Identification of Safe Zone with Intraoperative Neurophysiological Monitoring during Surgical Removal of Peripheral Nerve Tumor

Kim, Dong-hun; Choi, Jin-gyu; Son, Byung-chul

doi:10.21129/nerve.2016.2.2.78

Cited by 5 publications

(4 citation statements)

References 7 publications

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“…After exposing the whole tumor, the proximal and distal sciatic nerve circumferentially, we stimulated the surface of the tumor to find the 'safe zone' , the area that fascicles are widely splayed apart, suitable for beginning dissection [5]. A stimulating electrode was applied on the surface of the tumor with 5 Hz, 2 mA stimulation.…”

Section: Case Reportmentioning

confidence: 99%

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Successful enucleation of a large sciatic schwannoma with intraoperative neurostimulation-guided dissection: a case report

Park

Choi

2022

J Korean Ster Func Neurosurg

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Advances in intraoperative neurophysiological monitoring (IONM) have enabled safer peripheral nerve tumor surgery. We report a patient in whom a large sciatic nerve schwannoma was successfully removed using intraoperative nerve stimulation. A 62-year-old male presented with a palpable mass in the right posterior upper thigh, just below the gluteal fold. Magnetic resonance imaging showed an approximately 9-cm encapsulated solid mass in the middle of the sciatic nerve. After a vertical skin incision with a laterally curved upper end extending to the inferior gluteal region, the proximal sciatic nerve was secured laterally to the biceps femoris and the distal nerve medial to the muscle. We avoided causing trauma to the viable nerve fascicles by dissecting through the “safe zone,” as confirmed by monitoring the distal muscle contractions induced by intraoperative nerve stimulation on the tumor surface. In this report, we present the details of our surgical approach to the middle portion of the sciatic nerve and the use of IONM for safe tumor excision.

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Section: Case Reportmentioning

confidence: 99%

“…Stimulation induced EMG waveform was monitored in gastrocnemius muscle and in tibialis anterior muscle (Fig. 3) [5,13]. Additionally, visual observation and palpation of the distal muscles enhances the effectiveness of detecting stimulation-induced muscle contractions.…”

Section: Intraoperative Neurostimulation-guided Internal Neurolysismentioning

confidence: 99%

Successful enucleation of a large sciatic schwannoma with intraoperative neurostimulation-guided dissection: a case report

Park

Choi

2022

J Korean Ster Func Neurosurg

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“…Intraoperative neuromonitoring (IONM) is a proven and useful tool in neurosurgery, but its usage in PNT surgery only came years after brain surgery. Main purpose for using IONM is to find a safe entry zone for intracapsular enucleation of a schwannoma since the tumor can be surrounded by a bundle of nerve fascicles (16,25). Direct nerve stimulation (DNS) is, therefore, especially useful.…”

Section: Intraoperative Neuromonitoringmentioning

confidence: 99%

Peripheral Nerve Tumors as an Ongoing Challenge in Neuro-oncology: An Overview of Their Biological and Technical Nuances

Matić

Lepić

Kovačević

et al. 2021

ama

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This paper aims to provide an overview of recent advances in the diagnosis and treatment of peripheral nerve tumors (PNTs) with regard to biological and technological nuances, and to highlight some recommendations for achieving better outcomes in the treatment of patients suffering from PNT. PNTs are probably the most challenging entity in the field of peripheral nervous system surgery. The goal of removing a nerve tumor while also preserving nerve function at the same time is often complicated, regardless of the surgeon’s experience. Still, in most cases, high-quality results can be achieved upon carefully planned surgery. Clinical presentation, diagnosis, and indications for a specific type of treatment of PNTs still remain a topic of debate. Recent technological advances have led to an exponential improvement in the field with utilization of intraoperative ultrasound, neurostimulation devices, and intraoperative electrophysiological monitoring, along with the development of modern surgical techniques, whereby a multidisciplinary and individually shaped approach is necessary.Conclusion. These advances, however, still remain limited, and recent research is focused on the development of biological therapy. Biologically targeted therapies will emerge when there is a better understanding of the genetic and molecular mechanisms driving the development and growth of PNTs.

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“…However, we believe that the transgluteal approach using microscopic vision is a better option for complete dissection of the sciatic nerve pathway in the subgluteal space. In particular, intraoperative nerve stimulation facilitated localization and verification of tibial and peroneal divisions, which are major divisions of the sciatic nerve during dissection 12) . Plantar flexion of the foot was observed with low-intensity stimulation (1-2 mA) of the tibial division, and dorsiflexion was observed for stimulation in the peroneal division.…”

Section: Management Of Sciatic Nerve Entrapmentmentioning

confidence: 99%

Sciatic Nerve Entrapment (Deep Gluteal Syndrome) as a Cause of Failed Back Surgery Syndrome: A Case Report

Hwang

Son

2020

Nerve

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Sciatic nerve entrapment, which is a cause of non-discogenic extraspinal sciatica is characterized by buttock pain and sitting intolerance. If significant asymptomatic lumbar stenosis in the lower lumbar spine is found in patients with buttock pain and sciatica, caused by sciatic nerve entrapment, it is possible that needless spinal surgery may have been recommended. A 72-year-old male presented with a 2-year history of severe buttock and sole pain in his right lower extremity. His pain did not improve after decompression and fusion surgery for severe lumbar stenosis. A pelvic magnetic resonance imaging (MRI) used to evaluate the failed back surgery syndrome revealed a type II variation between the sciatic nerve and piriformis muscle. Transgluteal decompression of the sciatic nerve completely eliminated chronic disability associated with right buttock and sole pain. The patient's pain was improved by sciatic nerve decompression through a transgluteal approach. Although vascular claudication, hip joint pathology, and peripheral neuropathy have been suggested in the differential diagnosis of lumbar stenosis, sciatic nerve entrapment involving the gluteal region should be suspected in patients presenting with buttock pain associated with sciatica, combined with severe lumbar stenosis based on MRI.

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Identification of Safe Zone with Intraoperative Neurophysiological Monitoring during Surgical Removal of Peripheral Nerve Tumor

Cited by 5 publications

References 7 publications

Successful enucleation of a large sciatic schwannoma with intraoperative neurostimulation-guided dissection: a case report

Successful enucleation of a large sciatic schwannoma with intraoperative neurostimulation-guided dissection: a case report

Peripheral Nerve Tumors as an Ongoing Challenge in Neuro-oncology: An Overview of Their Biological and Technical Nuances

Sciatic Nerve Entrapment (Deep Gluteal Syndrome) as a Cause of Failed Back Surgery Syndrome: A Case Report

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