Centrocentral anastomosis in the prevention and treatment of painful terminal neuroma

1985 ◽  
Vol 63 (5) ◽  
pp. 754-758 ◽  
Author(s):  
José González-Darder ◽  
José Barberá ◽  
M. José Abellán ◽  
Antonio Mora
Keyword(s):  
Sciatic Nerve ◽  
Control Parameter ◽  
Histological Study ◽  
Nerve Graft ◽  
Nerve Section ◽  
Content Type ◽  
Proximal Stump ◽  
Neuroma Formation ◽  
Fine Print ◽  
Observation Period

✓ In this experimental study, microsurgical centrocentral anastomosis was applied to an experimental model of painful terminal neuroma resulting from left sciatic nerve section in the rat. The anastomosis consisted of end-to-end suturing of the sciatic nerve fascicles to the tibial branch, with the interposition of a nerve graft taken from the same anastomosed fascicle. As a control parameter for the experiment, the autotomy which follows sciatic nerve section in the rat was evaluated. Autotomy is considered an objective indication of abnormal sensations that are provoked by the formation of a terminal neuroma. Histological study of the proximal stump of the sciatic nerve was also performed. The observation period was 10 weeks. The study demonstrates that centrocentral anastomosis reduces the size of the neuroma formation and the incidence of autotomy.

Relief of facial pain after combined removal of precentral and postcentral cortex

1971 ◽  
Vol 34 (4) ◽  
pp. 537-543 ◽  
Author(s):  
Richard A. Lende ◽  
Wolff M. Kirsch ◽  
Ralph Druckman
Keyword(s):  
Facial Pain ◽  
The Other ◽  
Precentral Gyrus ◽  
Nerve Section ◽  
Content Type ◽  
Burning Pain ◽  
Cortical Localization ◽  
The Brain ◽  
Fine Print ◽  
Frontal Lobotomy

✓ Cortical removals which included precentral and postcentral facial representations resulted in relief of facial pain in two patients. Because of known failures following only postcentral (SmI) ablations, these operations were designed to eliminate also the cutaneous afferent projection to the precentral gyrus (MsI) and the second somatic sensory area (SmII). In one case burning pain developed after a stroke involving the brain stem and was not improved by total fifth nerve section; prompt relief followed corticectomy and lasted until death from heart disease 20 months later. In the other case persistent steady pain that developed after fifth rhizotomy for trigeminal neuralgia proved refractory to frontal lobotomy; relief after corticectomy was immediate and has lasted 14 months. Cortical localization was established by stimulation under local anesthesia. Each removal extended up to the border of the arm representation and down to the upper border of the insula. Such a resection necessarily included SmII, and in one case responses presumably from SmII were obtained before removal. The suggestions of Biemond (1956) and Poggio and Mountcastle (1960) that SmII might be concerned with pain sensibility may be pertinent in these cases.

Prevention of painful neuromas by oblique transection of peripheral nerves

2006 ◽  
Vol 104 (2) ◽  
pp. 285-289 ◽  
Author(s):  
Wieslaw Marcol ◽  
Katarzyna Kotulska ◽  
Magdalena Larysz-Brysz ◽  
Grazyna Bierzyñska-Macyszyn ◽  
Pawel Wlaszczuk ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Sciatic Nerve ◽  
Peripheral Nerves ◽  
Traditional Method ◽  
Healing Process ◽  
Nerve Transection ◽  
Proximal Stump ◽  
Sciatic Nerves ◽  
Neuroma Formation

Object Neuroma formation often occurs at the proximal stump of the transected nerve, complicating the healing process after gap injuries or nerve biopsies. Most such neuromas cause therapy-resistant neuropathic pain. The purpose of this study was to determine whether oblique transection of the proximal stump of the sciatic nerve can prevent neuroma formation. Methods The sciatic nerves of 10 rats were transected unilaterally at an angle of 30°, and the peripheral segments of the nerves were removed. In 10 control animals the sciatic nerves were transected at a perpendicular angle. Twenty weeks after surgery the nerves were reexposed and collected. The presence of neuromas was determined by two board-certified pathologists on the basis of histopathological evaluations. Conclusions The oblique transection of peripheral nerves, contrary to perpendicularly transected nerves, is rarely followed by classic neuroma development. Moreover, neuropathic pain is significantly reduced compared with that following the traditional method of nerve transection.

Neuroepithelial cyst in the optic nerve

1987 ◽  
Vol 67 (1) ◽  
pp. 137-139 ◽  
Author(s):  
Alberto Isla ◽  
José Palacios ◽  
José M. Roda ◽  
Manuel Gutierrez ◽  
Cesáreo González ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Computerized Tomography ◽  
Cystic Lesion ◽  
Histological Study ◽  
Content Type ◽  
Neuroepithelial Cyst ◽  
Loss Of Vision ◽  
Progressive Loss ◽  
Suprasellar Region ◽  
Fine Print

✓ A 34-year-old woman presented with progressive loss of vision in her left eye of 2 months' evolution. Computerized tomography showed a hypodense lesion in the suprasellar region. At surgery a cystic lesion was found inside the optic nerve. Histological study proved it to be a neuroepithelial cyst. The pathogenesis of a neuroepithelial cyst in such an exceptional site is discussed.

Management and results of sciatic nerve injuries: a 24-year experience

1998 ◽  
Vol 89 (1) ◽  
pp. 13-23 ◽  
Author(s):  
David G. Kline ◽  
Daniel Kim ◽  
Rajiv Midha ◽  
Carter Harsh ◽  
Robert Tiel
Keyword(s):  
Sciatic Nerve ◽  
Spontaneous Recovery ◽  
Nerve Injuries ◽  
Management Guidelines ◽  
Content Type ◽  
Surgical Exploration ◽  
Excellent Outcome ◽  
Retrospective Clinical Study ◽  
Late Referral ◽  
Fine Print

Object. The purpose of this retrospective clinical study was to present results and provide management guidelines for various types of sciatic injuries. Methods. Over a 24-year period, 380 patients with sciatic nerve injuries were managed. In 230 patients (60%), the injury was at the buttock level, with injection injuries comprising more than half of these cases. Thigh-level sciatic injury was evaluated in 150 cases (40%) and was usually secondary to one of four main causes: 1) gunshot wound; 2) femur fracture; 3) laceration; or 4) contusion. Patients with partial deficits uncomplicated by severe pain or with significant spontaneous recovery or late referral were managed medically. Surgical exploration was not indicated in 23% of injuries at the thigh level and almost 50% of those at the buttock level. Most of these patients achieved partial but good spontaneous recovery, especially in the tibial division distribution. Surgical intervention was required for more complete and persistent deficits in either the tibial or peroneal distribution. Divisions of the sciatic nerve were split apart and evaluated independently. Management was guided by nerve action potential (NAP) recordings, which indicated whether neurolysis or resection of the lesion was required. Repair was then made by using sutures or more frequently by graft placement. In most cases in which neurolysis was performed because a positive NAP was recorded distal to the lesion, useful function was found in the peroneal distribution. Unfortunately, significant recovery occurred in only 36% of patients who received suture or graft repairs of the peroneal division. Good-to-excellent outcome was common for the tibial division, even in cases in which repair was proximal and required lengthy grafts. The relatively favorable recovery of tibial as opposed to peroneal divisions of the sciatic nerve occurred regardless of the level or mechanism of injury. Conclusions. Surgical exploration and, when necessary, repair of sciatic nerve injuries is worthwhile in selected cases.

Survival of adult rat retinal ganglion cells with regrown axons in peripheral nerve grafts: a comparison of graft attachment with suture or fibrin glue

2000 ◽  
Vol 93 (2) ◽  
pp. 275-278 ◽  
Author(s):  
Grant A. Robinson ◽  
Roger D. Madison
Keyword(s):  
Nervous System ◽  
Peripheral Nerve ◽  
Fibrin Glue ◽  
Ganglion Cells ◽  
Nerve Graft ◽  
Retinal Ganglion ◽  
Content Type ◽  
Adult Rat ◽  
Peripheral Nerve Graft ◽  
Fine Print

Object. The goal of this study was to examine whether the method of attachment of a peripheral nerve graft would have an effect on retinal ganglion cell (RGC) regeneration.Methods. The number of adult rat RGCs with regrown axons in a peripheral nerve graft was compared under two grafting conditions: 1) attachment of the graft to the optic nerve stump made using a suture; and 2) attachment made using fibrin glue. Counts of RGCs retrogradely labeled with FluoroGold from the grafts 1 month after attachment revealed approximately seven times the number of RGCs in the fibrin-glue group compared with the suture group.Conclusions. The use of fibrin glue may be a useful tool for enhancing the regrowth of central nervous system neuron axons into peripheral nervous system grafts.

Saccular aneurysm associated with segmental duplication of the basilar artery

1984 ◽  
Vol 61 (6) ◽  
pp. 1005-1008 ◽  
Author(s):  
Samuel P. W. Black ◽  
Linda E. Ansbacher
Keyword(s):  
Basilar Artery ◽  
Segmental Duplication ◽  
Histological Study ◽  
Postmortem Examination ◽  
Saccular Aneurysm ◽  
Single Specimen ◽  
Content Type ◽  
Synthetic Rubber ◽  
Fine Print ◽  
Need For Information

✓ Saccular aneurysm associated with segmental duplication (also called “fenestration”) of the basilar artery is an anomaly that results from an embryonic fault. Reports of the treatment of the aneurysmal component have only recently appeared in the neurosurgical literature, and little has been written on the morphology of this anomaly. This study answers the need for information about its structure to the extent permitted by the examination of a single specimen. The specimen was obtained at postmortem examination. A cast of its interior features was made with a synthetic rubber. After the cast was removed, the entire anomaly was serially sectioned for histological study. Defects in the wall of the basilar artery were seen microscopically at each end of the fenestration. At the extensive proximal defect, a saccular aneurysm arose that bulged into the window between the two limbs of the segmental duplication and also presented dorsally and ventrally. It had fatally ruptured. The manner in which the fenestration was formed by intraluminal septa was also revealed.

Management and outcomes in 353 surgically treated sciatic nerve lesions

2004 ◽  
Vol 101 (1) ◽  
pp. 8-17 ◽  
Author(s):  
Daniel H. Kim ◽  
Judith A. Murovic ◽  
Robert Tiel ◽  
David G. Kline
Keyword(s):  
Sciatic Nerve ◽  
Functional Outcomes ◽  
Surgical Techniques ◽  
Fracture Dislocation ◽  
Suture Repair ◽  
Nerve Lesions ◽  
Content Type ◽  
Injury Mechanisms ◽  
Grade 3 ◽  
Fine Print

Object. This is a retrospective analysis of 353 surgically treated sciatic nerve lesions in which injury mechanisms, location, time to surgical repair, surgical techniques, and functional outcomes are reported. Results are presented to provide guidelines for management of these injuries. Methods. One hundred seventy-five patients with buttock-level and 178 with thigh-level sciatic nerve injury were surgically treated at the Louisiana State University Health Sciences Center between 1968 and 1999. Buttock-level injury mechanisms included injection in 64 patients, hip fracture/dislocation in 26, contusion in 22, compression in 19, gunshot wound (GSW) in 17, hip arthroplasty in 15, and laceration in 12; at the thigh level, GSW was the cause in 62 patients, femoral fracture in 34, laceration in 32, contusion in 28, compression in 12, and iatrogenic injury in 10. Patients with sciatic nerve divisions in which positive intraoperative nerve action potentials (NAPs) were found underwent neurolysis and attained at least Grade 3 functional outcomes in 108 (87%) of 124 and in 91 (96%) of 95 buttock- and thigh-level tibial divisions, respectively, compared with 84 (71%) of 119 and 75 (79%) of 95, respectively, in the peroneal divisions. For suture repair, recovery to at least Grade 3 occurred in eight (73%) of 11 buttock-level and in 27 (93%) of 29 thigh-level tibial division injuries, and in three (30%) of 10 buttock-level and 20 (69%) of 29 thigh-level peroneal division lesions. For graft repair, good recovery occurred in 21 (62%) of 34 and in 43 (80%) of 54 buttock- and thigh-level tibial divisions, respectively, even in proximal repairs requiring long grafts, and in only nine (24%) of 37 and 22 (45%) of 49 buttock- and thigh-level peroneal division lesions, respectively. Conclusions. Surgical exploration and neurolysis after positive NAP readings, or repair with sutures or grafts after negative NAP results are worthwhile in selected cases.

Neural regeneration along longitudinal polyglactin sutures across short and extended defects in the rat sciatic nerve

2001 ◽  
Vol 95 (2) ◽  
pp. 316-323 ◽  
Author(s):  
Peter Scherman ◽  
Göran Lundborg ◽  
Martin Kanje ◽  
Lars B. Dahlin
Keyword(s):  
Sciatic Nerve ◽  
Neural Regeneration ◽  
Extended Defects ◽  
Force Measurements ◽  
Neurofilament Protein ◽  
Content Type ◽  
Nerve Grafts ◽  
Rat Sciatic Nerve ◽  
Nerve Segment ◽  
Fine Print

Object. The authors have previously shown that longitudinal sutures without artificial tube support regeneration across a 7-mm gap in the rat sciatic nerve. In the present study, the authors compared this new approach with the use of autologous nerve grafts across short defects and examined whether the approach could be used to support regeneration across extended gaps and whether the interposition of a short nerve segment (the stepping-stone procedure) was applicable in this model. Methods. Longitudinal sutures were used to bridge 7- and 15-mm gaps in the rat sciatic nerve. Contralateral comparisons were made to nerve autografts in the 7-mm group and to sutures plus a short interposed nerve segment in the 15-mm group. Regeneration was evaluated at 2, 4, and 12 weeks by using immunocytochemical analysis for Schwann cells, neurofilament protein, and macrophages and at 12 weeks also by using histological examination, including morphometry in the distal tibial trunk and tetanic force measurements in the gastrocnemius muscle. Conclusions. The authors found that the results of regeneration after repair with longitudinal polyglactin sutures across short defects were not significantly different from those produced by the use of autologous nerve grafts. Regeneration, although poor, occurred along sutures across extended gaps and was significantly enhanced by an interposed nerve segment acting as a Schwann cell resource in this model.

scholarly journals Direct thrombosis of experimental aneurysms with cellulose acetate polymer (CAP): technical aspects, angiographic follow up, and histological study

1995 ◽  
Vol 83 (3) ◽  
pp. 531-538 ◽  
Author(s):  
Kenji Sugiu ◽  
Kazushi Kinugasa ◽  
Shinya Mandai ◽  
Koji Tokunaga ◽  
Takashi Ohmoto
Keyword(s):  
Endothelial Cells ◽  
Cellulose Acetate ◽  
Histological Analysis ◽  
Histological Study ◽  
Parent Artery ◽  
Content Type ◽  
Parent Artery Occlusion ◽  
Endovascular Approach ◽  
Fine Print

✓ Experimental aneurysms were created using a microsurgical technique to produce anastomosed venous pouches in the bilateral common carotid arteries of 12 dogs. The 24 aneurysms were then thrombosed via an endovascular approach with injection of a cellulose acetate polymer (CAP) solution that the authors have developed for use as a liquid thrombotic material. Angiography performed 1 to 4 weeks after CAP injection revealed complete thrombosis of the aneurysm with patency of the parent artery in 16 aneurysms. Histological analysis disclosed that the aneurysmal orifice in these cases was completely covered with newly formed endothelial cells 2 weeks after CAP thrombosis. Three other aneurysms exhibited parent artery occlusion caused by protrusion of the CAP mass through the aneurysmal orifice into the parent artery; this was thought to be caused by over-injection of the CAP solution. Histological analysis of the remaining five aneurysms, initially shown to have incomplete occlusion, revealed that they each possessed a residual neck that was partially covered with endothelial cells. No rupture of the aneurysms or migration of CAP into the distal arteries was observed. These results suggest that using an endovascular approach, direct thrombosis of cerebral aneurysms with CAP is safe and effective. This technique may prove to be an alternative treatment for such aneurysms. However, there is a potential risk of regrowth or rupture of aneurysms that retain a residual neck and long-term follow-up studies will be required to evaluate this issue.

Centrocentral anastomosis of the proximal nerve stump in the treatment of painful amputation neuromas of major nerves

1993 ◽  
Vol 79 (3) ◽  
pp. 331-334 ◽  
Author(s):  
Jose Barbera ◽  
Rafael Albert-Pamplo
Keyword(s):  
Lower Limb ◽  
Peroneal Nerve ◽  
Nerve Stump ◽  
Laboratory Findings ◽  
Content Type ◽  
Nerve Grafts ◽  
Amputation Neuroma ◽  
Proximal Stump ◽  
Neuroma Formation

✓ The term “centrocentral anastomosis” is used to describe the end-to-end connection across interposed nerve grafts between paired fascicular groups of the proximal stump of a severed nerve. In 22 patients harboring a painful terminal neuroma following amputation of a lower limb (20 neuromas on the sciatic nerve and two on the peroneal nerve), a centrocentral anastomosis was performed on the end of the sectioned nerve to treat pain that had not improved with conventional conservative treatment. Follow-up review at 1 year revealed that the typical neuroma pain had disappeared in all cases, although sporadic diffuse pain persisted in four. Where previous phantom sensation was present, no change was observed. The results presented here are consistent with laboratory findings demonstrating the absence of neuroma formation after centrocentral anastomosis. Therefore, this technique is recommended for the treatment of painful amputation neuroma.

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