Management of spastic hand by selective peripheral neurotomies

Fouad, Wael

doi:10.1016/j.ajme.2011.07.012

Cited by 14 publications

(12 citation statements)

References 23 publications

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“…Several previous studies reported good outcomes following SPN for limb spasticity [19,20,21,22,23,24,25,26]. Regarding SPN for upper limb hypertonia, in addition to reduction of limb spasticity, most studies showed marked functional amelioration of the upper extremity, particularly in subjects who had residual hand motor function [21,22,23,24,25,26]. In our series, the majority of patients undergoing SPN for upper limb spasticity possessed nonfunctional upper extremities preoperatively.…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcomes of Microsurgical Selective Peripheral Neurotomy for Intractable Limb Spasticity

Sitthinamsuwan¹,

Chanvanitkulchai²,

Phonwijit³

et al. 2013

Stereotact Funct Neurosurg

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Background: The authors frequently employed selective peripheral neurotomy (SPN) as the primary treatment of severe intractable focal and multifocal spastic hypertonia. We occasionally operated SPN in diffuse spastic disorders. Objective: To study surgical outcome of SPN in terms of severity of spasticity and functional condition. Methods: Patients harboring refractory harmful spasticity of various origins were enrolled into the present study. They were clinically evaluated by using the Modified Ashworth Scale (MAS), passive range of motion (PROM) and functional status. These variables were compared between pre- and postsurgery by using the paired t test and the Wilcoxon signed-rank matched-pairs test. Results: One hundred and forty-one SPNs were accomplished in 33 patients. Overall mean pre- and postoperative MAS and PROM were 3.0 and 0.7 (p < 0.001) and 78.3 and 102.3° (p < 0.001), respectively. Analysis of individual SPN subgroups also demonstrated statistically significant improvement of both parameters. Furthermore, we found significant gait improvement among 10 ambulatory subjects. Nine bed-bound cases attained significant enhancement of sitting competency and ambulatory condition. Conclusion: SPN is an efficacious neurosurgical intervention in the treatment of spasticity. It is apparently beneficial in the reduction of spasticity, amelioration of functional status, facilitation of patient care and prevention of long-term musculoskeletal sequelae.

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Section: Discussionmentioning

confidence: 99%

Surgical Outcomes of Microsurgical Selective Peripheral Neurotomy for Intractable Limb Spasticity

Sitthinamsuwan¹,

Chanvanitkulchai²,

Phonwijit³

et al. 2013

Stereotact Funct Neurosurg

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“…Consensus is also needed on the nomenclature for surgical management of spasticity [34]. "Selective neurotomy" is a common term for this surgery now [37][38][39], but "partial selective denervation" was used by Brunelli in 1983, and Fouad [40] and Gras et al [41] used "selective peripheral neurectomy" and "hyperse-lective neurotomy", respectively.…”

Section: Technical Principles For Spnmentioning

confidence: 99%

Selective peripheral neurotomy (SPN) as a treatment strategy for spasticity

Fan

Milosevic

Wang

2020

Brain Science Advances

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Spasticity can be caused by central nervous system dysfunction, such as cerebral palsy and stroke. The accepted pathogenesis of spasticity is that the muscles are in the state of uninhibited stretch reflex without enough control of central nervous system. So far, there is no ideal way about how to repair central nervous system. However, the uninhibited stretch reflex can be reduced, targeting the posterior root of the spinal cord and peripheral nerves innervating the limbs, which are called selective posterior rhizotomy (SPR) and selective peripheral neurotomy (SPN), respectively. SPN is indicated for focal or multifocal spasticity, which is well accepted due to its low invasiveness and ease of use. How does the operation work? What do we do before and during this operation? Is there any risk to the patients? Our review summarizes the mechanism, indications, preoperative assessments, techniques, and complications of SPN. We hope that the spastic patients, such as pediatric cerebral palsy patients and older stroke patients, will benefit from this surgery.

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“…“Selective neurotomy” is a commonly described term; 8 , 9 , 11 however, “fasciculotomy” has been reported in two publications which seem to originate from the same team, 7 , 10 whilst Brunelli and Brunelli 3 used the term “partial selective denervation (hyponeurotisation)” in 1983. Fouad 12 used the term “selective peripheral neurectomy” and Leclercq and Gras used the term “hyperselective neurectomy”. The definition of the term “neurotomy” is cutting a nerve, when “neurectomy” is defined as the removal of all or part of a nerve.…”

Section: Controversiesmentioning

confidence: 99%

“…Fouad 12 published the results of ten patients who had spasticity in the median and ulnar nerve-innervated muscles. After careful dissection and use of nerve stimulation the motor branches were identified and resection of 50% to 80% of the isolated motor branches of fascicles was performed.…”

mentioning

confidence: 99%

“… 9 , 11 Where it was reported that there was resection of part of the nerve, two more publications reported recurrence. 8 , 12 Fouad 12 reported in his technique that if there was more than one motor branch to the spastic muscle he performed sectioning of one or more of the branches, but when there was only one motor branch he performed resection of part of the nerve at that level. He also stated that the recurrence reported in his paper was due to insufficient nerve sectioning.…”

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confidence: 99%

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The role of neurectomy in the management of spasticity of the upper limb

Mikalef

Power

2017

EFORT Open Reviews

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Neurectomy is one of the treatments available to the surgeon treating patients with spasticity of the upper limb.Its popularity has increased in recent years.Accurate knowledge of the anatomical variations of the terminal branches to the muscles is required in order to achieve a successful outcome.Although the anatomy has been thoroughly studied, there are still controversies regarding the percentage of the nerve to be resected for a successful result, and also regarding the terminology that has been used in the literature to describe the procedure.The literature for neurectomies for the upper limb is reviewed and an agreement regarding terminology is proposed.Cite this article: EFORT Open Rev 2017;2:469-473. DOI: 10.1302/2058-5241.2.160074

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Management of spastic hand by selective peripheral neurotomies

Cited by 14 publications

References 23 publications

Surgical Outcomes of Microsurgical Selective Peripheral Neurotomy for Intractable Limb Spasticity

Surgical Outcomes of Microsurgical Selective Peripheral Neurotomy for Intractable Limb Spasticity

Selective peripheral neurotomy (SPN) as a treatment strategy for spasticity

The role of neurectomy in the management of spasticity of the upper limb

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