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This is a retrospective review of a new surgical treatment of intractable periorbital neuropathic pain. Five patients with post-herpetic (three), post-traumatic (one) and idiopathic (one) neuralgia underwent transection of the nerves supplying the dermatomes affected by the neuropathic pain. The transection was combined with procedures to reduce the risk of neuroma formation and recurrent pain. These included coaptation to adjacent nerves, grafting with a processed nerve allograft, or implantation into orbital fat. Prior to surgery the patients had experienced neuropathic pain for a median of 10 years, with a median preoperative McGill pain score of 8.4 (inter-quartile range 8.2-10). Postoperatively with a median follow-up of nine months, the median pain score was 0 (IRQ of 0-4.8, p<0.001). Three patients reported complete resolution, and two had significant improvement. Two were off all analgesic medication, the other three on reduced regimens. Peripheral neurectomy has been previously described but is associated with a high recurrence rate of neuropathic pain. Combining peripheral neurectomy with repair for trigeminal neuralgia has not been reported previously. It has less complications than neurosurgical or stereotactic radiosurgical interventions, and this preliminary pilot study suggests that recurrent pain may be less frequent or severe with these additional steps than with simple neurectomy alone.

Peripheral neurectomy with customized nerve reconstruction for periorbital neuropathic pain: initial experience and clinical outcomes.
Kim JS, Tian J, Gross A, et al.
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James Hsuan

Aintree University Hospital, Liverpool, UK.

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