Schweizerische Rundschau für Medizin Praxis = Revue suisse de médecine Praxis
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Schweiz. Rundsch. Med. Prax. · Oct 1989
Review[Palliative neurosurgical treatment of chronic pain following peripheral nerve lesions].
Pathogenesis of pain after traumatic or iatrogenic lesions to peripheral nerves as well as local and conservative therapeutic possibilities are briefly reviewed. If pain subsides or in the case of relapse with establishment of a chronic pain-state the therapy of choice consists in implanting a programmable neuro-stimulator with the electrodes placed near the dorsal sensory roots in the cervical epidural space for the upper extremities or along the posterior columns of the medulla in the thoracic epidural space for the legs. With a success rate for long term pain control of approximately 80% this reversible method which is well tolerated by the nervous system should always be considered for deafferentation-pain (neurogenic pain).
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The state of the art in restoration of severed peripheral nerves is outlined. Discussion of the prerequisites for an optimal nerve-repair such as intraneural anatomy of peripheral nerves (topography of nerves in cross-section), techniques for preparation of nerve stumps, lesions in continuity, precise rotational orientation, nerve-suture, interfascicular dissection and nerve-grafting, including harvesting of autologous nerve grafts and finally the postoperative management after restoration of peripheral nerves are discussed.