Neurectomy for Treatment of Intercostal Neuralgia

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Presentation transcript:

Neurectomy for Treatment of Intercostal Neuralgia Eric H. Williams, MD, Christopher G. Williams, MD, Gedge D. Rosson, MD, Richard F. Heitmiller, MD, A. Lee Dellon, MD, PhD The Annals of Thoracic Surgery Volume 85, Issue 5, Pages 1766-1770 (May 2008) DOI: 10.1016/j.athoracsur.2007.11.058 Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Preoperative photo of patient 2 in the lateral decubitous position with markings of the locations of positive Tinel signs of the 8th, 9th, and 10th right intercostal nerves after a thoracoscopic lung biopsy. The asterisks (*) mark the most tender locations that cause radiating pain into the anterior chest wall. The Annals of Thoracic Surgery 2008 85, 1766-1770DOI: (10.1016/j.athoracsur.2007.11.058) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Intraoperative photos of patient 2. (A) Anterior ramus of lateral cutaneous sensory branch of the intercostal nerve (nerve loop marked with **) and posterior ramus (nerve loop marked with *) lateral cutaneous sensory branch of the intercostal nerve as it exits the chest wall. Patient is in the lateral decubious position. (B) Isolation of the anterior and posterior rami of the lateral cutaneous branches of the 8th, 9th, and 10th intercostal nerves. The posterior rami are marked with the nerve loops and numbered. (C) The black arrow marks the lateral cutaneous branch of the intercostal nerve proximal to its division into the anterior and posterior rami as it is dissected through the chest wall. The epineurium of the freshly cut end of the intercostal nerve is held in the Crile clamp ready for intramuscular implantation. Nerves are injected with bupivicaine before division. (D) Intramuscular implantation of the lateral cutaneous branch of the intercostal nerve into the latissimus dorsi muscle. The anterior border of the latissimus dorsi muscle is marked with the two black arrows. The Crile clamp holds the implanted end of the nerve into the muscle. The Annals of Thoracic Surgery 2008 85, 1766-1770DOI: (10.1016/j.athoracsur.2007.11.058) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Left subcostal neuroma (12th intercostal nerve) after nephrectomy stuck in the incision, resulting in chronic, debilitating flank pain. The exposure was carried out through the original nephrectomy scar. In this case, the actual neuroma can be seen tethered to the scar. The neuroma was resected in this case, and the proximal nerve implanted into the latissimus. One could accomplish the same denervation by resecting the subcostal nerve more proximally as well. The Annals of Thoracic Surgery 2008 85, 1766-1770DOI: (10.1016/j.athoracsur.2007.11.058) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions