Several neurosurgical options exist to treat neuropathic pain:
- Neurotomy (surgical cutting of a nerve): This method is not a method of choice because it favours the development of neuromas. If immediate pain relief is indeed achieved, the subsequent development of a neuroma may cause pain which is even stronger that before. In addition, nerve sectioning will cause a loss of sensation in the corresponding innervated regions and may even lead to loss of function.
- Neurolysis and decompression of the affected nerve (surgical treatment to relieve the pressure on a particular nerve in the case of adhesions): This method is particularly effective when pain is caused by an adhesion or a compression.
- Neuromodulation (weak current electrical stimulation): Neuromodulation is the method of choice to treat a severely damaged nerve. The fact that electrical stimulation can relieve pain without affecting sensory and motor functions has been known since antiquity. The electric fish from the Red Sea used in ancient times have since been replaced by electrodes placed in direct contact with the nerve and connected transcutaneously to an external stimulator in a first test phase. This method is painless and may even be perceived as pleasant. If pain can be eliminated by this external stimulator during a test phase (which may last several days), an additional, brief surgical intervention may be carried out to connect the electrodes to a stimulator implanted directly under the skin, which will then stimulate the target nerve. The intensity of stimulation can be adjusted by the patient using a remote control device. This method can help relieve neuropathic pain for many years without any side effects. Unsurprisingly, neuromodulation has been extensively used in the treatment of pain. However, it is only recently that an appropriate neurosurgical technique has been developed for the implantation of electrodes on pelvic nerves. Professor Possover, a pioneer in this area, has devoted recent years to developing and applying the LION procedure. This procedure relies on laparoscopy to implant electrodes directly on the affected nerves of the pelvis.
Laparoscopy is the only method that allows neurosurgery to be performed and electrodes to be implanted on all pelvic nerves. As such, it is a revolutionary approach in the treatment of pain lesions in the small pelvis.