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Phototherapy in peripheral nerve regeneration: From basic science to clinical study

Shimon Rochkind

I njury of a peripheral nerve frequently results in considerable disability. In an extremity, such lesions may be associated with loss of sensory and motor functions, which leads to severe occupational and social consequences. Surgical repair is the preferred modality of treatment for the complete or severe peripheral nerve injury. 2 , 8 , 9 , 11 , 27–29 In most cases, the repair can be successful if the surgery is performed in the first 6 months after injury, in comparison with long-term cases in which surgical treatment is less successful. Nonetheless

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Computerized tomography of peripheral nerve lesions

Stephen K. Powers, David Norman, and Michael S. B. Edwards

T he use of computerized tomography (CT) in the identification of soft-tissue tumors is now well recognized. However, its specific application to the detection and delineation of peripheral nerve lesions has only recently been described. 3, 5 During the past 3 years, we have used high-resolution CT routinely in patients suspected of having, or known to have, a peripheral nerve tumor. Clinical Material and Methods We evaluated nine patients with peripheral nerve lesions. Six of these patients had a lesion involving the brachial plexus: three proved to be

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Intraoperative ultrasound-assisted peripheral nerve surgery

Clayton L. Haldeman, Christopher D. Baggott, and Amgad S. Hanna

H istorically , peripheral nerve surgery has relied on landmarks and fairly extensive dissection for localization of both normal and pathological anatomy. Surgeons can refine anatomical localization with electromyography and nerve conduction studies. More recently, MRI and ultrasound (US) have been used preoperatively as diagnostic adjuncts to limit the need for extensive dissections, particularly in cases of tumors and neuromas. 4 Here, we present 5 cases in which intraoperative US was particularly helpful in localization of the pathology. Ultrasound

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Peripheral nerve injury by chymopapain injection

Susan E. Mackinnon, Alan R. Hudson, Faustino Llamas, A. Lee Dellon, David G. Kline, and Dan A. Hunter

through a defect in the anulus fibrosis. Injected material may also track back along the needle path and run into the extradural space once the needle has been withdrawn. Thus, it is probably not uncommon for chymopapain to come into contact with peripheral nerve elements during the routine procedure of chemonucleolysis ( Fig. 1 ). Fig. 1. Diagram of needle tracks. Note the close relationship between the needle and the spinal nerve. The uppermost injection illustrates the injected enzyme running posteriorly and inferiorly in the epidural space, having exited

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Peripheral nerve stimulation for pain relief using a multicontact electrode system

Technical note

Blaine S. Nashold Jr., John B. Mullen, and Roger Avery

I n 1965, White and Sweet 1, 6 implanted a pair of Silastic split-ring platinum electrodes around the ulnar and median nerves in a woman with intractable burning pain in the left hand. Stimulation of the median nerve resulted in a pleasant tingling sensation in the first three fingers with relief of her pain. Since then, other reports have appeared of satisfactory long-term pain relief from peripheral nerve stimulation. 2, 3, 5 The cuff-type electrode has been used extensively and, although it does satisfactorily stimulate the nerve, Nielson, et al. , 4

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Peripheral nerve surgery and neurosurgeons: results of a national survey of practice patterns and attitudes

Allen Maniker and Marian Passannante

same questions can now be asked of neurosurgeons and their relationship with peripheral nerve surgery. A credible, although undocumented, opinion has been that fewer neurosurgeons are now performing surgery on the peripheral nervous system. If this indeed is the case, who is performing peripheral nerve surgery? Although peripheral nerve surgery is an obvious, logical extension of neurosurgical practice, orthopedic and plastic surgeons have also claimed it as part of their domains. What types of peripheral nerve procedures do neurosurgeons feel comfortable with and

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Convection-enhanced delivery in intact and lesioned peripheral nerve

John K. Ratliff and Edward H. Oldfield

R esearch on nerve regeneration has yielded greater understanding of responses to injury in the peripheral and central nervous systems. A number of excellent reviews summarize advances in neurotrophin physiology and peripheral nerve regeneration. 6, 9, 16, 17, 21, 30, 39–42, 44, 45 Numerous agents with possible therapeutic applications have been developed. Most of these agents are macromolecules, however, and effective translation of basic science insights into successful treatment methods has not occurred because results from human trials have shown that

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Delayed motor weakness following peripheral nerve schwannoma resection: illustrative cases

Rohin Singh and Robert J. Spinner

Similar to the goals of vestibular schwannoma (VS) resection, the aims of surgery in peripheral nerve schwannomas are to achieve complete tumor resection and preserve neurological function. 1 , 2 In VS surgery, this means hearing and facial nerve preservation whenever possible. 3 Delayed facial palsy (DFP) is seen in a small subset of patients who undergo VS surgery. This phenomenon is generally defined as a decline in facial nerve function from the immediate postoperative period and can occur any time from 1 day to several weeks postoperatively. 4 Most

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Peripheral nerve fibromyxoid sarcoma

Case report

Raanan Y. Alter, Christina C. Wamsley, John T. Mullen, Winta Z. Haile, Jeffrey D. Goldsmith, and Ekkehard M. Kasper

retroperitoneum. 7 It was previously thought that LGFMS was unassociated with peripheral nerves or neurofibromatosis, 6 and thus far there has not been any reported LGFMS growth associated with a peripheral nerve. Soft-tissue sarcomas embody approximately 0.7% of all systemic cancers, and LGFMS represents only a small fraction of those, making it an exceedingly rare disease. 8 Local recurrence and distal metastases have been found in as high as 75% and 58% of reported cases. However, advances in systemic medical treatment have reduced these to 9% and 6%, respectively. 6

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Sciatic nerve sarcoidosis: utility of magnetic resonance peripheral nerve imaging and treatment with radiation therapy

Case report

Andrew T. Dailey, Matthew T. Rondina, Jeannette J. Townsend, Dennis C. Shrieve, J. Richard Baringer, and Kevin R. Moore

S arcoidosis is a systemic, idiopathic granulomatous disease that involves the CNS in approximately 5% of patients. 16, 22, 24, 26 Of the patients with neurological involvement, most present with CNS or cranial nerve manifestations. Peripheral nervous system manifestations are seen only rarely in patients with sarcoidosis and are usually encountered later in the course of the disease. In one clinical series of patients with neurosarcoidosis, only 10% of patients had primarily peripheral nerve or muscle lesions, whereas the majority (90%) had primarily CNS or