Neurectomy

A neurectomy, or nerve resection is a neurosurgical procedure in which a peripheral nerve is cut or removed to alleviate neuropathic pain or permanently disable some function of a nerve. The nerve is not intended to grow back. For chronic pain it may be an alternative to a failed nerve decompression when the target nerve has no motor function and numbness is acceptable.^[1] Neurectomies have also been used to permanently block autonomic function (e.g. excessive sweating in hands^[2] or involuntary muscle movement causing cramps^[3]), and special sensory function not related to pain (e.g. vestibular nerve dysfunction causing vertigo^[4]).

A temporary nerve block with an anesthetic if usually performed before surgery to confirm the diagnosis of neuropathic pain.^[1] Risks include numbness, neuroma, and complications due to lack of innervation.

Procedures

Presacral neurectomy

A presacral neurectomy is typically conducted to decrease severe pain and

Recent technological advances have allowed this same procedure to be done robotically, a minimally invasive technique similar to laparoscopy. The outcome of the procedure is identical to an open approach (laparotomy), but the incisions are much smaller allowing for less post-operation pain. Less pain following this surgery allows for a quicker recovery period too; two weeks as opposed to six weeks, on average.[6]

Vestibular neurectomy

A vestibular neurectomy is an operation that severs the vestibular nerve, which contributes to balance, while sparing the cochlear nerve, which contributes to hearing. The procedure has the potential to relieve

In cases of Ménière's disease, a neurectomy may be needed when no other medical treatment is sufficient for over six months. In bilateral Ménière's disease, the procedure is done on the worse-off ear. Some procedures are done on both ears, but the risk of hearing loss then becomes significantly greater.^[8]

Pulsed radiofrequency ablation neurectomy

Some ablations that have been previously performed laparoscopically are also now offered via the pulsed radiofrequency technique. Pulsed radiofrequency ablation relies on delivering an electrical field specifically to neural tissue in order to damage it while minimizing injury to the surrounding area. For example, this technique has been used in patients with chronic shoulder pain as a way to perform a neurectomy of the suprascapular nerve with less risk of damage to nearby muscles within the rotator cuff.^[10] There is still a lack of evidence directly comparing the efficacy and safety of this technique compared to the traditional laparoscopic method, but there is evidence that it improves range of motion and pain compared to placebo^[10] or sham surgery.^[11]

Neurectomy for nerve entrapment

Neurectomy can be an alternative to a nerve decompression for nerve entrapment, such as when the nerves have no motor function and numbness along the dermatome is acceptable. A neurectomy is not a mutually exclusive option to a decompression as a neurectomy can also be used after a failed decompression.^[12]

There are many nerves in the human body that are purely sensory such as the cutaneous nerves, which provide innervation to all parts of the skin. The cutaneous nerves are especially susceptible to compression from wearables or injuries due to their superficial location. Some examples of wearable-induced irritation are supraorbital neuralgia from tight goggles,^[13] superficial radial neuropathy from handcuffs,^[14] and meralgia paresthetica from tight pants.^[15] As cutaneous nerves cover all areas of the skin, and any surgery which requires incisions may inadvertently cause injury or scarring, now entrapping a cutaneous nerve.^[16]

A common tradeoff when electing to a neurectomy is that numbness along the nerve distribution is expected. Studies that have measured how bothersome numbness is to patients have found that most patients are not bothered at all by the numbness, and the ones that are find the numbness minimally bothering.^[17][18]

Intercoastal cutaneous nerve neurectomy

Intercoastal neuralgia is a neuropathic condition that involves the intercoastal nerves. The primary symptom is pain and it may be localized to the distribution of one or more of the intercoastal nerves, manifesting as chest and abdominal pain.^[19] No treatment modality prior to neurectomy (e.g. systemic medications, cryoablation, therapeutic nerve blocks, and radioablation) has given effective pain relief and none have been curative.^[20]

The success outcome is typically measured as a 50% or more decrease in

Lateral femoral cutaneous neuralgia, often known as Meralgia Paresthetica, involves neuropathic pain on the outer thigh. The use of a nerve decompression or neurectomy to treat nerve pain along the lateral femoral cutaneous nerve is a firmly established surgical treatment. ^[25][26] However, the more effective treatment between a decompression and neurectomy is still being researched.

Between a nerve decompression and a neurectomy, the neurectomy is associated with a higher success rate which has been validated by two Cochrane reviews. The reviews found decompressions beneficial in 88% of cases and neurectomy beneficial in 94% of cases.^[27][28] A German national cohort study found similar results where complete pain relief from decompression was seen in 63% of cases but complete pain relief from neurectomy was seen in 85%.^[29]

Use in horses

Neurectomy is also used in equine medicine, primarily for cases of persistent

• nerve block
• nerve compression syndrome
• nerve decompression

References