Root Ganglionectomy for treatment of postherpetic intercostal pain, technical aspects and literature review.

Abstract

Introduction. The dorsal root ganglionectomy has been described in articles more than a hundred years ago with favorable results, but shelved by the perioperative complications. We will discuss the use of this procedure by its high effectiveness neuritic pain resistant to conventional treatments, low cost and simplicity taking into account adequate anatomical repair.
Material and methods. Literature search was done on root ganglionectomia. We analyze the different operative techniques presented. They were reproduced on cadaveric models. We reviewed technical things decreasing bone removal and incorporating the Microsurgical technique. It is applied on four consecutive cases of postherpetic intercostal neuralgia, which held them follow-up of 24 months. Finally it was made an analysis and a description of the main recommendations.
Results. We were surprised that this technique is little mentioned individually, to complement rizotomy and neurectomias, in all cases radically improving outcomes in the long term. Major reported complications were associated to bone resection and pleurodural lesions. They were amended with microsurgery techniques without zigoapofisectomia. The microanatomy study of the region facilitated the individualization of the arterial branches and rest of nervous branchs that we want to preserve. On the cases of post-herpetic intercostal neuralgia, he gave us a solution from EVA 8/10 to painless anesthesia sustained, without drugs. There were no complications or discomfort in the anesthetized dermatomes.
Conclusion. It’s an interesting tool for the treatment of neuritic and nociceptive pain of the thoracic region.Applying the resection of 6 mm in diameter on the zigoapofisaria union dismiss the dangers of regional instability, as well as the Microsurgical resection dismiss risks of vascular, pleural or dural lesions. We think that it is by studying even more indications and results of this technique.