Novel Utilization of the Regenerative Peripheral Nerve Interface Technique after Unsuccessful Nerve Release for Bilateral Frontal Migraines.

Several human studies show positive signals, while research methods and sample sizes continue to develop.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Regenerative peripheral nerve interface (RPNI) is a surgical technique whose indications include preventing or treating painful neuromas after amputation or peripheral nerve injuries. The procedure involves implanting the distal end of a transected peripheral nerve containing sensory fibers into a selected free muscle graft. Although RPNI procedures have primarily been used after limb amputations, select case reports detail the potential for RPNI to mitigate other sources of neuropathic pain, introducing novel uses to its clinical utility. We present the case of a 49-year-old woman who presented to our clinic in June 2021 with chronic frontal migraines with right retro-orbital pain. Bilateral supraorbital and supratrochlear nerve releases with fat grafting were performed in August 2018 via a blepharoplasty approach; however, this procedure was unsuccessful in reducing her neuropathic pain. After discussion with the patient, we elected to proceed with transection of bilateral supraorbital and supratrochlear nerves with RPNI. The postoperative course was uneventful. Follow-up visits up to 1-year postoperative revealed that she had adequate pain control, discontinued her migraine medications, and reported satisfaction with the procedure. The novel RPNI surgical technique may be a low-risk adjunctive option in the surgical management of refractory supraorbital and supratrochlear ne

Evidence level

Several human studies show positive signals, while research methods and sample sizes continue to develop.

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