Peripheral Nerve Injuries: Electrophysiology for the Neurosurgeon

Kamble, Nitish; Shukla, Dhaval; Bhat, Dhananjaya I.

doi:10.4103/0028-3886.273626

Cited by 59 publications

(55 citation statements)

References 19 publications

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“…Nerve entrapment or infiltration by fibrous endometriosis nodules requires meticulous nerve dissection, excision of the epineurium, and fiber manipulation, as well as repeated hemostasis procedures responsible for thermal diffusion into the nerve, edema, and limited ischemia. These circumstances unavoidably lead to neuropraxia [16], followed by postoperative sensory, motor, or vegetative temporary disorders. Neuropraxia refers to mild nerve injury involving impairment of both motor and sensory functions and is the first type of peripheral nerve injury according to the Seddon and Sunderland classification [17,18], with no loss of axon but a temporary loss of myelin sheath.…”

Section: Discussionmentioning

confidence: 99%

“…Neuropraxia refers to mild nerve injury involving impairment of both motor and sensory functions and is the first type of peripheral nerve injury according to the Seddon and Sunderland classification [17,18], with no loss of axon but a temporary loss of myelin sheath. This demyelination leads to the impairment of impulse conduction across the nerve segment [16] without Wallerian degeneration. The prognosis is favorable, with complete recovery likely within weeks or months owing to axon remyelination [19].…”

Section: Discussionmentioning

confidence: 99%

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Postoperative Outcomes after Surgery for Deep Endometriosis of the Sacral Plexus and Sciatic Nerve: A 52-patient Consecutive Series

Roman

Dehan²,

Merlot

et al. 2021

Journal of Minimally Invasive Gynecology

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To assess 1-year postoperative outcomes of surgery for deep endometriosis involving the sacral roots and sciatic nerve. Design: Retrospective case series. Setting: Three referral centers. Patients: Fifty-two women. Interventions: Surgery for deep endometriosis involving the sacral roots and sciatic nerve. Measurements and Main Results: Deep endometriosis involved the sacral roots in 49 women (94.2%) and the sciatic nerve in 3 cases (5.8%). Sciatic pain (buttock or leg) was recorded in 43 women (82.7%), pudendal neuralgia in 11 women (21.2%), and leg motor weakness in 14 cases (27%). The surgical procedures carried out on the pelvic nerves included complete release and decompression (92.3%), excision of the epineurium by shaving (5.8%), and intraneural excision (1.9%). Additional major surgical procedures involved the digestive tract in 82.7% of the cases and the urinary tract in 46.2%. Rectovaginal fistula occurred in 13.5% of the cases. Self-catheterization was required in 14 cases (27%) at 3 weeks after surgery and in 3 women (5.8%) 12 months later. One-year follow-up showed significant improvement in quality of life measured using the Short-Form 36 questionnaire and standardized gastrointestinal scores. De novo hypoesthesia, hyperesthesia, or allodynia were recorded in 9 women (17.2%). The cumulative pregnancy rate was 77.2%% after natural conception in 47%. Conclusion: Laparoscopic management of deep endometriosis involving the sacral roots and sciatic nerve improves patients' symptoms and overall quality of life. Although pain reduction may be rapid after surgery, other sensory or motor complaints, including bladder dysfunction, may be recorded over months or years. Journal of Minimally Invasive Gynecology (2020) 00, 1−9.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Postoperative Outcomes after Surgery for Deep Endometriosis of the Sacral Plexus and Sciatic Nerve: A 52-patient Consecutive Series

Roman

Dehan²,

Merlot

et al. 2021

Journal of Minimally Invasive Gynecology

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show abstract

“…Neuropraxia refers to mild nerve injury involving impairment of both motor and sensory functions and is the first type of peripheral nerve injury according to the Seddon and Sunderland classification 16,17 with no loss of axon but a temporary loss of myelin sheath. This demyelination leads to impairment of impulse conduction across the nerve segment 15 without Wallerian degeneration. The prognosis is favourable with complete recovery likely within weeks or months, due to axon remyelination 18 .…”

Section: Discussionmentioning

confidence: 99%

Postoperative outcomes following surgery for deep endometriosis of the sacral plexus and sciatic nerve: a 52-patient consecutive series

Roman¹,

Dehan

Merlot³

et al. 2020

Preprint

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Background: Surgical management of deep endometriosis infiltrating pelvic nerves may allow an overall improvement in pain and neurologic disorders. Objective: To assess 1-year postoperative outcomes of surgery for deep endometriosis involving sacral roots and the sciatic nerve. Study Design: Retrospective study including 52 women undergoing surgery for deep endometriosis involving sacral roots and the sciatic nerve. We assessed 1-year postoperative outcomes. Results: Deep endometriosis involved sacral roots in 49 women (94.2%) and the sciatic nerve in 3 cases (5.8%). Sciatic pain was recorded in 43 women (82.7%), pudendal neuralgia in 11 women (21.2%) and leg motor weakness in 14 cases (27%). Surgical procedures carried out on pelvic nerves included complete releasing and decompression (92.3%), excision of epineurium (5.8%) and intraneural excision (1.9%). Additional procedures involved the digestive tract in 82.7% of cases and the urinary tract in 46.2%. Rectovaginal fistula occurred in 13.5% of cases. Self-catheterisation was required in 14 cases (27%) at 3 weeks after surgery, and in only 3 women (5.8%) 12 months later. One-year follow up showed significant improvement in quality of life using SF36 and standardised gastrointestinal scores. De novo hypoesthesia, hyperaesthesia or allodynia were recorded in 9 women (17.2%). The cumulative pregnancy rate was 77.2% following natural conception in 47%. Conclusions: Laparoscopic management of deep endometriosis involving sacral roots and the sciatic nerve improves patient symptoms and overall quality of life. Although pain reduction may be rapid following surgery, other sensory or motor complaints including bladder dysfunction may be recorded over months or years.

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“…There is no axonal loss, but only damage in the myelin sheath. Due to this demyelination, there is an interruption or impairment of nerve impulse conduction along the nerve segment, but recovery and remyelination usually occurs between days to weeks and the prognosis is good (9,10). Regarding axonotmesis, an axonal lesion occurs, but most connective tissue layers involving the nerve (endoneurium, perineurium, and epineurium) are wholly or partially intact, allowing nerve regeneration to occur.…”

Section: Introductionmentioning

confidence: 99%

“…Regarding axonotmesis, an axonal lesion occurs, but most connective tissue layers involving the nerve (endoneurium, perineurium, and epineurium) are wholly or partially intact, allowing nerve regeneration to occur. It usually arises secondarily to crush or stretch injuries (10,11).…”

Section: Introductionmentioning

confidence: 99%

Establishment of a Sheep Model for Hind limb Peripheral Nerve Injury: Common Peroneal Nerve

Alvites¹,

Branquinho²,

Sousa³

et al. 2020

Preprint

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Thousands of people worldwide suffer from injuries in the peripheral nerve and deal daily with the resulting physiological and functional deficits. Recent advances in this field are still insufficient to guarantee effective outcomes, and the development of new and effective therapeutic options requires the use of valid preclinical models that effectively replicate the characteristics and challenges associated with these injuries in humans. In this study, we established a sheep model for common peroneal nerve injuries that can be applied in preclinical research with the advantages associated with the use of large animal models. In an integrative way, this article includes a detailed description of the anatomy and functionality of the peripheral nerves of sheep’s hind limb, the surgical protocol for accessing the common peroneal nerve, the induction of different types of nerve damage and the application of possible therapeutic options. A neurological exam protocol directed to the common peroneal nerve was also established, allowing to identify the changes and deficits related with the nerve injury and to evaluate the functional progression over time. Finally, a preliminary stereological study was carried out to establish control values for the healthy peroneal common nerves of this model and to identify preliminary differences between therapeutic methods. The ultimate goal is to demonstrate that sheep is a valid model of peripheral nerve injury to be used in pre-clinical and translational works and to evaluate the efficacy and safety of nerve injury therapeutic options before its clinical application in human and veterinary patients.

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Peripheral Nerve Injuries: Electrophysiology for the Neurosurgeon

Cited by 59 publications

References 19 publications

Postoperative Outcomes after Surgery for Deep Endometriosis of the Sacral Plexus and Sciatic Nerve: A 52-patient Consecutive Series

Postoperative Outcomes after Surgery for Deep Endometriosis of the Sacral Plexus and Sciatic Nerve: A 52-patient Consecutive Series

Postoperative outcomes following surgery for deep endometriosis of the sacral plexus and sciatic nerve: a 52-patient consecutive series

Establishment of a Sheep Model for Hind limb Peripheral Nerve Injury: Common Peroneal Nerve

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