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A neurectomy, or nerve resection is a neurosurgical procedure in which a peripheral nerve is cut or removed to alleviate neuropathic pain or permanently disable some function of a nerve. The nerve is not intended to grow back. For chronic pain it may be an alternative to a failed nerve decompression when the target nerve has no motor function and Hypoesthesia is acceptable. Neurectomies have also been used to permanently block autonomic function (e.g. Hyperhidrosis in hands or involuntary muscle movement causing Cramp), and special Sensory nerve not related to pain (e.g. vestibular nerve dysfunction causing vertigo).
A temporary nerve block with an anesthetic is usually performed before surgery to confirm the diagnosis of neuropathic pain. Risks include numbness, neuroma, and complications due to lack of innervation.
The incision is typically directly under the navel. Normally three small holes are made in the lower abdomen to allow for the instruments and other various surgical tools. Nerve tissue that runs to the uterus is interrupted at the sacral promontory; a point at which spine and sacrum meet. This is the best area to access and obtain a clear view of the nerves in the uterus. Proper precautions must be taken as to avoid unnecessary complications with the major blood vessels surrounding the uterus. Some of the complications post-operation include urinary retention, as well as constipation. Neither has been reported to cause lasting effects.
Recent technological advances have allowed this same procedure to be done robotically, a minimally invasive technique similar to laparoscopy. The outcome of the procedure is identical to an open approach (laparotomy), but the incisions are much smaller allowing for less post-operation pain. Less pain following this surgery allows for a quicker recovery period too; two weeks as opposed to six weeks, on average.
The general procedure begins by positioning the patient supine with the head turned to the side with surgical ear upright. An incision is made at the lower portion of the zygomatic root to the area of the Temporal bone region for roughly seven centimeters. Precautions are taken by clamping flaps of tissue as to not impede further actions. To expose the IAC (Inner Auditory Canal) properly, portions of bone from the metal fundus and also the tegmen tympani must be removed. The SVN (superior vestibular nerve) is then identified and cut at the point furthest from the vestibular crest. Along with the SVN, Scarpa's ganglion is also cut and removed.
In cases of Ménière's disease, a neurectomy may be needed when no other medical treatment is sufficient for over six months. In bilateral Ménière's disease, the procedure is done on the worse-off ear. Some procedures are done on both ears, but the risk of hearing loss then becomes significantly greater.
There are many nerves in the human body that are purely sensory such as the Cutaneous nerve, which provide innervation to all parts of the skin. The cutaneous nerves are especially susceptible to compression from wearables or injuries due to their superficial location. Some examples of wearable-induced irritation are supraorbital neuralgia from tight goggles, superficial radial neuropathy from handcuffs, and meralgia paresthetica from tight pants. As cutaneous nerves cover all areas of the skin, and any surgery which requires incisions may inadvertently cause injury or scarring, now entrapping a cutaneous nerve.
A common tradeoff when electing to a neurectomy is that numbness along the nerve distribution is expected. Studies that have measured how bothersome numbness is to patients have found that most patients are not bothered at all by the numbness, and the ones that are find the numbness minimally bothering.
The success outcome is typically measured as a 50% or more decrease in visual analog scale (VAS) scores, which are numerical pain scores from 0–10 or 0–100. Success rates are often reported as 70%. Studies reporting on intercostal neurectomy often report cure rates (100% reduction in symptoms), even though it is not the primary success outcome. For example, patients may say they are cured or report pain scores of zero. There is a wide span of the reported cure rates, ranging from 22–67%. A double-blind, randomized, controlled surgery trial found a 22% cure rate for the surgery group and a 4% cure rate for the sham surgery group, suggesting that these cure rates cannot be purely attributable to the natural history of the disease or a Placebo Effect.
Between a nerve decompression and a neurectomy, the neurectomy is associated with a higher success rate which has been validated by two Cochrane reviews. The reviews found decompressions beneficial in 88% of cases and neurectomy beneficial in 94% of cases. A German national cohort study found similar results where complete pain relief from decompression was seen in 63% of cases but complete pain relief from neurectomy was seen in 85%.
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