The Use of Nerve Caps after Nerve Transection in Headache Surgery: Cadaver and Case Reports.
Journal
Plastic and reconstructive surgery. Global open
ISSN: 2169-7574
Titre abrégé: Plast Reconstr Surg Glob Open
Pays: United States
ID NLM: 101622231
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
received:
15
02
2023
accepted:
11
07
2023
medline:
4
9
2023
pubmed:
4
9
2023
entrez:
4
9
2023
Statut:
epublish
Résumé
Nerve transection with nerve reconstruction is part of the treatment algorithm for patients with refractory pain after greater occipital nerve (GON) and lesser occipital nerve (LON) decompression or during primary decompression when severe nerve injury or neuroma formation is present. Importantly, the residual nerve stump is often best addressed via contemporary nerve reconstruction techniques to avoid recurrent pain. As a primary aim of this study, nerve capping is explored as a potential viable alternative that can be utilized in certain headache cases to mitigate pain. The technical feasibility of nerve capping after GON/LON transection was evaluated in cadaver dissections and intraoperatively. Patient-reported outcomes in the 3- to 4-month period were compiled from clinic visits. At 1-year follow-up, subjective outcomes and Migraine Headache Index scores were tabulated. Two patients underwent nerve capping as a treatment for headaches refractory to medical therapy and surgical decompressions with significant improvement to total resolution of pain without postoperative complications. These improvements on pain frequency, intensity, and duration remained stable at a 1-year time point (Migraine Headache Index score reductions of -180 to -205). Surgeons should be equipped to address the proximal nerve stump to prevent neuroma and neuropathic pain recurrence. Next to known contemporary nerve reconstruction techniques such as targeted muscle reinnervation/regenerative peripheral nerve interface and relocation nerve grafting, nerve capping is another viable method for surgeons to address the proximal nerve stump in settings of GON and LON pain. This option exhibits short operative time, requires only limited dissection, and yields significant clinical improvement in pain symptoms.
Sections du résumé
Background
UNASSIGNED
Nerve transection with nerve reconstruction is part of the treatment algorithm for patients with refractory pain after greater occipital nerve (GON) and lesser occipital nerve (LON) decompression or during primary decompression when severe nerve injury or neuroma formation is present. Importantly, the residual nerve stump is often best addressed via contemporary nerve reconstruction techniques to avoid recurrent pain. As a primary aim of this study, nerve capping is explored as a potential viable alternative that can be utilized in certain headache cases to mitigate pain.
Methods
UNASSIGNED
The technical feasibility of nerve capping after GON/LON transection was evaluated in cadaver dissections and intraoperatively. Patient-reported outcomes in the 3- to 4-month period were compiled from clinic visits. At 1-year follow-up, subjective outcomes and Migraine Headache Index scores were tabulated.
Results
UNASSIGNED
Two patients underwent nerve capping as a treatment for headaches refractory to medical therapy and surgical decompressions with significant improvement to total resolution of pain without postoperative complications. These improvements on pain frequency, intensity, and duration remained stable at a 1-year time point (Migraine Headache Index score reductions of -180 to -205).
Conclusions
UNASSIGNED
Surgeons should be equipped to address the proximal nerve stump to prevent neuroma and neuropathic pain recurrence. Next to known contemporary nerve reconstruction techniques such as targeted muscle reinnervation/regenerative peripheral nerve interface and relocation nerve grafting, nerve capping is another viable method for surgeons to address the proximal nerve stump in settings of GON and LON pain. This option exhibits short operative time, requires only limited dissection, and yields significant clinical improvement in pain symptoms.
Identifiants
pubmed: 37662472
doi: 10.1097/GOX.0000000000005234
pmc: PMC10473362
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e5234Informations de copyright
Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.
Déclaration de conflit d'intérêts
ILV is a consultant for Axogen Corporation, Checkpoint Surgical Inc., and Integra LifeSciences Corporation. All the other authors have no financial interest to declare in relation to the content of this article.
Références
Clin Neurol Neurosurg. 2021 Oct;209:106920
pubmed: 34500341
Ann Vasc Surg. 2022 Feb;79:421-426
pubmed: 34656720
J Clin Neurosci. 2003 May;10(3):338-9
pubmed: 12763341
Plast Reconstr Surg. 2019 Sep;144(3):421e-430e
pubmed: 31461024
Ann Surg. 2022 Feb 1;275(2):e315-e323
pubmed: 35007230
Plast Reconstr Surg. 2000 Aug;106(2):429-34; discussion 435-7
pubmed: 10946944
Adv Sci (Weinh). 2018 Mar 27;5(6):1700876
pubmed: 29938170
J Hand Microsurg. 2019 Oct;11(Suppl 1):S50-S52
pubmed: 31616128
Plast Reconstr Surg Glob Open. 2018 Oct 16;6(10):e1952
pubmed: 30534497
J Hand Surg Am. 2001 Jul;26(4):635-44
pubmed: 11466637
J Neurol Psychiatry. 1942 Jul;5(3-4):130-41
pubmed: 21611408
J Hand Surg Eur Vol. 2022 Feb;47(2):212-214
pubmed: 34107783
Adv Biomed Res. 2016 Jul 29;5:121
pubmed: 27563631
Ann Surg. 2019 Aug;270(2):238-246
pubmed: 30371518
J Am Acad Orthop Surg. 2000 Jul-Aug;8(4):243-52
pubmed: 10951113
J Neurocytol. 1991 Aug;20(8):682-701
pubmed: 1719140
J Hand Surg Am. 1976 Sep;1(2):144-51
pubmed: 1032972
Int Surg. 2014 Nov-Dec;99(6):807-11
pubmed: 25437591
Pain. 2009 Dec 15;147(1-3):122-7
pubmed: 19783099
Neurosurgery. 2018 Sep 1;83(3):354-364
pubmed: 29053875
Ann Plast Surg. 2014 Feb;72(2):184-7
pubmed: 24322636
Plast Reconstr Surg Glob Open. 2022 Mar 07;10(3):e4168
pubmed: 35265445
J Reconstr Microsurg. 2021 Jun;37(5):413-420
pubmed: 33058096
PLoS One. 2014 Apr 04;9(4):e93973
pubmed: 24705579
J Orthop Res. 2006 Jul;24(7):1427-37
pubmed: 16732614
Plast Reconstr Surg. 2002 Jun;109(7):2183-9
pubmed: 12045534
Tissue Eng Part A. 2020 May;26(9-10):503-511
pubmed: 31884890
Equine Vet J. 1988 Nov;20(6):451-6
pubmed: 2463915
J Neurosurg. 2019 Feb 08;132(3):856-864
pubmed: 30964248
Plast Reconstr Surg. 2021 Jun 1;147(6):1004e-1021e
pubmed: 34019515
Clin Orthop Relat Res. 2014 Oct;472(10):2984-90
pubmed: 24562875
Biomed Res Int. 2014;2014:547187
pubmed: 25006578
Prosthet Orthot Int. 1996 Dec;20(3):176-81
pubmed: 8985997
ANZ J Surg. 2018 May;88(5):491-496
pubmed: 29654613
Microsurgery. 2009;29(7):568-72
pubmed: 19693931
Am J Orthop (Belle Mead NJ). 2000 Mar;29(3):167-73
pubmed: 10746467
Plast Reconstr Surg. 2011 Jul;128(1):123-131
pubmed: 21701329
Ear Nose Throat J. 2021 Sep;100(5_suppl):830S-834S
pubmed: 32192381
J Am Coll Surg. 2019 Mar;228(3):217-226
pubmed: 30634038
J Korean Med Sci. 2016 Apr;31(4):479-88
pubmed: 27051229
Hand (N Y). 2021 Mar;16(2):157-163
pubmed: 31137979
Arch Surg (1920). 1946 Dec;53(6):646-51
pubmed: 20279413
Hand Clin. 2021 Aug;37(3):335-344
pubmed: 34253307
Plast Reconstr Surg. 1985 Sep;76(3):345-53
pubmed: 4034753
J Hand Surg Br. 1985 Feb;10(1):49-53
pubmed: 3998601
Hand Clin. 2013 Aug;29(3):317-30
pubmed: 23895713
Plast Reconstr Surg Glob Open. 2022 Mar 25;10(3):e4201
pubmed: 35350148