Ultrasound-Guided Treatment of Peripheral Nerve Pathology

AbstractHigh-resolution ultrasound serves as a fast, accessible, reliable, and radiation-free tool for anatomical and dynamic evaluation of various peripheral nerves. It can be used not only to identify and diagnose peripheral nerve and perineural pathology accurately but also to guide various nerve and perineural interventions. We describe the normal and pathologic appearances of peripheral nerves, the pathologies commonly affecting the individual peripheral nerves, and the current ultrasound-guided peripheral nerve interventions and techniques. Future directions are also highlighted.

Download Full-text

High-resolution ultrasonography in evaluating peripheral nerve entrapment and trauma

Neurosurgical FOCUS ◽

10.3171/foc.2009.26.2.e13 ◽

2009 ◽

Vol 26 (2) ◽

pp. E13 ◽

Cited By ~ 78

Author(s):

Ralph W. Koenig ◽

Maria T. Pedro ◽

Christian P. G. Heinen ◽

Thomas Schmidt ◽

Hans-Peter Richter ◽

...

Keyword(s):

High Resolution ◽

Peripheral Nerve ◽

Peripheral Nerves ◽

Imaging Modality ◽

Nerve Entrapment ◽

Nerve Lesions ◽

Peripheral Nerve Lesions ◽

Continuous Progress ◽

Number Of Publications ◽

High Resolution Ultrasonography

High-resolution ultrasonography is a noninvasive, readily applicable imaging modality, capable of depicting real-time static and dynamic morphological information concerning the peripheral nerves and their surrounding tissues. Continuous progress in ultrasonographic technology results in highly improved spatial and contrast resolution. Therefore, nerve imaging is possible to a fascicular level, and most peripheral nerves can now be depicted along their entire anatomical course. An increasing number of publications have evaluated the role of high-resolution ultrasonography in peripheral nerve diseases, especially in peripheral nerve entrapment. Ultrasonography has been shown to be a precious complementary tool for assessing peripheral nerve lesions with respect to their exact location, course, continuity, and extent in traumatic nerve lesions, and for assessing nerve entrapment and tumors. In this article, the authors discuss the basic technical considerations for using ultrasoniography in peripheral nerve assessment, and some of the clinical applications are illustrated.

Download Full-text

Cadaveric Model Simulations for Training in Ultrasound-Guided Percutaneous Placement of a Novel Peripheral Nerve Stimulation Electrode

Surgical Technology Online ◽

10.52198/21.sti.38.ns1401 ◽

2021 ◽

Author(s):

Roberto Gazzeri ◽

Alessandro Cesaroni ◽

Ezio Amorizzo ◽

Emanuele Piraccini ◽

Fabrizio Micheli ◽

...

Keyword(s):

Peripheral Nerve ◽

Nerve Stimulation ◽

Peripheral Nerves ◽

Peripheral Nerve Stimulation ◽

Electrode Placement ◽

Surgical Approaches ◽

Ultrasound Guided ◽

Model Simulations ◽

Cadaveric Model ◽

Stimulation Electrode

Peripheral nerve stimulation (PNS) electrodes are used to treat intractable painful conditions involving peripheral nerves. Methods for performing PNS continue to evolve, from open surgical to minimally invasive placement of electrodes. A PNS system consisting of subcutaneously implanted leads with an integrated anchor and electrodes, and an external pulse generator to produce peripheral neuromodulation, is now available for use in the clinical setting. This novel system allows either surgical or percutaneous lead positioning, and avoids the use of long leads or extensions crossing the joints, which are exposed to mechanical stress and damage. To identify methods for successfully inserting these electrodes, we investigated if a cadaver model could be an effective educational tool for teaching PNS electrode placement using ultrasound guidance. Six cadavers were studied in an attempt to find an ideal approach for ultrasound-guided electrode placement into the upper and lower extremities and cervical spine, and to describe the unique anatomy of the peripheral nerves relative to percutaneous stimulation-electrode placement. The use of cadaveric model simulations offers opportunities to practice percutaneous placement of PNS electrodes under stress-free conditions without patient discomfort, to acquire skill and confidence in performing these surgical approaches. Ultrasound-guided percutaneous placement of PNS electrodes should be learned in a simulation laboratory before such placement is performed in actual patients.

Download Full-text

High-resolution ultrasound in the assessment of peripheral nerves in leprosy: A comparative cross-sectional study

Indian Journal of Dermatology Venereology and Leprology ◽

10.25259/ijdvl_106_20 ◽

2021 ◽

Vol 0 ◽

pp. 1-8

Author(s):

Kalathummarath Sreejith ◽

Sarita Sasidharanpillai ◽

Kidangazhiathmana Ajithkumar ◽

Reeba Mary Mani ◽

Anuradha Thalian Chathoth ◽

...

Keyword(s):

High Resolution ◽

Peripheral Nerve ◽

Clinical Examination ◽

Peripheral Nerves ◽

Cross Sectional Area ◽

Nerve Function ◽

Sectional Area ◽

Cross Sectional ◽

Function Impairment ◽

The Cross

Background: Detection of peripheral nerve thickening and nerve function impairment is crucial in the diagnosis and the management of leprosy. Aims and objectives: (1) To document the cross-sectional area, echotexture and blood flow of peripheral nerves in healthy controls and leprosy cases using high-resolution ultrasound, (2) to compare the sensitivities of clinical examination and high-resolution ultrasound in detecting peripheral nerve thickening in leprosy. Methods: Peripheral nerves of 30 leprosy patients and 30 age- and sex-matched controls were evaluated clinically and by high-resolution ultrasound. When the cross-sectional area of a peripheral nerve on high-resolution ultrasound in a leprosy patient was more than the calculated upper bound of the 95% confidence interval for mean for that specific nerve in controls, that particular peripheral nerve was considered to be enlarged. Results: Cross-sectional areas more than 7.1 mm2 for the radial nerve, 8.17 mm2 for ulnar, 10.17 mm2 for median, 9.50 mm2 for lateral popliteal and 11.21mm2 for the posterior tibial nerve were considered as nerve thickening on high-resolution ultrasound. High-resolution ultrasound detected 141/300 (47%) nerves enlarged in contrast to the 60 (20%) diagnosed clinically by palpation (P < 0.001). Clinical examination identified thickening in 31/70 (44.3%) nerves in cases with impairment of nerve function and 29/230 (12.6%) in the absence of nerve function impairment. High-resolution ultrasound detected thickening in 50/70 (71.4%) nerves with impairment of function and in 91/230 (39.6%) nerves without any impairment of function. Limitation: A single-centre study design was the major study limitation. Conclusion: High-resolution ultrasound showed greater sensitivity than clinical examination in detecting peripheral nerve thickening in leprosy cases. High-resolution ultrasound, may therefore improve the sensitivity of the diagnostic criterion of peripheral nerve enlargement in the diagnosis and classification of leprosy.

Download Full-text

High-resolution in vivo imaging of peripheral nerves using optical coherence tomography: a feasibility study

Journal of Neurosurgery ◽

10.3171/2019.2.jns183542 ◽

2020 ◽

Vol 132 (6) ◽

pp. 1907-1913 ◽

Cited By ~ 2

Author(s):

Anne E. Carolus ◽

Marcel Lenz ◽

Martin Hofmann ◽

Hubert Welp ◽

Kirsten Schmieder ◽

...

Keyword(s):

Optical Coherence Tomography ◽

High Resolution ◽

Peripheral Nerve ◽

Peripheral Nerves ◽

Imaging Technique ◽

Ex Vivo ◽

Imaging Techniques ◽

Optical Biopsy ◽

Optical Coherence

OBJECTIVEBecause of their complex topography, long courses, and small diameters, peripheral nerves are challenging structures for radiological diagnostics. However, imaging techniques in the area of peripheral nerve diseases have undergone unexpected development in recent decades. They include MRI and high-resolution sonography (HRS). Yet none of those imaging techniques reaches a resolution comparable to that of histological sections. Fascicles are the smallest discernable structure. Optical coherence tomography (OCT) is the first imaging technique that is able to depict a nerve’s ultrastructure at micrometer resolution. In the current study, the authors present an in vivo assessment of human peripheral nerves using OCT.METHODSOCT measurement was performed in 34 patients with different peripheral nerve pathologies, i.e., nerve compression syndromes. The nerves were examined during surgery after their exposure. Only the sural nerve was twice examined ex vivo. The Thorlabs OCT systems Callisto and Ganymede were used. For intraoperative use, a hand probe was covered with a sterile foil. Different postprocessing imaging techniques were applied and evaluated. In order to highlight certain structures, five texture parameters based on gray-level co-occurrence matrices were calculated according to Haralick.RESULTSThe intraoperative use of OCT is easy and intuitive. Image artifacts are mainly caused by motion and the sterile foil. If the artifacts are kept at a low level, the hyporeflecting bundles of nerve fascicles and their inner parts can be displayed. In the Haralick evaluation, the second angular moment is most suitable to depict the connective tissue.CONCLUSIONSOCT is a new imaging technique that has shown promise in peripheral nerve surgery for particular questions. Its resolution exceeds that provided by recent radiological possibilities such as MRI and HRS. Since its field of view is relatively small, faster acquisition times would be highly desirable and have already been demonstrated by other groups. Currently, the method resembles an optical biopsy and can be a supplement to intraoperative sonography, giving high-resolution insight into a suspect area that has been located by sonography in advance.

Download Full-text

Ultrasound-guided percutaneous injection of methylene blue to identify nerve pathology and guide surgery

Neurosurgical FOCUS ◽

10.3171/2015.6.focus15220 ◽

2015 ◽

Vol 39 (3) ◽

pp. E2 ◽

Cited By ~ 10

Author(s):

Joseph A. Osorio ◽

Jonathan D. Breshears ◽

Omar Arnaout ◽

Neil G. Simon ◽

Ashley M. Hastings-Robinson ◽

...

Keyword(s):

Methylene Blue ◽

Peripheral Nerve ◽

Peripheral Nerves ◽

Preoperative Period ◽

Ultrasound Guided ◽

Promising Technique ◽

Percutaneous Injection ◽

Surgical Exploration ◽

Road Map ◽

Nerve Surgery

OBJECT The objective of this study was to provide a technique that could be used in the preoperative period to facilitate the surgical exploration of peripheral nerve pathology. METHODS The authors describe a technique in which 1) ultrasonography is used in the immediate preoperative period to identify target peripheral nerves, 2) an ultrasound-guided needle electrode is used to stimulate peripheral nerves to confirm their position, and then 3) a methylene blue (MB) injection is performed to mark the peripheral nerve pathology to facilitate surgical exploration. RESULTS A cohort of 13 patients with varying indications for peripheral nerve surgery is presented in which ultrasound guidance, stimulation, and MB were used to localize and create a road map for surgeries. CONCLUSIONS Preoperative ultrasound-guided MB administration is a promising technique that peripheral nerve surgeons could use to plan and execute surgery.

Download Full-text

The phenomenon of focal peripheral nerve constriction: review of the literature

Neuromuscular Diseases ◽

10.17650/2222-8721-2019-9-1-24-31 ◽

2019 ◽

Vol 9 (1) ◽

pp. 24-31 ◽

Cited By ~ 1

Author(s):

D. S. Druzhinin ◽

E. S. Naumova ◽

S. S. Nikitin ◽

N. N. Spirin

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

High Resolution ◽

Peripheral Nerve ◽

Peripheral Nerves ◽

Imaging Techniques ◽

Review Of The Literature ◽

Resonance Imaging ◽

Pubmed Database ◽

Additional Imaging

Today the description of phenomenon of the focal “hourglass-like constriction” of the peripheral nerves in patients with acute pain mononeuropathy is often found in literature. The use of additional imaging techniques of peripheral nerves such as high-resolution ultrasound and magnetic resonance imaging allowed to detect this pathology more often. The purpose of the review is to summarize information about the phenomenon of the focal “hourglass-like constriction”. We analyzed 30 publications in PubMed database by key words: “Hourglass like construction of peripheral nerve” with the description of 158 patients with the focal “hourglass-like constriction”.

Download Full-text

Peripheral nerve magnetic resonance imaging

F1000Research ◽

10.12688/f1000research.19695.1 ◽

2019 ◽

Vol 8 ◽

pp. 1803 ◽

Cited By ~ 5

Author(s):

Yongsheng Chen ◽

E. Mark Haacke ◽

Jun Li

Keyword(s):

Magnetic Resonance Imaging ◽

Nervous System ◽

Magnetic Resonance ◽

High Resolution ◽

Peripheral Nerve ◽

Peripheral Nerves ◽

Morphological Changes ◽

Quantitative Mri ◽

Resonance Imaging

Magnetic resonance imaging (MRI) has been used extensively in revealing pathological changes in the central nervous system. However, to date, MRI is very much underutilized in evaluating the peripheral nervous system (PNS). This underutilization is generally due to two perceived weaknesses in MRI: first, the need for very high resolution to image the small structures within the peripheral nerves to visualize morphological changes; second, the lack of normative data in MRI of the PNS and this makes reliable interpretation of the data difficult. This article reviews current state-of-the-art capabilities in in vivo MRI of human peripheral nerves. It aims to identify areas where progress has been made and those that still require further improvement. In particular, with many new therapies on the horizon, this review addresses how MRI can be used to provide non-invasive and objective biomarkers in the evaluation of peripheral neuropathies. Although a number of techniques are available in diagnosing and tracking pathologies in the PNS, those techniques typically target the distal peripheral nerves, and distal nerves may be completely degenerated during the patient’s first clinic visit. These techniques may also not be able to access the proximal nerves deeply embedded in the tissue. Peripheral nerve MRI would be an alternative to circumvent these problems. In order to address the pressing clinical needs, this review closes with a clinical protocol at 3T that will allow high-resolution, high-contrast, quantitative MRI of the proximal peripheral nerves.

Download Full-text

Algorithms for automated montage synthesis of images from laser-scanning confocal microscopes

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100139627 ◽

1995 ◽

Vol 53 ◽

pp. 650-651

Author(s):

D. E. Becker

Keyword(s):

Image Analysis ◽

High Resolution ◽

Laser Scanning ◽

Cell Counting ◽

Wide Area ◽

Data Set ◽

Computational Synthesis ◽

Automated Cell Counting ◽

Partial View ◽

The Individual

An efficient, robust, and widely-applicable technique is presented for computational synthesis of high-resolution, wide-area images of a specimen from a series of overlapping partial views. This technique can also be used to combine the results of various forms of image analysis, such as segmentation, automated cell counting, deblurring, and neuron tracing, to generate representations that are equivalent to processing the large wide-area image, rather than the individual partial views. This can be a first step towards quantitation of the higher-level tissue architecture. The computational approach overcomes mechanical limitations, such as hysterisis and backlash, of microscope stages. It also automates a procedure that is currently done manually. One application is the high-resolution visualization and/or quantitation of large batches of specimens that are much wider than the field of view of the microscope.The automated montage synthesis begins by computing a concise set of landmark points for each partial view. The type of landmarks used can vary greatly depending on the images of interest. In many cases, image analysis performed on each data set can provide useful landmarks. Even when no such “natural” landmarks are available, image processing can often provide useful landmarks.

Download Full-text

On the Individual

European Psychologist ◽

10.1027//1016-9040.4.4.205 ◽

1999 ◽

Vol 4 (4) ◽

pp. 205-218 ◽

Cited By ~ 34

Author(s):

David Magnusson

Keyword(s):

School Psychologist ◽

Real Life ◽

Psychological Research ◽

Developmental Research ◽

Future Directions ◽

The 1950S ◽

The Individual ◽

Over Time

A description of two cases from my time as a school psychologist in the middle of the 1950s forms the background to the following question: Has anything important happened since then in psychological research to help us to a better understanding of how and why individuals think, feel, act, and react as they do in real life and how they develop over time? The studies serve as a background for some general propositions about the nature of the phenomena that concerns us in developmental research, for a summary description of the developments in psychological research over the last 40 years as I see them, and for some suggestions about future directions.

Download Full-text