Preoperative ultrasound-guided mapping of peripheral nerves

Bristow, Sandee J.; Chiu, Sheila; Kliot, Michel

doi:10.3171/2013.5.jns122243

Cited by 38 publications

(25 citation statements)

References 20 publications

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“…5,6,16,17 In addition to contributing to the diagnostic workup of patients with suspected CTS, sonographic examination allows noninvasive detection of aberrations. 4,9,10 In our investigation, however, electrodiagnostic studies seemed to be more sensitive in picking up preoperative deficits-our patients with motor deficits had statistically significantly longer preoperative dmL (10.5 ± 2.8 msec vs 6.5 ± 2.3 msec; p = 0.021 in multivariate analysis), but not greater CSA (p = 0.124) or circumference (p = 0.252).…”

Section: Discussionmentioning

confidence: 76%

Sonographic short-term follow-up after surgical decompression of the median nerve at the carpal tunnel: a single-center prospective observational study

Tas

Staub²,

Dombert³

et al. 2015

FOC

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OBJECT Carpal tunnel syndrome causes increased cross-sectional area (CSA) of the median nerve, which can be assessed by high-definition ultrasonography. It is unclear today, however, whether high-definition ultrasonography may play a role in the postoperative period. This prospective study aimed to determine the natural history of the morphology of the median nerve at the carpal tunnel after surgical decompression assessed by high-definition ultrasonography. METHODS Between October and December 2014, patients with suspected carpal tunnel syndrome who were referred to the authors’ center for peripheral neurosurgery were prospectively enrolled and underwent pre- and postoperative (3 months) high-definition ultrasonography, electrophysiology, and clinical testing. RESULTS Eighty-one patients were enrolled in the study, and 100% were clinically better at the 3-month follow-up. The mean CSA decreased from 14.7 ± 4.9 mm2 to 12.4 ± 3.4 mm2 (mean ± SD, p < 0.0001). The mean distal motor latency decreased from 6.6 ± 2.4 msec to 4.8 ± 1.0 msec (mean ± SD, p < 0.0001). Ninety-eight percent of patients who were available for electrodiagnostic follow-up showed an improvement of the distal motor latency; only 80% had a reduction in the CSA. CONCLUSIONS The authors present the second-largest series of patients with sonographic follow-up after surgical decompression of the carpal tunnel reported in the literature so far. This study, which showed a decrease in size of the median nerve after surgical decompression, suggests that the preoperative increase in median nerve CSA at the carpal tunnel may be due to compression and that enlargement of the median nerve is (partially) reversible.

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Section: Discussionmentioning

confidence: 76%

Sonographic short-term follow-up after surgical decompression of the median nerve at the carpal tunnel: a single-center prospective observational study

Tas

Staub²,

Dombert³

et al. 2015

FOC

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“…5 It is noted that the present study is the first to address the use of HRUS to delineate the location of nerve fascicles relative to tumor tissue in schwannomas.…”

Section: Discussionmentioning

confidence: 99%

High-resolution ultrasonography and diffusion tensor tractography map normal nerve fascicles in relation to schwannoma tissue prior to resection

Simon¹,

Cage

Narvid

et al. 2014

JNS

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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.…”

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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Preoperative ultrasound-guided mapping of peripheral nerves

Abstract: Preoperative ultrasound-guided nerve mapping may be useful in facilitating surgical access to a targeted nerve and thereby minimizing tissue dissection and operating time.

Cited by 38 publications

References 20 publications

Sonographic short-term follow-up after surgical decompression of the median nerve at the carpal tunnel: a single-center prospective observational study

Sonographic short-term follow-up after surgical decompression of the median nerve at the carpal tunnel: a single-center prospective observational study

High-resolution ultrasonography and diffusion tensor tractography map normal nerve fascicles in relation to schwannoma tissue prior to resection

Ultrasonography for neonatal brachial plexus palsy

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