Peled Migraine Surgery Blog

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Decompression, neurolysis and ablation

Several people have had questions about what ‘neurolysis’ actually means and how it might differ from the term ‘ablation’.

Several people have had questions about what ‘neurolysis’ actually means and how it might differ from the term ‘ablation’. From a peripheral nerve surgeon’s perspective, neurolysis means removal of scar tissue (i.e. adhesions) immediately around or slightly more precisely, from within a nerve itself. The latter definition is even more precise, hence the very specific term, “internal neurolysis” which refers to removal of scar tissue from within and between nerve bundles within a nerve. Nerve decompression means removal of overlying connective tissue that may be placing pressure on the underlying nerve, but it does not necessitate any actual contact with or manipulation of the nerve itself. For example, in a carpal tunnel release, the median nerve is often decompressed by releasing the transverse carpal ligament, but during surgery the instruments often never have to touch the median nerve. However, if during that procedure the nerve is observed and felt to be hard (it should feel like a wet noodle), then there is probably scar tissue immediately around the nerve sheath or within the nerve itself and a neurolysis may need to be performed.

Ablation on the other hand is defined as separation, detachment, removal or destruction of a body part. This term can be used in many ways and one common way to ablate nerves is by use of radio frequency – hence the term “RFA” or radiofrequency ablation. People have asked me if there is a difference between surgical neurolysis and “radiofrequency neurolysis”, but I have actually never heard that latter term. I am uncertain how one could place a radiofrequency probe through the skin and muscle, near a nerve (guided only generally by ultrasound) and perform a neurolysis as this maneuver requires meticulous microneurosurgical technique even with high powered loupe or microscope magnification under direct vision in the OR. Hence, a RF probe in my opinion is much more likely to perform an ablation of the nerve (or other soft tissue) around which it is placed as opposed to a neurolysis.

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Monday, 21 May 2018

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