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Peripheral Neurectomy With Customized Nerve Reconstruction for Periorbital Neuropathic Pain: Initial Experience and
Jane S Kim1,2, James Tian1, Andrew Gross1
1Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, U.S.A.
Ophthalmic Plastic and Reconstructive Surgery
|May 23, 2022
Summary
A novel surgical technique involving peripheral neurectomy and nerve repair effectively treats severe periorbital neuropathic pain. This minimally invasive approach provided significant pain relief, with 60% of patients experiencing complete resolution.
Area of Science:
- Neurosurgery
- Pain Management
- Ophthalmology
Background:
- Severe, intractable periorbital neuropathic pain poses a significant challenge to treatment.
- Existing therapies, including pharmacotherapy and neurolysis, often fail to provide adequate relief for refractory cases.
Purpose of the Study:
- To describe a novel, minimally invasive surgical technique for treating severe, intractable periorbital neuropathic pain.
- To evaluate the efficacy and safety of peripheral neurectomy with customized nerve reconstruction for this condition.
Main Methods:
- Retrospective analysis of 5 patients with severe, treatment-refractory periorbital pain.
- Surgical technique involved transection of affected sensory trigeminal branches (supraorbital, supratrochlear, infratrochlear, infraorbital, zygomaticotemporal, zygomaticofacial nerves) with customized nerve reconstruction.
- Preoperative and postoperative pain scores (McGill Pain Score) were compared using the Wilcoxon signed-rank test.
Main Results:
- All 5 patients experienced improvement in periorbital pain post-surgery.
- 60% (3/5) achieved complete pain resolution, and 40% (2/5) had partial pain relief over a median follow-up of 9 months.
- Median McGill pain scores significantly decreased from 8.4 to 0.0 (p < 0.001).
- Patient satisfaction was high, with all willing to undergo the procedure again.
Conclusions:
- Peripheral neurectomy combined with customized sensory nerve reconstruction is a successful strategy for managing recalcitrant periorbital neuropathic pain.
- This technique offers a viable alternative for patients unresponsive to conventional treatments.
- The procedure demonstrated a favorable safety profile with manageable complications.
