Thoroughness in Surgical Technique

Tree of nerves
Thoroughness in surgical technique can make the difference in a successful nerve decompression operation. (Why the tree photo? Read on….) Earlier this week we saw a woman with over 20 years of headache pain from occipital neuralgia who had been operated on previously by another surgeon. She reports that her surgery was unsuccessful. The surgeon who had done her surgery is well known and well accomplished and a good surgeon, but this patient was looking for more help. A nerve block further down her neck at this visit turned her pain level from a 7 out of 10 to a 2 out of 10… why?
Nerves are very much like trees, starting as a common trunk and “arborizing” or branching into several smaller and smaller branches before each little twig reaches its target. Sometimes when a nerve is decompressed further out in the branches, other branches may be present that are not addressed and thus the result of the operation is incomplete. In this patient’s case it is very likely that 2 of the three nerves that were addressed in her original operation had further branches which remained inflamed and constricted. In this case a nerve block further down the trunk toward the base of the nerves disabled the entire nerve and all of the branches further out, alleviating her pain. This indicates that a more thorough decompression or a disruption of these nerves toward their base is likely to provide this patient with more significant improvement.
This can happen to any good surgeon and certainly is one of the risks of nerve decompression headache surgery is incomplete resolution of symptoms. That said, the manner in which I was trained to do nerve decompression emphasizes addressing the nerve at the common trunk, rather than at the branches where there is more risk of an incomplete result. (Using a photo of this tree in the African savanna to represent a problematic nerve does not do justice to the beauty of nature, and for that I apologize.)

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