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. Neurectomies have also been used to permanently block autonomic function (e. g. excessive sweating in hands or involuntary muscle movement causing cramps), and special sensory function not related to pain (e. g. vestibular nerve dysfunction causing vertigo). A temporary nerve block with an anesthetic if usually performed before surgery to confirm the diagnosis of neuropathic pain. 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 NSAIDs should consider this procedure. Techniques have been developed for this procedure to be performed laparoscopically.

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 vertigo, but may preserve the ability to hear. 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. There are several different surgical approaches that can be used to complete this procedure: the middle cranial fossa, retrolabrynthine, retrosigmoid, and translabrynthine. The middle cranial fossa approach is one that most often requires neurosurgical expertise. The advantage of this procedure is that the vestibular nerve is clearly visible and can be sectioned without harming the cochlear nerve fibers. 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

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. 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, superficial radial neuropathy from handcuffs, and meralgia paresthetica from tight pants. 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. 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.

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. 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. The success outcome is typically measured as a 50% or more decrease in visual analog scale (VAS) scores, which are numerical pain scores from 0 10 or 0 100. Success rates are often reported as 70%. Studies reporting on intercoastal neurectomy often report cure rates (100% reduction in symptoms), even though it's not the primary success outcome. For example, patients may say they are cured or report pain scores of zero. There is a wide span of the reported cure rates, ranging from 22 67%. A double blind, randomized, controlled surgery trial found a 22% cure rate for the surgery group and a 4% cure rate for the sham surgery group, suggesting that these cure rates cannot be purely attributable to the natural history of the disease or a placebo effect. 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. 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%.

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 with navicular syndrome and suspensory ligament desmitis.