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Neurectomy

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Title: Neurectomy  
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Subject: Neurolytic block, Neurosurgery, Ventriculostomy, Hypophysectomy, Axotomy
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Neurectomy

A neurectomy is a type of nerve block involving the severing or removal of a nerve. This surgery is performed in rare cases of severe chronic pain where no other treatments have been successful, and for other conditions such as involuntary twitching and excessive blushing or sweating.[1]

A brief "rehearsal" local anesthetic nerve block is usually performed before the actual neurectomy, to determine efficacy and detect side effects. The patient is typically under general anesthetic during the neurectomy, which is performed by a neurosurgeon.[1]

Contents

  • Procedures 1
    • Presacral neurectomy 1.1
    • Vestibular neurectomy 1.2
  • Use in Horses 2
  • References 3
  • External links 4

Procedures

Presacral neurectomy

A presacral neurectomy is typically conducted to decrease severe pain and

  • Surgical treatment of Ménière's disease.
  • Candiani, Giovanni Battista; Fedele, Luigi; Vercellini, Paolo; Bianchi, Stefano; Nola, Giuliana Di (1992). "Presacral neurectomy for the treatment of pelvic pain associated with endometriosis: A controlled study". American Journal of Obstetrics and Gynecology 167 (1): 100–3.  
  • Castro-Lopes, Josém.; Tavares, Isaura; Coimbra, Antonio (1993). "GABA decreases in the spinal cord dorsal horn after peripheral neurectomy". Brain Research 620 (2): 287–91.  
  • Tjaden, B; Schlaff, W. D.; Kimball, A; Rock, J. A. (1990). "The efficacy of presacral neurectomy for the relief of midline dysmenorrhea". Obstetrics and gynecology 76 (1): 89–91.  
  • Perez, J. J. (1990). "Laparoscopic presacral neurectomy. Results of the first 25 cases". The Journal of reproductive medicine 35 (6): 625–30.  
  • Halmagyi, G. M.; Curthoys, I. S.; Cremer, P. D.; Henderson, C. J.; Todd, M. J.; Staples, M. J.; d'Cruz, D. M. (1990). "The human horizontal vestibulo-ocular reflex in response to high-acceleration stimulation before and after unilateral vestibular neurectomy". Experimental Brain Research 81 (3): 479–90.  

External links

  1. ^ a b McMahon, M. (November 6, 2012). Wallace, O., ed. "What is a Neurectomy?". wise GEEK. 
  2. ^ a b c "Presacral Neurectomy". 
  3. ^ The Robotic Surgery Center. (n.d.). Robotic Presacral Neurectomy. (N. L. Center, Producer) Retrieved from The Robotic Surgery Center: http://robotic-surgery.med.nyu.edu/for-patients/our-departments/gynecology/procedures/presacral-neurectomy
  4. ^ Vestibular Neurectomy at eMedicine
  5. ^ a b c d "Vestibular Neurectomy (Balance Nerve section)". Dallas Ear Institute. 

References

Neurectomy is also used in equine medicine, primarily for cases of persistent lameness that is non-responsive to other forms of treatment. It is most commonly used for animals suffering from navicular syndrome and suspensory ligament desmitis.

Use in Horses

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.[5]

The general procedure begins by positioning the patient supine with the head turned to the side with surgical ear upright. An incision is made at the lower portion of the zygomatic root to the area of the temporal region for roughly seven centimeters. Precautions are taken by clamping flaps of tissue as to not impede further actions. To expose the IAC (Inner Auditory Canal) properly, portions of bone from the metal fundus and also the tegmen tympani must be removed.[5] The SVN (superior vestibular nerve) is then identified and cut at the point furthest from the vestibular crest. Along with the SVN, Scarpa's ganglion is also cut and removed.[5]

A vestibular neurectomy is an operation that severs the balance nerve, yet saving the hearing nerve from the ear to the brain. The procedure relieves vertigo and preserves the ability to hear.[4] It is important to note that this procedure will not reverse the effects of deafness. The risks include: hearing loss, tinnitus, dizziness, facial weakness, spinal fluid leak, and various infections.[5] The method of neurological surgery is the middle cranial fossa approach. The advantage of this procedure is that the vestibular nerve is clearly visible and can be sectioned without harming the cochlear nerve fibers.

Vestibular neurectomy

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.[3]

The incision is typically directly under the navel. Normally three small holes are made in the lower abdomen to allow for the instruments and other various surgical tools. Nerve tissue that runs to the uterus is interrupted at the sacral promontory; a point at which spine and tailbones meet. This is the best area to access and obtain a clear view of the nerves in the uterus. Proper precautions must be taken as to avoid unnecessary complications with the major blood vessels surrounding the uterus. Some of the complications post-operation include urinary retention, as well as constipation. Neither has been reported to cause lasting effects.[2]

[2].laparoscopically should consider this procedure. Techniques have been developed for this procedure to be performed NSAIDs Pain located on either side of the lower abdomen (but not mid line) should not be treated with a neurectomy. Only individuals with pain that is not relieved by the use of [2]

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