Multiple Compression Syndromes of the Same Upper Extremity: Prevalence, Risk Factors, and Treatment Outcomes of Concomitant Treatment.

PURPOSE: Multiple nerve compression syndromes can co-occur. Little is known about this coexistence, especially about risk factors and surgical outcomes. Therefore, this study aimed to describe the prevalence of multiple nerve compression syndromes in the same arm in a surgical cohort and determine risk factors. Additionally, the surgical outcomes of concomitant treatment were studied. METHODS: The prevalence of surgically treated multiple nerve compression syndromes within one year was assessed using a review of patients' electronic records. Patient characteristics, comorbidities, and baseline scores of the Boston Carpal Tunnel Questionnaire were considered as risk factors. To determine the treatment outcomes of simultaneous treatment, patients who underwent concomitant carpal tunnel release (CTR) and cubital tunnel release (CubTR) were selected. The treatment outcomes were Boston Carpal Tunnel Questionnaire scores at intake and at 3 and 6 months after the surgery, satisfaction 6 months after the surgery, and return to work within the first year. RESULTS: A total of 7,867 patients underwent at least one nerve decompression between 2011 and 2021. Of these patients, 2.9% underwent multiple decompressions for the same upper extremity within one year. The risk factors for this were severe symptoms, younger age, and smoking. Furthermore, the treatment outcomes of concomitant CTR and CubTR did not differ from those of CubTR alone. The median time to return to work after concomitant treatment was 6 weeks. Patients who underwent CTR or CubTR alone returned to work after 4 weeks. CONCLUSIONS: Approximately 3% of the patients who underwent surgical treatment for nerve compression syndrome underwent decompression for another nerve within 1 year. Patients who report severe symptoms at intake, are younger, or smoke are at a greater risk. Patients with carpal and cubital tunnel syndrome may benefit from simultaneous decompression. The time to return to work may be less than if they underwent decompressions in separate procedures, whereas their surgical outcomes are comparable with those of CubTR alone. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Internal Neurolysis (Nerve Combing) for Trigeminal Neuralgia without Neurovascular Compression

Objective The aim of the present study was to describe and evaluate the initial and the long-term clinical outcome of internal neurolysis (IN) for trigeminal neuralgia (TN) without neurovascular compression (NVC). Methods A total of 170 patients diagnosed with TN were treated by posterior fossa exploration, during the period between April 2012 and October 2019. The patients were divided into two groups: Group A (50 patients)was treated by IN and Group B (120 patients) received microvascular decompression (MVD). Surgical outcomes and postoperative complications were compared between the two groups. Pain intensity was assessed by the Barrow Neurological Institute (BNI) pain intensity score and BNI facial numbness score. Pain recurrence was statistically evaluated with Kaplan-Meier analysis. Results Pain was completely relieved in 44 patients (88%) who underwent IN (group A); 3 (6%) experienced occasional pain but did not require medication (BNI 2). In group B, 113 (94%) experienced immediate pain relief after MVD. The median duration of follow-ups was 4 years (6 months to 7.5 years). In Group A, there was a meantime recurrence of 27 months in 3 patients (6%). The recurrence in Group B was of 5.8% during the follow-up period. There were no statistically significant differences in the surgical outcomes between the two groups. All patients with IN experienced some degree of numbness, 88% of the cases resolved in 6 months, on average. Conclusion Internal neurolysis is an effective, safe and durable treatment option for trigeminal neuralgia when NVC is absent.

The morphological stenosis pattern of the suprascapular notch is revealed yielding higher incidence in the discrete type and elucidating the inevitability of osteoplasty in horizontally oriented stenosis.

PURPOSE: To identify the morphological patterns of suprascapular notch stenosis. METHODS: Suprascapular notch space capacity was assessed by morphometric analysis of 333 dry scapulae. Suprascapular notch parameters-superior transverse distance, middle width, depth, medial border length and lateral border length-were measured. The probable suprascapular notch stenosis was referenced by (1) comparing each obtained parameter measurement to the range of the suprascapular nerve diameter, and (2) quantifying the reduced parameters. Finally, the morphological pattern was determined based on the collective reduction of the parameters and their alignments. RESULTS: Five types of suprascapular notch based on depth to superior transverse distance ratio were identified and assessed. Type-I showed low incidence of stenosis (6/333) and low frequency within type (6/28) with potential risk of horizontal compression. Type-II showed relatively low incidence of stenosis (9/333) and low frequency within type (9/50) with undetermined pattern. Type-III showed relatively higher incidence of stenosis (47/333) but low frequency within type (47/158) with potential risk of vertical compression. Type-IV (foramen) showed low incidence of stenosis (6/333) and relatively lower frequency within type (6/26) with potential risk of encircled compression. Finally, type-V (discrete) showed relatively high incidence of stenosis (40/333) and high frequency within type (40/71) with potential risk of vertical compression. The suprascapular notch was found to be stenosed beyond its capacity to accommodate the suprascapular nerve in 49/333. Type-V is at most risk followed by Type-III. CONCLUSIONS: Suprascapular notch stenosis takes three morphological patterns: horizontal, vertical or mixed. An osteoplasty of suprascapular notch margins may be required beside the common surgical approach of the superior transverse scapular ligamentectomy.

The Correlation of Meralgia Paresthetica and Spinal Surgery in Prone Position.

AIM: To investigate the incidence, risk factors, and recovery of patients with meralgia paresthetica (MP) following posterior spine surgery. MATERIAL AND METHODS: Patients who underwent posterior spine surgeries in prone position at the authors’ clinics were included in this study. Patients with preoperative MP were excluded. RESULTS: Among the 560 patients who underwent spine surgery in prone position, 117 (21%) had impaired sensation along the anterolateral aspect of the thigh. One hundred three of them were treated with conservative treatment, whereas 14 underwent surgery for MP. CONCLUSION: Conservative treatment is the first option for MP. Patients who do not recover with conservative treatment may undergo surgical treatment.

Incidence and operations of median, ulnar and radial entrapment neuropathies in Finland: a nationwide register study.

The aim of this study was to investigate the incidence rates and operations for carpal tunnel syndrome and ulnar and radial neuropathies in specialist care in Finland. Patients diagnosed with entrapment neuropathies of the upper extremity were identified from the Care Register for Health Care, 2007-2016. There were 81,911 cases in 54,095,070 person-years. The total crude incidence rates per 100,000 person-years among women and men were 197 and 105 for carpal tunnel syndrome, 26 and 36 for ulnar neuropathies, and 5.7 and 8.5 for radial neuropathies, respectively. Of these, carpal tunnel syndrome was operated on in 63% of women and 61% of men, ulnar neuropathy in 43% of women and 47% of men, and radial neuropathy in 11% of women and 8% of men. Incidence of carpal tunnel syndrome and ulnar neuropathies increased up to late middle age, while radial neuropathies were less common. Level of evidence: III.

Neurosurgical treatment of leprosy neuropathy in a low-incidence, European country.

INTRODUCTION: Leprosy is nowaday increasingly encountered in non-endemic countries. Nerve involvement is common. Swelling of the nerves may lead to entrapment neuropathy causing pain and neurological deficits. Delay in diagnosis and treatment may lead to loss of chance of improvement. Surgical decompression in conjunction with medical therapy allows relief of symptoms. METHODS: We present a retrospective series of 21 patients surgically treated in our center for leprosy entrapment neuropathy. We report presentation, treatment, and outcome at follow-up including a brief literature review. RESULTS: Twenty-one patients were treated for nerve entrapments in four different anatomical districts. We reported good clinical outcomes mainly in motor deficits but also in improvement of sensitive deficits and pain symptoms. We did not experience surgical complications. DISCUSSION: Although there is a lack of high-quality prospective studies comparing medical and surgical treatment of leprosy neuropathy, benefits of surgery are widely reported in series and case reports from endemic countries. There is scant literature from low-incidence countries even if leprosy incidence is nowaday increasing in these countries and will likelihood further increase in the future. Our results are in line with the literature presenting good outcomes after surgery. CONCLUSION: We believe that a precise knowledge of the pathology and its management is crucial also for physicians who work in low-incidence countries to maximize healing chances with timely diagnosis and treatment.

Trigeminal Nerve Compression Without Trigeminal Neuralgia: Intraoperative vs Imaging Evidence.

BACKGROUND: While high-resolution imaging is increasingly used in guiding decisions about surgical interventions for the treatment of trigeminal neuralgia, direct assessment of the extent of vascular contact of the trigeminal nerve is still considered the gold standard for the determination of whether nerve decompression is warranted. OBJECTIVE: To compare intraoperative and magnetic resonance imaging (MRI) findings of the prevalence and severity of vascular compression of the trigeminal nerve in patients without classical trigeminal neuralgia. METHODS: We prospectively recruited 27 patients without facial pain who were undergoing microvascular decompression for hemifacial spasm and had undergone high-resolution preoperative MRI. Neurovascular contact/compression (NVC/C) by artery or vein was assessed both intraoperatively and by MRI, and was stratified into 3 types: simple contact, compression (indentation of the surface of the nerve), and deformity (deviation or distortion of the nerve). RESULTS: Intraoperative evidence of NVC/C was detected in 23 patients. MRI evidence of NVC/C was detected in 18 patients, all of whom had intraoperative evidence of NVC/C. Thus, there were 5, or 28% more patients in whom NVC/C was detected intraoperatively than with MRI (Kappa = 0.52); contact was observed in 4 of these patients and compression in 1 patient. In patients where NVC/C was observed by both methods, there was agreement regarding the severity of contact/compression in 83% (15/18) of patients (Kappa = 0.47). No patients exhibited deformity of the nerve by imaging or intraoperatively. CONCLUSION: There was moderate agreement between imaging and operative findings with respect to both the presence and severity of NVC/C.

[Epidemiological and Etiological Characteristics of Myelopathies in the Neurology Department of the University Hospital Center of Cocody, Abidjan (Ivory Coast)]. / Caractéristiques épidémiocliniques et étiologiques des myélopathies dans le service de neurologie du CHU de Cocody d'Abidjan (Côte-d'Ivoire).

The term myelopathy defines a suffering of the spinal cord whatever the etiologies. They often represent real therapeutic emergencies and are burdened by serious functional sequelae. The aim of this work was to describe the epidemiological, clinical, and etiological aspects of all myelopathies. We have conducted a prospective and descriptive study from January 1, 2015 to December 31, 2016 at the Neurology department of the Cocody University Hospital in Abidjan. Seventy-one patients out of 1,006 were included, that is, a prevalence of 7.06%. The sex ratio was 1.7. The average age was 49 years old. HIV was associated with myelopathy in 24.7% of cases. Medullary compression syndrome was predominant. Pott's disease was the etiology of compressive myelopathies (43.9%) followed by bone metastases (26.8%). Tuberculous myelitis was the most common etiology of non-compressive myelopathies (30%). Myelites of undetermined causes account for 50% of non-compressive myelopathies.

Le terme de myélopathie définit une souffrance de la moelle épinière quelles que soient les étiologies. Les myélopathies réalisent souvent de véritables urgences thérapeutiques et sont grevées de lourdes séquelles fonctionnelles. L'objectif de ce travail était de décrire les aspects épidémiologiques, cliniques et étiologiques de toutes les myélopathies identifiées lors d'une étude prospective et descriptive qui s'est déroulée du 1er janvier 2015 au 31 décembre 2016 dans le service de neurologie du CHU de Cocody d'Abidjan. Soixante et onze patients sur 1 006 ont été inclus, soit une prévalence de 7,06 %. Le sex-ratio (H/F) était égal à 1,7. L'âge moyen était de 49 ans. Le VIH était associé à la myélopathie dans 24,7 % (17 patients) des cas. Le syndrome de compression médullaire était majoritaire. Le mal de Pott était l'étiologie la plus fréquante des myélopathies compressives (43,9 %), suivi des métastases osseuses (26,8 %). La myélite tuberculeuse était l'étiologie la plus fréquente des myélopathies non compressives (30 %). Les myélites de cause indéterminée représentaient 50 % des cas des myélopathies non compressives.

Visual complaints in intracranial germinomas.

OBJECTIVE: Patients with brain tumors often report having visual complaints. This may be due to increased intracranial pressure, compression/invasion of the optic pathway or diplopia. We assessed the incidence and the etiology of visual symptoms in patients with intracranial germinoma tumors (ICGTs). METHODS AND MATERIALS: We performed a blinded retrospective review of the clinical charts and the initial magnetic resonance imaging (MRI) of 28 patients with ICGT. Thirteen tumors were pineal, five suprasellar, seven bifocal, and further three involved either the optic nerve, the corpus callosum, or the brainstem. RESULTS: Twelve patients reported visual disturbances, seven of whom mainly experienced a decrease in vision. Two of those were initially managed as "retrobulbar neuritis" when endocrinologic symptoms prompted assessment by MRI. Involvement of the optic pathway was underestimated, and both relapsed. Field deficits were definitive sequelae, whereas visual acuity was sometimes regressive in the absence of optic atrophy. CONCLUSIONS: Compression or invasion of the optic pathway by germinomas is not a rare occurrence, and this possibility should not be overlooked when thickening or contrast enhancement is detected. Radiotherapy fields should be extended accordingly.

Load Carriage-Related Paresthesias (Part 2): Meralgia Paresthetica.

This is the second of a two-part series addressing symptoms, evaluation, and treatment of load carriage- related paresthesias. Part 1 addressed rucksack palsy and digitalgia paresthetica; here, meralgia paresthetica (MP) is discussed. MP is a mononeuropathy involving the lateral femoral cutaneous nerve (LFCN). MP has been reported in load carriage situations where the LFCN was compressed by rucksack hipbelts, pistol belts, parachute harnesses, and body armor. In the US military, the rate of MP is 6.2 cases/10,000 personyears. Military Servicewomen have higher rates than Servicemen, and rates increase with age, longer loadcarriage distance or duration, and higher body mass index. Patients typically present with pain, itching, and paresthesia on the anterolateral aspect of the thigh. There are no motor impairments or muscle weakness, because the LFCN is entirely sensory. Symptoms may be present on standing and/or walking, and may be relieved by adopting other postures. Clinical tests to evaluate MP include the pelvic compression test, the femoral nerve neurodynamic test, and nerve blocks using lidocaine or procaine. In cases where these clinical tests do not confirm the diagnosis, specialized tests might be considered, including somatosensory evoked potentials, sensory nerve conduction studies, high-resolution ultrasound, and magnetic resonance imaging. Treatment should initially be conservative. Options include identifying and removing the compression if it is external, nonsteroidal inflammatory medication, manual therapy, and/or topical treatment with capsaicin cream. Treatments for intractable cases include injection of corticosteroids or local anesthetics, pulsed radiofrequency, electroacupuncture, and surgery. Military medical care providers may see cases of MP, especially if they are involved with units that perform regular operations involving load carriage.

[Peripheral Nerve Injuries in Sports]. / Sportverletzungen peripherer Nerven.

Peripheral nerve injuries due to sports are relatively rare but the exact incidence is not known due to a lack of epidemiological studies. Particular sports activities tend to cause certain peripheral nerve injuries including direct acute compression or stretching, repetitive compression and stretching over time, or another mechanism such as ischemia or laceration. These nerve lesions may be severe and delay or preclude the athlete's return to sports, especially in cases with delayed diagnosis. Repetitive and vigorous use or overuse makes the athlete vulnerable to disorders of the peripheral nerves, and sports equipment may cause compression of the nerves. Depending on etiology, the treatment is primarily conservative and includes physiotherapy, modification of movements and sports equipment, shoe inserts, splinting, antiphlogistic drugs, sometimes local administration of glucocorticoids or, lately, the use of extracorporeal shock waves. Most often, cessation of the offending physical activity is necessary. Surgery is only indicated in the rare cases of direct traumatic nerve injury or when symptoms are refractory to conservative therapy. Prognosis mainly depends on the etiology and the available options of modifying measures.This article is based on the publications "Reuter I, Mehnert S. Engpasssyndrome peripherer Nerven bei Sportlern". Akt Neurol 2012;39:292-308 and Sportverl Sportschad 2013;27:130-146.

[Complex regional pain syndrome in nerve root compression and after spinal surgery]. / Komplexes regionales Schmerzsyndrom bei Nervenwurzelkompression und nach Wirbelsäulenoperation.

Complex regional pain syndrome (CRPS) is an extremely painful and partially disabling disease. It often occurs secondary to trauma, but also spontaneously. The emergence of CRPS has been reported following nerve root compression and/or spinal surgery, but its incidence is unknown. In this article, the present knowledge about the incidence of CRPS in the context of nerve root compression and spine surgery is reviewed and therapeutic and diagnostic consequences are discussed.

Prevalence of Anterior Cutaneous Nerve Entrapment Syndrome in a Pediatric Population With Chronic Abdominal Pain.

OBJECTIVE: Anterior cutaneous nerve entrapment syndrome (ACNES) is a frequently overlooked condition causing chronic abdominal pain (CAP). The objective of the present study was to investigate the rate of ACNES in a pediatric outpatient cohort with CAP. METHODS: A cross-sectional cohort study was conducted in a population 10 to 18 years of age consulting a pediatric outpatient department with new-onset CAP during a 2 years' time period. All individuals were identified through a standard hospital registration system. History, physical examination, diagnosis, and success of treatment were obtained in patients who were diagnosed as having ACNES. RESULTS: Twelve of 95 adolescents with CAP were found to be experiencing ACNES. Carnett sign was positive at the lateral border of the rectus abdominus muscle in all 12. Altered skin sensation was present in 11 of 12 patients with ACNES. Six weeks after treatment (1-3 injections, n = 5; neurectomy, n = 7), pain was absent in 11 patients. CONCLUSIONS: ACNES is present in 1 of 8 adolescents presenting with CAP to a pediatric outpatient department of a teaching hospital. Simple physical examinational testing allows for the diagnosis. Treatments including nerve blocks or surgery are beneficial in most.

Focal and entrapment neuropathies.

Of the many patterns of peripheral nerve disorders in diabetes mellitus (DM), isolated clinical involvement of single nerves, though less common than distal symmetric polyneuropathy and perhaps polyradiculoneuropathy, constitute an important collection of characteristic syndromes. These fall into four anatomical regions of the body: cranial, upper limb, truncal, and lower limb territories. Each of these groups of mononeuropathies has its own ensemble of epidemiologic patterns, clinical presentations, laboratory and radiologic findings, differential diagnosis, management principles and prognosis.

Nerve compression syndromes of the hand and forearm associated with tumours of non-neural origin and tumour-like lesions.

Nerve compression syndromes caused by non-neural tumours or tumour-like lesions are rare. We retrospectively reviewed 541 consecutive patients operated on by the same surgeon to study nerve compression syndromes in the forearm and hand. There were 414 due to nerve compression and 127 caused by tumours. Twenty-two patients showed compression neuropathy associated with 17 tumours and six tumour-like lesions, with 13 different pathological types. The most common types were fatty and vascular tumours. Twenty-one tumours were extraneural and one was intraneural. The median nerve was affected in nine cases, the ulnar nerve or the dorsal sensory branch of the ulnar nerve in five cases, the posterior interosseous nerve or the superficial radial branch in four cases and the common digital nerves in two cases. There was a concomitant involvement of the median and ulnar nerves in two other patients. Clinically, there were eight different compression neuropathies, of which the most frequent was the carpal tunnel syndrome. The postoperative histology was consistent with preoperative magnetic resonance imaging findings in the vascular and fatty tumours. Pain disappeared completely in 15 out of 16 patients with preoperative pain. All patients had preoperative paraesthesia, which persisted after tumour excision in three patients: attenuated in two patients and unchanged in one. In three patients, we did not observe any change in paresis or amyotrophy. The mean postoperative follow-up was 31 months, without tumour recurrence. The quick Disabilities of the Arm, Shoulder and Hand (DASH) score went from 49.9 points preoperatively to 10.2 points after surgery.

Entrapment syndrome of multiple nerves in graft-versus-host disease.

INTRODUCTION: Peripheral nerve entrapment syndromes are associated with hereditary neuropathy with liability to pressure palsies and a variety of rheumatic and endocrinological diseases. METHODS: We report a patient with entrapment syndromes of multiple nerves associated with chronic graft-versus-host-disease (GVHD) after allogeneic hematopoietic stem cell transplantation. Nerve ultrasound, histology, and ultrastructural changes were assessed. RESULTS: The 51-year-old man had developed severe deep dermal sclerosis due to chronic GVHD with a progressive polyneuropathy and entrapment syndromes of multiple nerves. Pre-stenotic enlargement was shown by nerve ultrasound. Histology demonstrated fibrosis of the epineurium with scarce infiltration of macrophages. Electron microscopy demonstrated alterations of the myelin sheaths and marked depletion of normal-sized myelinated nerve fibers. CONCLUSIONS: In addition to polyneuropathy, chronic GVHD can be associated with peripheral nerve entrapment syndromes and should be added to the differential diagnosis of compressive neuropathies.

Chronic abdominal wall pain misdiagnosed as functional abdominal pain.

INTRODUCTION: The abdominal wall is often neglected as a cause of chronic abdominal pain. The aim of this study was to identify chronic abdominal wall pain syndromes, such as anterior cutaneous nerve entrapment syndrome (ACNES), in a patient population diagnosed with functional abdominal pain, including irritable bowel syndrome, using a validated 18-item questionnaire as an identification tool. METHODS: In this cross-sectional analysis, 4 Dutch primary care practices employing physicians who were unaware of the existence of ACNES were selected. A total of 535 patients ≥18 years old who were registered with a functional abdominal pain diagnosis were approached when they were symptomatic to complete the questionnaire (maximum 18 points). Responders who scored at least the 10-point cutoff value (sensitivity, 0.94; specificity, 0.92) underwent a diagnostic evaluation to establish their final diagnosis. The main outcome was the presence and prevalence of ACNES in a group of symptomatic patients diagnosed with functional abdominal pain. RESULTS: Of 535 patients, 304 (57%) responded; 167 subjects (31%) recently reporting symptoms completed the questionnaire. Of 23 patients who scored above the 10-point cutoff value, 18 were available for a diagnostic evaluation. In half of these subjects (n = 9) functional abdominal pain (including IBS) was confirmed. However, the other 9 patients were suffering from abdominal wall pain syndrome, 6 of whom were diagnosed with ACNES (3.6% prevalence rate of symptomatic subjects; 95% confidence interval, 1.7-7.6), whereas the remaining 3 harbored a painful lipoma, an abdominal herniation, and a painful scar. CONCLUSION: A clinically relevant portion of patients previously diagnosed with functional abdominal pain syndrome in a primary care environment suffers from an abdominal wall pain syndrome such as ACNES.

[Nerve entrapment syndromes in athletes]. / Engpasssyndrome peripherer Nerven bei Sportlern.

Sports-related injuries most commonly involve the musculoskeletal system. However, physicians are less familiar with damage to the peripheral nerves attributable to particular sports activities. Nerve entrapment syndromes associated with physical activity may affect all nerves for which entrapment syndromes are known. Peripheral nerve lesions are serious and may delay or preclude the athletes' return to sports, especially in cases with a delayed diagnosis. The aim of the paper is to give an overview of chronic sports-related nerve lesions. Acute nerve injuries are not the focus of this review. A literature search regarding sports-related nerve lesions was conducted. Due to the lack of prospective epidemiological studies, case reports were included (evidence level 4). Nerve entrapment syndromes specific for particular sports activities are described including clinical presentation, diagnostic work-up and treatment. Repetitive and vigorous use or overuse makes the athlete vulnerable to disorders of the peripheral nerves, additionally sports equipment may cause compression of the nerves. The treatment is primarily conservative and includes modification of movements and sports equipment, shoe inserts, splinting, antiphlogistic drugs and local administration of glucocorticoids. Most often cessation of the offending physical activity is necessary. When symptoms are refractory to conservative therapy a referral to surgery is indicated. The outcome of surgical treatment regarding the return of the athlete to competitive sports is not sufficiently investigated in many nerve entrapment -syndromes. This article was primarily published in "Akt Neurol 2012; 6: 292-308".

Recognition and management of nerve entrapment pain after uterosacral ligament suspension.

OBJECTIVE: To estimate the incidence, risk factors, and characteristics of neuropathic pain related to nerve entrapment after uterosacral ligament suspension. METHOD: A review of patients who underwent uterosacral ligament suspension from January 2007 to August 2011 was performed. Patients with neuropathic pain attributable to nerve entrapment from uterosacral ligament suspensory suture placement were identified. Factors including surgeon's dominant hand, side of pain, onset of pain, day of suture removal, number of sutures placed and removed, patient age, and body mass index (BMI) were collected. Follow-up of patients with neuropathic pain was performed at postoperative visits and by telephone contact. RESULT: Eight (1.6%) of 515 patients had neuropathic pain requiring suture removal from the affected side. The postoperative pain was recognized after discontinuation of intravenous narcotics on postoperative day 1. Patients reported their pain improved after removal of all sutures on the affected side. Patients with neuropathic pain did not differ from those without in regard to age, BMI, and preoperative prolapse stage, or in the number of sutures placed. None of the eight had recurrent pelvic organ prolapse (POP), with a median follow-up of 5 months. CONCLUSION: Eight patients (1.6%) had postoperative neuropathic pain that resolved after all sutures were removed on the affected side. The removal of sutures was not associated with recurrent POP in the short-term. LEVEL OF EVIDENCE: II.

Trigeminal neuralgia in young adults.

OBJECT: Trigeminal neuralgia (TN) is a form of facial pain that can be debilitating if left untreated. It typically affects elderly adults and is thought to be related to neurovascular compression. It is uncommon in people younger than 30 years of age, with only 1% of cases reportedly occurring in those younger than 20 years of age. The most common cause of compression in young adults is thought to be venous nerve compression either alone or in association with arterial nerve compression. The objective of this study was to review data in cases of TN in which patients were 25 years of age or younger and to identify TN disease characteristics, demographics, clinical features, operative findings, and outcome. METHODS: The authors retrospectively reviewed the clinical records, surgical treatment, and long-term outcome in patients 25 years of age or younger with TN who underwent surgery performed by the senior author (K.J.B.) at Oregon Health & Science University between 1995 and 2008. RESULTS: Seven patients (2 males and 5 females) met the inclusion criteria. The average age at symptom onset was 19.6 ± 3.4 years (± SD) and the average age at surgery was 22.9 ± 1.7 years. Six patients had right-sided symptoms and 1 had left-sided symptoms. Pain distribution was the V2 in 3 cases, V2-3 in 3 cases, and V3 in 1 case, with no cases of V1 affliction. A total of 11 procedures were performed in 7 patients, and 4 patients underwent a second procedure. Surgery and imaging revealed venous compression in all cases. The average follow-up period was 35.5 ± 39.9 months (median 12 months). Three patients reported a good outcome (no pain with or without medications) and 4 reported a poor outcome (either no pain relief or mild pain relief after surgery). CONCLUSIONS: Trigeminal neuralgia is uncommon in young adults. Patients tend to present with symptoms similar to those in adults: long periods of pain and venous compression, but outcome unfortunately is not as good as that reported in the older population.