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Abstract：
Background: Nervus intermedius neuralgia (NIN), known as geniculate neuralgia (GN), is an uncommon cranial nerve disease caused by an offending vessel compressing the nervus intermedius (NI). Microvascular decompression (MVD) has now become a valued treatment approach for NIN because it can resolve neurovascular conflict (NVC) at the root entry zone of the NI. In the era of continuously optimizing and improving the surgical technique of MVD, further minimization of all possible postoperative complications is not only welcome but also necessary. Objective: The aim of this work is to assess the postoperative outcome of direct visualization of the NI during the MVD procedure. Methods: This study retrospectively reviewed the clinical records of a group of seven consecutive patients with NIN who underwent MVD in the period of 2013-2020 in our clinic and 16 studies reported NIN patients who underwent MVD in the period of 2007-2020. Results: In total, 91.3% of all patients experienced immediate and complete relief of cranial neuralgia after MVD. Six of 23 patients have experienced direct visualization of the NI intraoperatively, and 66.7% of those patients had complications such as facial paralysis, dysacousia, or a combination of these conditions postoperatively. Slight surgical approach-related complications such as complaints associated with excessive drainage of cerebrospinal fluid (CSF), nausea and vertigo, and delayed wound union were observed in 80% of the remaining 15 patients, and these symptoms are totally relieved in the telephone and outpatient follow-up after 6 months. Conclusion: Our case series shows that MVD produced immediate pain relief in the majority of NIN patients. MVD carries surgical risk, especially in patients who experience direct visualization of the NI after mechanical stretch and blunt dissection in surgical procedures. Attempts to avoid mechanical stretch and blunt dissection of the compressed nerve were important for intraoperative neuroprotection, especially facial nerve protection.
摘要：
背景：中间神经痛（NIN），称为膝状神经痛（GN），是一种罕见的颅神经疾病，由压迫中间神经（NI）的血管引起。微血管减压术（MVD）可以解决NI根入区神经血管冲突（NVC），现已成为NIN的一种有价值的治疗方法。在不断优化和提高MVD手术技术的时代,进一步减少所有可能的术后并发症不仅是受欢迎的，而且是必要的。目的：这项工作的目的是评估MVD过程中直接可视化NI的术后结果。方法：本研究回顾了我们诊所2013-2020年期间接受MVD的7例NIN患者的临床记录，16项研究报告了2007-2020年期间接受MVD的NIN患者。结果：总的来说，所有患者中有91.3％的患者在MVD后颅神经痛得到了立即和完全缓解。23例患者中有6例在术中经历了NI的直接可视化，其中66.7%的患者有面瘫等并发症，失语症,或这些情况的组合术后。与手术入路相关的轻微并发症，例如与脑脊液（CSF）过度引流相关的投诉，恶心和眩晕,其余15例患者中有80％观察到伤口延迟愈合，这些症状在6个月后的电话和门诊随访中完全缓解。结论：我们的病例系列显示，MVD在大多数NIN患者中立即缓解疼痛。MVD有手术风险，尤其是在手术中机械拉伸和钝器解剖后经历NI直接可视化的患者。尝试避免机械拉伸和钝性解剖受压神经对术中神经保护很重要。尤其是面神经保护.
