As neurectomias periféricas no tratamento das neuralgias do trigêmeo

As neurectomias periféricas no tratamento das neuralgias do trigêmeo

José Zaclis

Assistente de Neurologia na Fac. Med. da Univ. de São Paulo (Prof. A. Tolosa)

SUMMARY

The purpose of this report is to divulge peripheral neurectomy as a method for treatment of trigeminal neuralgia. This essay is based on 34 personal cases which have been operated upon, following a no scar producing method, during the period comprised between October, 1947 and December, 1950. Twenty patients of the series were submitted to neurectomy of the infra-orbital branches of one maxillary nerve; eight have undergone ipsilateral neurectomy of both infra-orbital and mentonian branches; in three cases the mentonian branches of one side were ressected the frontal branches were ressected in two cases and, in one case of bilateral neuralgia, ressection of the infra-orbital branches in both sides was performed.

Five patients had to be reoperated upon after a painless period superior to one year, on account of return of pain. The follow-up period of 23 out of the 34 operated patients is superior to one year; in this group are included 10 cases with a follow-up period of over two years and 4 with more than three years. Except for six patients with whom no contact could be maintained (and whose present condition we ignore), the remaining were feeling no pain at the time of the last test. During the follow-up period all the patients experienced or are still having paresthesias. In no instance, however, such abnormal sensations were so annoying as to require any therapeutic care.

The loss of sensation resulting from the nerve section has a tendency to disappear after a varying period of time, the cause of which (contrary to many authors), is the regeneration of the divided nerves themselves. The return of anesthesia following a second operation (at the time when sensibility was almost normalized) is, we think, the best proof that progressive return of sensibility on the hitherto anesthetic area has nothing to do with the surrounding nerves.

Facial palsy or any other serious complication were never observed; one patient had transient paralysis of the extrinsic movements of the eye on the same side that ressection of the infra-orbital branches was performed; three had suppuration and in one instance occurred a scorch due to hot compresses.

Though it is still early to conclude about the actual value of peripheral neurectomy of the fifth cranial nerve as if it can or can not be considered as a method for lasting relief of neuralgic pain, our observations lead us to a few partial conclusions which can be summarized as follows:

1 - Neurectomy of the extracranial divisions of the fifth cranial nerve brings off anesthesia on the corresponding territory of the face. This loss of sensibility has a tendency to disappear after a varying period of time.

2 - The return of sensibility in the anesthetic area is performed by regeneration of the divided nerves themselves.

3 - By regeneration of the sectioned nerves, recurrence of pain may occur.

4 - Alcohol injected in the proximal stump of a divided nerve does delay its regeneration.

5 - If pain returns, the patients can undergo a second operation either following the same method or any type of operation for trigeminal neuralgia.

We feel that it is too early for a real evaluation of peripheral neurectomy as a lasting procedure for relief of trigeminal pain. Nevertheless, the simplicity of the operation, the possibility of a definite cure, and the fact that it will not interfere with re-operation or with a further greater procedure, lead us to suggest peripheral neurectomy as the first thing to be done in proper cases, i.e., those cases which bear the topographical requirements pointed out in a chapter of this paper.

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BIBLIOGRAFIA

Serviço de Neurologia da Fac. Med. da Univ. de São Vaulo

Tese de Doutoramento apresentada à Faculdade de Medicina da Universidade de São Paulo (Cadeira de Clínica Neurológica), em junho de 1951.

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Datas de Publicação

• Publicação nesta coleção
  06 Fev 2015
• Data do Fascículo
  Set 1951