On the applicability of two different stimulation techniques for intra‐operative peroneal nerve conduction testing

Abstract

Dysfunction of the peroneal nerve is an important complication of knee surgery. We compared two monitoring procedures of peroneal nerve function during a standardized operation, a closing wedge high tibial osteotomy. For two types of stimulation the evoked compound motor unit action potentials (CMAPs) were recorded on the tibialis anterior muscle. We used direct perineural electrical Stimulation of the common peroneal nerve distal to the cuff (dCMAPs) after nerve identification in the surgical field. Additionally, magnetic stimulation of the sacral plexus proximal to the cuff (pCMAPs) was performed. It was found that dCMAPs were recorded during almost one hour of tourniquet time whereas the pCMAPs were blocked after 25-30 min in 9 out of 11 cases. On the other hand, the CMAP obtained after proximal stimulation exhibited a latency shift with tourniquet yielding an indicator of ischaemic changes present beneath and distal to the tourniquet cuff. In conclusion, different applicabilities of both stimulation techniques under tourniquet conditions were demonstrated.

An experimental study to determine and correlate choline acetyltransferase assay with functional muscle testing after nerve injury

“…As such, various histomorphometric approaches have been proposed and continue to be used and advocated. 2,16,18 A histomorphometric approach for differentiating be tween sensory and/or motor function and the presence of viable motor nerve fibers is Karnovsky staining. This type of staining visualizes acetylcholinesterase (AChE), an enzyme present in the neuromuscular junctions and motor neurons that is responsible for degradation of the neurotransmitter acetylcholine into choline and acetate.…”

Investigation of Neurologic Complications in Closed Wedge High Tibial Valgization Osteotomy Technique by Using Electrophysiological Methods

“…The nerve penetrated the muscle from the fibular side in twenty one cases, from the tibial side in 6 cases and from the anterior aspect in 6 cases. The nerve following the fibular route was extending very close to fibular periosteum (3).…”