neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2024-26-1-83-91neurosurgery-1499Research ArticleНАБЛЮДЕНИЕ ИЗ ПРАКТИКИFROM PRACTICEХирургическое лечение невралгии промежуточного нерва с использованием интраоперационного нейрофизиологического мониторингаSurgical treatment of intermediate nerve neuralgia using intraoperative neurophysiological monitoringhttps://orcid.org/0000-0002-0460-7016ДементьевскийВ. С.DementievskiyV. S.

107031 Москва,  ул. Петровка, 25, стр. 2

Bld. 2, 25 Petrovka St., Moscow 107031

https://orcid.org/0000-0002-6253-9883ЛехновЕ. А.LekhnovE. A.

Евгений Анатольевич Лехнов 

630087 Новосибирск, ул. Немировича-Данченко, 132

Evgeniy Anatolyevich Lekchnov 

132 / 1 Nemirovicha-Danchenko St.,  Novosibirsk 630087

lekchnov@gmail.comБалдинаС. С.BaldinaS. S.

630087 Новосибирск,  ул. Немировича-Данченко, 130

130 Nemirovicha-Danchenko St., Novosibirsk 630087

ЛитвинчукГ. Н.LitvinchukG. N.

630087 Новосибирск, ул. Немировича-Данченко, 132

132 / 1 Nemirovicha-Danchenko St.,  Novosibirsk 630087

https://orcid.org/0000-0002-1209-8960РзаевД. А.RzaevD.  A.

630087 Новосибирск, ул. Немировича-Данченко, 132

132 / 1 Nemirovicha-Danchenko St.,  Novosibirsk 630087

ФГБНУ «Федеральный научно-клинический центр реаниматологии и реабилитологии»РоссияFederal Scientific and Clinical Center of Intensive Care and RehabilitationRussian FederationФГБУ «Федеральный центр нейрохирургии» Минздрава РоссииРоссияFederal Neurosurgical Center (Novosibirsk), Ministry of Health of RussiaRussian FederationГБУЗ НСО «Государственная Новосибирская областная клиническая больница»РоссияNovosibirsk State Regional Clinical HospitalRussian Federation20240404202426183‑91Copyright © Дементьевский В.С., Лехнов Е.А., Балдина С.С., Литвинчук Г.Н., Рзаев Д.А., 20242024Дементьевский В.С., Лехнов Е.А., Балдина С.С., Литвинчук Г.Н., Рзаев Д.А.Dementievskiy V.S., Lekhnov E.A., Baldina S.S., Litvinchuk G.N., Rzaev D.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1499

Невралгия промежуточного нерва (НПН) – редкая патология, диагностика которой сложна, а общепринятый хирургический протокол лечения на сегодняшний день отсутствует. В связи с этим выбор оптимальной хирургической стратегии нередко представляет собой сложную задачу.

Цель работы – определить оптимальный хирургический подход для лечения пациентов с НПН с использованием интраоперационного нейрофизиологического мониторинга (ИОНМ).

Представлен случай пациентки, у которой диагностирована НПН. Интраоперационно была выполнена диссекция вестибулокохлеарного комплекса с пересечением промежуточного нерва под контролем ИОНМ. В раннем послеоперационном периоде у больной отмечался регресс болей в ухе, однако определялись вкусовые расстройства в передних отделах левой половины языка. В отдаленном послеоперационном периоде диагностированы отсроченный парез лицевого нерва и признаки раневой ликвореи, которые после проведения консервативной терапии и повторного хирургического вмешательства полностью регрессировали. Период катамнестического наблюдения составил >12 мес, достигнут стойкий регресс отоалгии.

Пересечение промежуточного нерва является эффективной и распространенной методикой для лечения пациентов с НПН. Использование ИОНМ позволяет улучшить хирургические результаты и снизить вероятность развития различных осложнений.

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.

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The authors declare that there are no conflicts of interest present.