Novel Utilization of the Regenerative Peripheral Nerve Interface Technique after Unsuccessful Nerve Release for Bilateral Frontal Migraines

Abstract

Summary: Regenerative peripheral nerve interface (RPNI) is a surgical technique whose indications include preventing or treating painful neuromas after amputation or peripheral nerve injuries. The procedure involves implanting the distal end of a transected peripheral nerve containing sensory fibers into a selected free muscle graft. Although RPNI procedures have primarily been used after limb amputations, select case reports detail the potential for RPNI to mitigate other sources of neuropathic pain, introducing novel uses to its clinical utility. We present the case of a 49-year-old woman who presented to our clinic in June 2021 with chronic frontal migraines with right retro-orbital pain. Bilateral supraorbital and supratrochlear nerve releases with fat grafting were performed in August 2018 via a blepharoplasty approach; however, this procedure was unsuccessful in reducing her neuropathic pain. After discussion with the patient, we elected to proceed with transection of bilateral supraorbital and supratrochlear nerves with RPNI. The postoperative course was uneventful. Follow-up visits up to 1-year postoperative revealed that she had adequate pain control, discontinued her migraine medications, and reported satisfaction with the procedure. The novel RPNI surgical technique may be a low-risk adjunctive option in the surgical management of refractory supraorbital and supratrochlear neuralgia. Future studies should include a prospective randomized controlled trial comparing supraorbital and supratrochlear neurectomy alone to neurectomy with RPNI in refractory supraorbital and supratrochlear neuralgia management. Further exploration of RPNI may reveal additional uses and modifications, which may revolutionize the treatment of neuralgia and other similar ailments.