Surgical treatment of intermediate nerve neuralgia using intraoperative neurophysiological monitoring

Abstract

Intermediate nerve neuralgia (INN) is a rare pathology with difficult diagnostics and currently there is no generally accepted surgical management protocol. In this regard, an optimal surgical strategy in this case is a difficult task. The aim was to determine an optimal approach for surgical management of patients with INN using intraoperative neurophysiological monitoring (IONM).The INN was diagnosed in a patient, a vestibulo‑cochlear complex dissection with intermediate nerve sectioning under IONM control of was performed intraoperatively. There was the earache regression, but there were gustatory disorders in the anterior portion on the left side of the tongue in the early postoperative period. In the late postoperative period, a delayed facial nerve paresis and signs of liquorrhea were diagnosed, which were completely regressed after reoperation and medication. The follow‑up period was more than 12 months; a stable regression of otoalgia was achieved. Intermediate nerve sectioning is an effective and common technique for the treatment of patients with INN. IONM improves surgical results and reduces a likelihood of different complications.