Neurectomy for nerve entrapment

From: Helen Dynda (olddad66@runestone.net)
Sun Aug 27 11:55:31 2000


Click: The Neurology and Neurosurgery Forum ...if you want to go directly to the Neurology and Neurosurgery Forum.

Subject: neurectomy for nerve entrapment Forum: The Neurology and Neurosurgery Forum Topic Area: Pain neurectomy for nerve entrapment posted by Maggie on December 10, 1998 at 00:15:59:

-------------------------------------------------------------------------------- -------------------------------------------------------------------------I have had extensive pelvic nerve damage as a result of an extensive = -------------------------------------------------------------------------laparotomy to remove ovarian remnant tissue. The worst of this damage has resulted in severe lateral hip and buttock pain. This was initially diagnosed and treated as trochanter bursitis. It was treated as trochanter bursitis for almost a year. Finally, this diagnosis was found to be incorrect, and the correct diagnosis of nerve damage was made.

The lateral cutaneous branch of the iliohypogastric nerve has been diagnostically blocked and has successfully relieved the pain. Two attempts have been made to resect this branch of the nerve. Neither attempt has been successful. The diagnostic blocks have worked but the surgery has not. Do you have any explanation for this?

Also, I understand there is testing called MR neurography available that will successfully diagnose nerve damage. Is it available at Cleveland Clinic and who would I contact regarding this? Do you have an expert on pelvic nerve damage?

The ilioinguinal nerve was also success - fully resected after three attempts with diagnostic blocks that worked.

The failure of this surgery to resect the lateral cutaneous branch of the iliohypogastric nerve remains a mystery. Any information you can give would be helpful. Thank you.

Subject: Re: neurectomy for nerve entrapment Forum: The Neurology and Neurosurgery Forum Topic Area: Pain Posted by CCF Neurology MD:NT on December 16, 1998 at 21:20:50: In Reply to: neurectomy for nerve entrapment posted by Maggie on December 10, 1998 at 00:15:59:

Dear Maggie: The iliohypogastric nerve is not a pelvic nerve. It arises from the lumbar plexus and courses in the abdominal wall above the iliac crest ( bony ridge along the upper edge of the pelvic bone, or ilium ) to supply a small area of skin over the lower abdomen. A lateral cutaneous branch supplies a small patch of skin over the upper hip and upper buttock. While the anterior end may be injured in laparotomy incisions, the lateral cutaneous branch is not involved in such a procedure.

The diagnosis, a iliohypogastric neuropathy, remains clinical. EMG has little, if any value. MR neurography remains an investigational procedure for the study of large nerve trunks ( such as the sciatic nerve ), and is of no value in the diagnosis of a entrapment of minor nerves such as the iliohypogastric nerve. A successful nerve block is often used as a "diagnostic test" for iliohypogastric neuropathy and related problems.

I do not have an explanation for the dissociation between the efficacies of iliohypogastric blocks and neurectomy. It is possible that your pain is indeed a "local pain" such as from bursitis, and that the block reduced the local pain.

Pains such as yours frequently improve or disappear with time.


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