical approach-related complications such as complaints associated with excessive drainage of cerebrospinal fluid (CSF), nausea and vertigo, and delayed wound union were observed in 80% of the remaining 15 patients, and these symptoms are totally relieved in the telephone and outpatient follow-up after 6 months.Conclusion: Our case series shows that MVD produced immediate pain relief in the majority of NIN patients. MVD carries surgical risk, especially in patients who experience direct visualization of the NI after mechanical stretch and blunt dissection in surgical procedures. Attempts to avoid mechanical stretch and blunt dissection of the compressed nerve were important for intraoperative neuroprotection, especially facial nerve protection

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Aetiology and management options for secondary referred otalgia: a systematic review and meta-analyses

Ally

Moinie

Lomas

et al. 2022

Eur Arch Otorhinolaryngol

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Microvascular Decompression of the VII/VIII Cranial Nerve Complex for the Treatment of Intermediate Nerve Neuralgia: A Retrospective Case Series

Abstract: This study suggests MVD as a valid treatment for medically refractory INN. MVD carries surgical risk, but given the severity of complaints of these patients, we believe the treatment benefits outweigh the associated complications.

Cited by 11 publications

References 22 publications

Nervus intermedius and the surgical management of geniculate neuralgia

Nervus intermedius and the surgical management of geniculate neuralgia

Case Report: Direct Visualization of the Nervus Intermedius During the Microvascular Decompression Procedure: Should We Take It Seriously?

Aetiology and management options for secondary referred otalgia: a systematic review and meta-analyses

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