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- W4386392375 abstract "Trigeminal neuralgia is a facial pain syndrome most commonly caused by a neurovascular compression (NVC) of the trigeminal nerve. Microvascular decompression (MVD) is the most durable surgical treatment, however patients without a NVC are not candidates for this procedure. Alternative treatments such as percutaneous rhizotomy and radiosurgery are effective, but with higher recurrence rates. Internal neurolysis (IN) is a less frequently utilized procedure that aims to provide long-term relief to patients without NVC. We present the surgical techniques for internal neurolysis developed at our institution. We also discuss the technical nuances related to the nerve consistency and present a new classification based on these findings. Finally, we provide pain and numbness outcomes for our cohort of patients stratified by extent of neurolysis and nerve consistency. Patients with medically intractable trigeminal neuralgia eligible for posterior fossa exploration are consented for MVD and possible IN. If no NVC or a mild NVC is encountered, an IN is performed. We have divided the procedure into 4 main steps: opening the outer connective sheath, fascicular dissection, “inside-out” dissection and the “fascicular-irrigation” technique. Trigeminal nerve consistency has been classified in three main types. Type 1 are soft and friable. Type 2 are of intermediate consistency and ideal for neurolysis. Type 3 are firm and present a more challenging dissection. In the absence of microvascular compression, we advocate for a thorough neurolysis utilizing the techniques described in our article." @default.
- W4386392375 created "2023-09-03" @default.
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- W4386392375 date "2023-09-01" @default.
- W4386392375 modified "2023-10-02" @default.
- W4386392375 title "Internal Neurolysis for Trigeminal Neuralgia: Technical Nuances and a Single Institution Experience" @default.
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- W4386392375 doi "https://doi.org/10.1016/j.wneu.2023.08.126" @default.
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