A presacral neurectomy is typically conducted to decrease severe pain and menstrual cramps in the lower abdomen.
However, this often does not relieve endometriosis pain because the disease is left behind on other organs such as the bladder, bowels, or pelvic side walls, and it can thrive on its own hormone supply.
Nerve tissue that runs to the uterus is interrupted at the sacral promontory; a point at which spine and sacrum meet.
[5] Recent technological advances have allowed this same procedure to be done robotically, a minimally invasive technique similar to laparoscopy.
The outcome of the procedure is identical to an open approach (laparotomy), but the incisions are much smaller allowing for less post-operation pain.
The risks include: hearing loss, tinnitus, dizziness, facial weakness, spinal fluid leak, and various infections.
[8] There are several different surgical approaches that can be used to complete this procedure: the middle cranial fossa, retrolabrynthine, retrosigmoid, and translabrynthine.
[7] The general procedure begins by positioning the patient supine with the head turned to the side with surgical ear upright.
An incision is made at the lower portion of the zygomatic root to the area of the temporal region for roughly seven centimeters.
To expose the IAC (Inner Auditory Canal) properly, portions of bone from the metal fundus and also the tegmen tympani must be removed.
Pulsed radiofrequency ablation relies on delivering an electrical field specifically to neural tissue in order to damage it while minimizing injury to the surrounding area.
For example, this technique has been used in patients with chronic shoulder pain as a way to perform a neurectomy of the suprascapular nerve with less risk of damage to nearby muscles within the rotator cuff.
[18] No treatment modality prior to neurectomy (e.g. systemic medications, cryoablation, therapeutic nerve blocks, and radioablation) has given effective pain relief and none have been curative.
[21] Lateral femoral cutaneous neuralgia, often known as Meralgia Paresthetica, involves neuropathic pain on the outer thigh.