Peripheral Nerve Surgery: The Role of High-Resolution MR Neurography

Thawait, Shrey K.; Wang, K.; Subhawong, Ty K.; Williams, Eric H.; Hashemi, Shar; Machado, Antonio Jose; Thawait, Gaurav K.; Soldatos, Theodoros; Carrino, John A.; Chhabra, Avneesh

doi:10.3174/ajnr.a2465

Cited by 59 publications

(33 citation statements)

References 64 publications

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“…28,29 Nerve grafts and conduits are becoming increasingly utilized, 30 and, in the future, the same methodology as in this study can be applied to regeneration of nerves with grafts and conduits. 31 Second, nerve regeneration was only followed for 8 weeks after surgery when gadofluorine enhancement of the injured nerve was still present. Because histology showed that myelin debris clearance had almost completed and nerves showed no significant changes over time since 6 weeks after surgery, increasing observation time probably does not provide additional information to determine the role of T2 value and gadofluorine M-enhanced imaging in monitoring the enhanced nerve repair process mediated by TLR4 activation.…”

Section: Discussionmentioning

confidence: 99%

Enhanced Repair Effect of Toll-Like Receptor 4 Activation on Neurotmesis: Assessment Using MR Neurography

Zhang

et al. 2014

American Journal of Neuroradiology

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Section: Discussionmentioning

confidence: 99%

Enhanced Repair Effect of Toll-Like Receptor 4 Activation on Neurotmesis: Assessment Using MR Neurography

Zhang

et al. 2014

American Journal of Neuroradiology

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“…This in turn is imperative for proper decisions to be made by surgeons14. Current state-of-the-art conventional Magnetic Resonance Nerve imaging, involving 2D or 3D high-resolution T1-weighted, (fat-suppressed) T2-weighted, or short TI inversion recovery (STIR) imaging, provides detailed anatomic nerve depiction1516. Clinical application of three-dimensional reversed fast imaging by steady-state precession (3D-PSIF) with diffusion-weighted MR sequence showed the successful use in cranial nerve reconstruction in 200817, while a review of the current imaging literature showed rare correlation between MRN results with per-operative findings in BPI.…”

mentioning

confidence: 99%

Diagnostic Value and Surgical Implications of the 3D DW-SSFP MRI On the Management of Patients with Brachial Plexus Injuries

Qin

Yang

et al. 2016

Sci Rep

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Three-dimensional diffusion-weighted steady-state free precession (3D DW-SSFP) of high-resolution magnetic resonance has emerged as a promising method to visualize the peripheral nerves. In this study, the application value of 3D DW-SSFP brachial plexus imaging in the diagnosis of brachial plexus injury (BPI) was investigated. 33 patients with BPI were prospectively examined using 3D DW-SSFP MR neurography (MRN) of brachial plexus. Results of 3D DW-SSFP MRN were compared with intraoperative findings and measurements of electromyogram (EMG) or somatosensory evoked potentials (SEP) for each injured nerve root. 3D DW-SSFP MRN of brachial plexus has enabled good visualization of the small components of the brachial plexus. The postganglionic section of the brachial plexus was clearly visible in 26 patients, while the preganglionic section of the brachial plexus was clearly visible in 22 patients. Pseudomeningoceles were commonly observed in 23 patients. Others finding of MRN of brachial plexus included spinal cord offset (in 16 patients) and spinal cord deformation (in 6 patients). As for the 3D DW-SSFP MRN diagnosis of preganglionic BPI, the sensitivity, the specificity and the accuracy were respectively 96.8%, 90.29%, and 94.18%. 3D DW-SSFP MRN of brachial plexus improve visualization of brachial plexus and benefit to determine the extent of injury.

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“…[28,29] In experienced hands, MRI and US can provide crucial information in preoperative planning of revision nerve release surgery by documenting residual or recurrent pathology or the sequelae of previous surgery.…”

Section: Diagnosismentioning

confidence: 99%

Painful scar neuropathy: principles of diagnosis and treatment

Tos¹,

Crosio²,

Pugliese³

et al. 2015

Plast Aesthet Res

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Nerve-tissue interactions are critical. Peripheral nerve injuries may involve intraneural and extraneural scar formation and affect nerve gliding planes, sometimes leading to complex clinical presentations. All of these pathological entities involve pain as the main clinical symptom and can be subsumed under the term "painful scar neuropathy". The authors review the literature on treatment approaches to peripheral nerve scar neuropathy and the outcomes of neurolysis-associated procedures and propose a simple classification and a therapeutic approach to scar neuropathy. The search retrieved twenty-one papers, twenty of which reported pain reduction or resolution with various techniques. There is no consensus on the best therapeutic approach to neuropathic pain due to scar tethering. Most authors report good or excellent results with different techniques, from nerve wrapping with anti-adhesion devices to nerve coverage or wrapping with vascularized tissue. The authors' classification of and therapeutic approach to peripheral nerve scar lesions aims at promoting a logical approach based on the analysis of lesion type (perineural, or endoneural and perineural), pain type (due to traction or external trauma, pain at rest), and number of previous operations. Patients need to be informed that multiple procedures may be required, that outcomes may be partial, and that surgery can potentially worsen preoperative conditions. The review found no evidence for the best therapeutic approach to scar neuropathy, but there is consensus on a multidisciplinary approach.

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Peripheral Nerve Surgery: The Role of High-Resolution MR Neurography

Cited by 59 publications

References 64 publications

Enhanced Repair Effect of Toll-Like Receptor 4 Activation on Neurotmesis: Assessment Using MR Neurography

Enhanced Repair Effect of Toll-Like Receptor 4 Activation on Neurotmesis: Assessment Using MR Neurography

Diagnostic Value and Surgical Implications of the 3D DW-SSFP MRI On the Management of Patients with Brachial Plexus Injuries

Painful scar neuropathy: principles of diagnosis and treatment

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