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Neurotomy as a radical way to interrupt nerve conduction
Surgical neurotomy is an effective way of treating focal neurological pathologies of various nature and eliminating their symptoms, which is actively used in modern medicine.
The term neurotomy( from the Greek neuron nerve and tome section) denotes the suppression of the fibers of the nerve trunk. This procedure is considered a strong radical method, the use of which is necessary to remove the nervous effect, accompanied by pain syndromes, the emergence of spastic paralysis of various areas of the body, hyperkinesis or other signs.
This method of surgical intervention is used in those cases when another type of treatment does not give results.
History of the
Formation Schlichting( 1748) originally proposed neurotomy as a procedure for the elimination of trigeminal neuralgia. Later, Quenu introduced the use of this method to disable focal pain in gangrene.
In 1932, Ralf Fitch( Ralf Fitch) for the disposal of convulsive paralysis made a proposal for the use of chemical neurotomy - i.e.the i
Over the past decade, indications for the application of this procedure have been significantly extended. This is due to the fact that many diseases that were not previously associated with the presence of neurological problems were recognized as such.
Objectives of the operation
One of the main reasons for the application of the operation for the suppression of nerves is the presence of spastic paralysis. Its main symptom is the increase in muscle tone, which leads to the degradation of muscle fibers.
Muscle spasms bring severe pain to the patient, which significantly reduces the quality of the standard of living. The basis for influencing the development of this disease is acute disturbance of cerebral circulation, craniocerebral trauma and neuromuscular diseases.
In cerebral palsy, neurotomy is also recommended. Since, in the absence of proper treatment, muscle tone or hyperkinesis fetters the movement of a person according to increasing. The presence of osteochondrosis, spondyloatrosis, which does not respond to other, milder methods of treatment, is also an indication for the use of this intervention.
Indications for the operation are severe cases of diseases that are not amenable or difficult to treat conservatively, which limit the patient's ability to have severe pain or interfere with the care of the patient.
It is advisable to use this radical intervention method only in cases of non-treatable disorders in motor, secretory, sensory functions of the nervous system.
In this case, often, the procedure affects only those nerves, the motor function of which does not significantly affect human life. For example, on the lower parts of the shin, intercostal nerves, etc.
Which nerves are most often performed by the
intervention Neurotomy is performed in connection with various diseases. But most often the operation is carried out because of trigeminal neuralgia.
Procedures associated with the head area are based on cutting the affected branches in the peripheral areas, in particular, in a place that has an exit on the face. From intracranial access should be discarded, since this method is technically difficult to perform.
Effective are the dissection of the nerve on the neck, which in most cases is a simpler and safer way. Operations on the glossopharyngeal nerve also produce a good effect, in the sense of getting rid of pain and with inoperable cancers of the tongue and ulcers. In the latter case, they are marked in some cases by their healings.
From discomfortable spasms in the larynx, the cutting of the superior laryngeal nerve will be relieved. It is necessary to make an incision of 5-6 cm along the anterior margin of the sternum-clavicle-nipple muscle, starting from the part of the lower jaw and further downwards.
In non-healing ulcers on the legs, in particular the lower leg, the tibialis muscle and the extensor of the big toe are pushed apart, a nerve is found between them in the interosseous septum and further actions are taken to eliminate the spastic syndromes.
In severe cases of chest and hand disease, it is necessary to cut the affected nerves.
Procedure and technique
There are two main points in the operation: nudity and its cutting. Actions for the performance of neurotomy can be carried out with any kind of anesthesia.
The most effective is local infiltration anesthesia according to AV Vishnevsky, which makes it possible in every detail to understand the relationship of the vascular-neural bundle.
A solution of novocaine is injected into the nerve before its release. Further, after isolation, the necessary nerve is pulled to the edges of the wound with the help of special, wet, gauze holders, and a single movement of the acute scalpel is cut.
The section is recommended to be carried out whenever possible in a single step, since it is with such actions that it is most likely to obtain a smooth surface of the diameter of the nerve. The wound area is sewn layer by layer.
Complications include a pain symptom, which starts with the development of a neuroma, formed from soldering with scars. For this reason, under the necessary circumstances, a temporary disconnection of the nerve is made, and at the end of the operation a suture is applied.
Appropriate access to the nerve is an out-of-project access, since it protects the nerve from being squeezed by scars that may subsequently occur.
Thus, the main points of performing a neurotomy:
- specialist establishes that area of muscle groups that has a pathological tone;
- provides access to the peripheral nerve;
- nerve is divided into separate fascicles, electrophysiological and clinical nerve mapping is performed;
- reveals motoneurons that provoke spasticity, and their intersection is done.
Radiofrequency neurotomy is applicable for purposes identical to the usual technique of intervention. But unlike it, the main method for nerve destruction is ultrasound.
This operation is considered effective, as it provides long-term relief of pain. The operation is based on the introduction of electrodes. The patient can start the habitual way of life already the next day after the procedure.
Recovery stage and issue price
After the operation is completed, the patient is placed on the tire on the operated area. Microsurgical selective neurotomy is performed on an outpatient basis, but the patient can remain in the hospital until the next day.
Most often, recovery after surgery is rapid, so there is the opportunity to proceed to physiotherapy and other ways of rehabilitation in the near future.
The cost of the operation, including the preliminary consultation of a doctor and the payment of a bed, on average reaches 50,000 rubles.
Neurotomy has found application in the practice of specialists around the world. Clinical efficacy rates are close to 80% of cases when stable results are achieved, expressed as a decrease in muscle tone, removal of passive movement limitations and improvement of locomotor functions. As a result of the studies, there is a stable effect and a small percentage of complications.