Intraoperative high-resolution ultrasound: a new technique in the management of peripheral nerve disorders

Koenig, Ralph Werner; Schmidt, Thomas; Heinen, Christian; Wirtz, Christian Rainer; Kretschmer, Thomas; Antoniadis, Gregor; Pedro, Maria Teresa

doi:10.3171/2010.9.jns10464

Cited by 69 publications

(33 citation statements)

References 16 publications

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“…As Rodriguez et al 17 already pointed out in their pathological study, the differential diagnosis of these pathologies is difficult and controversial. Because we gained positive experience with the tissue-differentiating properties of iHRU in traumatic nerve lesions, 12 we decided to apply this technique to tumors and tumorlike lesions of peripheral nerves.…”

Section: Discussionmentioning

confidence: 99%

“…11 In 2011, our study group examined traumatic nerve lesions in an intraoperative setting by using the full technical capacity of HRU with its very high spatial resolution and tissue-differentiating properties. 12 By this means, the nerve is externally neurolyzed and embedded between 2 ultrasound gel cushions, and the transducer is set directly on the nerve segment to be evaluated. This technique enables the surgeon to see directly into the fascicular structure and epineurium.…”

mentioning

confidence: 99%

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Intraoperative high-resolution ultrasound and contrast-enhanced ultrasound of peripheral nerve tumors and tumorlike lesions

Pedro¹,

Antoniadis²,

Scheuerle

et al. 2015

FOC

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The diagnostic workup and surgical therapy for peripheral nerve tumors and tumorlike lesions are challenging. Magnetic resonance imaging is the standard diagnostic tool in the preoperative workup. However, even with advanced pulse sequences such as diffusion tensor imaging for MR neurography, the ability to differentiate tumor entities based on histological features remains limited. In particular, rare tumor entities different from schwannomas and neurofibromas are difficult to anticipate before surgical exploration and histological confirmation. High-resolution ultrasound (HRU) has become another important tool in the preoperative evaluation of peripheral nerves. Ongoing software and technical developments with transducers of up to 17–18 MHz enable high spatial resolution with tissue-differentiating properties. Unfortunately, high-frequency ultrasound provides low tissue penetration. The authors developed a setting in which intraoperative HRU was used and in which the direct sterile contact between the ultrasound transducer and the surgically exposed nerve pathology was enabled to increase structural resolution and contrast. In a case-guided fashion, the authors report the sonographic characteristics of rare tumor entities shown by intraoperative HRU and contrast-enhanced ultrasound.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Intraoperative high-resolution ultrasound and contrast-enhanced ultrasound of peripheral nerve tumors and tumorlike lesions

Pedro¹,

Antoniadis²,

Scheuerle

et al. 2015

FOC

Self Cite

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“…4,7,8 However, these studies were not performed in infants, and they were not focused on the brachial plexus. In adults, a recent study comparing MRI and ultrasound for peripheral nerve pathology did find increased sensitivity for ultrasound and equal specificity for the two.…”

Section: ©Aans 2014mentioning

confidence: 99%

Ultrasonography for neonatal brachial plexus palsy

Joseph¹,

DiPietro

Somashekar

et al. 2014

PED

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Ultrasonography has previously been reported for use in the evaluation of compressive or traumatic peripheral nerve pathology and for its utility in preoperative mapping. However, these studies were not performed in infants, and they were not focused on the brachial plexus. The authors report a case in which ultrasonography was used to improve operative management of neonatal brachial plexus palsy (NBPP). An infant boy was born at term, complicated by right-sided shoulder dystocia. Initial clinical evaluation revealed proximal arm weakness consistent with an upper trunk injury. Unlike MRI or CT myelography that focus on proximal nerve roots, ultrasonography of the brachial plexus in the supraclavicular fossa was able to demonstrate a small neuroma involving the upper trunk (C-5 and C-6) and no asymmetry in movement of the diaphragm or in the appearance of the rhomboid muscle when compared with the unaffected side. However, the supra- and infraspinatus muscles were significantly asymmetrical and atrophied on the affected side. Importantly, ultrasound examination of the shoulder revealed posterior glenohumeral laxity. Instead of pursuing the primary nerve reconstruction first, timely treatment of the shoulder subluxation prevented formation of joint dysplasia and formation of a false glenoid, which is a common sequela of this condition. Because the muscles innervated by proximal branches of the cervical nerve roots/trunks were radiographically normal, subsequent nerve transfers were performed and good functional results were achieved. The authors believe this to be the first report describing the utility of ultrasonography in the surgical treatment planning in a case of NBPP. Noninvasive imaging, in addition to thorough history and physical examination, reduces the intraoperative time required to determine the extent and severity of nerve injury by allowing improved preoperative planning of the surgical strategy. Inclusion of ultrasonography as a preoperative modality may yield improved outcomes for children with NBPP.

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“…11,14,20 Compared with other navigation technology such as intraoperative MRI and CT, ultrasound has the advantage of being portable, cost-effective, and radiation-free (compared with CT). Ultrasound guidance is an inexpensive and widely available technology that provides dynamic imaging that can be easily incorporated into the operating room.…”

Section: Neurosurgical Focusmentioning

confidence: 99%

Ultrasound-guided percutaneous injection of methylene blue to identify nerve pathology and guide surgery

Osorio

Arnaout

Simon

et al. 2015

FOC

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OBJECT The objective of this study was to provide a technique that could be used in the preoperative period to facilitate the surgical exploration of peripheral nerve pathology. METHODS The authors describe a technique in which 1) ultrasonography is used in the immediate preoperative period to identify target peripheral nerves, 2) an ultrasound-guided needle electrode is used to stimulate peripheral nerves to confirm their position, and then 3) a methylene blue (MB) injection is performed to mark the peripheral nerve pathology to facilitate surgical exploration. RESULTS A cohort of 13 patients with varying indications for peripheral nerve surgery is presented in which ultrasound guidance, stimulation, and MB were used to localize and create a road map for surgeries. CONCLUSIONS Preoperative ultrasound-guided MB administration is a promising technique that peripheral nerve surgeons could use to plan and execute surgery.

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Intraoperative high-resolution ultrasound: a new technique in the management of peripheral nerve disorders

Cited by 69 publications

References 16 publications

Intraoperative high-resolution ultrasound and contrast-enhanced ultrasound of peripheral nerve tumors and tumorlike lesions

Intraoperative high-resolution ultrasound and contrast-enhanced ultrasound of peripheral nerve tumors and tumorlike lesions

Ultrasonography for neonatal brachial plexus palsy

Ultrasound-guided percutaneous injection of methylene blue to identify nerve pathology and guide surgery

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