Witters Leonie, Lukes Anton, Menovsky Tomas
Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium; and.
Department of Neurosurgery, Lindenhofspital, Bern, Switzerland.
J Neurosurg Case Lessons. 2021 May 10;1(19):CASE2155. doi: 10.3171/CASE2155.
Intermediate nerve neuralgia is a rare type of cranial neuralgia that causes clinical, therapeutic, and diagnostic challenges. Studies have described pharmacological and surgical treatment options. Surgical treatment ranges from sectioning of neural structures to microvascular decompression. Given the rareness of the disease, there are no clear recommendations concerning treatment.
Reported is the case of a patient with typical intermediate nerve neuralgia. In this particular case, decision-making toward surgical decompression in an earlier stage of the disease could have been beneficial. The authors found excellent results using only microvascular decompression without sectioning of neural structures.
Knowledge of intermediate nerve anatomy is essential to understand this complex pain syndrome. This case illustrates that surgery should not only be regarded as a last resort in case of failure of conservative treatment but also should be considered early in the disease course, especially in the case of a clear neurovascular conflict. When no evident cause is found, surgery could be considered as an exploratory option to depict a neurovascular conflict intraoperatively. Microvascular decompression of the intermediate nerve without sectioning of neural structures can obtain excellent results. Since neural structures are saved, postoperative sequelae can be limited.
中间神经痛是一种罕见的颅神经痛类型，会带来临床、治疗及诊断方面的挑战。已有研究描述了药物和手术治疗方案。手术治疗范围从神经结构切断到微血管减压术。鉴于该疾病的罕见性，目前尚无关于治疗的明确建议。
报告了一例典型中间神经痛患者的病例。在这个特殊病例中，在疾病早期决定进行手术减压可能会有益。作者发现仅采用微血管减压术而不切断神经结构就能取得极佳效果。
了解中间神经解剖结构对于理解这种复杂的疼痛综合征至关重要。该病例表明，手术不应仅被视为保守治疗失败后的最后手段，还应在疾病进程早期就予以考虑，尤其是在存在明确神经血管冲突的情况下。当未发现明显病因时，手术可被视为一种术中描绘神经血管冲突的探索性选择。不切断神经结构的中间神经微血管减压术可取得极佳效果。由于保留了神经结构，术后后遗症可得到限制。
