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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Stephen K. Powers, David Norman, and Michael S. B. Edwards
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
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Injected material may also track back along the needle path and run into the extradural space once the needle has been withdrawn.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
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
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
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
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
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
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
Franklin C. Lee, Harminder Singh, Levon N. Nazarian, and John K. Ratliff
T he diagnosis and localization of peripheral nerve lesions relies primarily on the clinical history and physical examination. The diagnostic testing of peripheral nerve lesions has previously been limited to use of NCSs and EMG. The development of ultrasonography and MR imaging has allowed visualization of nerve lesions with varying degrees of clinical efficacy. 12 , 14–16 , 18 Magnetic resonance neurography provides high-resolution imaging of peripheral nerves; T2-weighted MR imaging sequences combining fat and flow suppression with 3D reconstruction
