Surgical outcome for intra- and extrapelvic femoral nerve lesions

1995 ◽  
Vol 83 (5) ◽  
pp. 783-790 ◽  
Author(s):  
Daniel H. Kim ◽  
David G. Kline
Keyword(s):  
Femoral Nerve ◽  
Common Mechanism ◽  
Nerve Injuries ◽  
Inguinal Herniorrhaphy ◽  
Nerve Lesions ◽  
Content Type ◽  
Ganglion Cysts ◽  
Neurogenic Sarcoma ◽  
Grade 3 ◽  
Fine Print

✓ Seventy-eight traumatic neuropathies were seen in 94 patients with femoral nerve lesions; 54 of these were operated on because of persistent complete functional loss and/or pain. The most common mechanism of injury to the femoral nerve was iatrogenic due to inguinal herniorrhaphy, total hip replacement, intraabdominal vascular or gynecological operation, and, less commonly, appendectomy, lumbar sympathectomy, and laparoscopic procedures. Femoral nerve injuries also resulted from penetrating gunshot and stab wounds, laceration by glass, and stretch/contusive injuries associated with pelvic fractures. There were no signs of clinical or electrical recovery in 45 of 78 patients with traumatic nerve injuries. These and other partial injuries associated with pain were explored and evaluated by intraoperative nerve stimulation and recording of nerve action potentials (NAPs). Despite complete loss of nerve function preoperatively, 13 patients had recordable NAPs and underwent neurolysis; each recovered function to at least a Grade 3 level. Twenty-seven patients had sural graft repairs performed with graft lengths varying from 2.5 to 14 cm. Most patients had some nerve regeneration and regained function to Grade 3 to 4 levels by 2 years postoperatively. Four of five patients with suture repairs recovered to Grade 3 or better within 2 years postoperatively. Despite a proximal pelvic level for most of these injuries and, as a result, lengthy graft repairs, recovery of some useful function was the rule rather than the exception. Tumors involved the femoral nerve in 16 patients and included eight neurofibromas, four schwannomas, one neurogenic sarcoma, two ganglion cysts, and one leiomyosarcoma. All tumors were treated surgically and most were removed successfully.

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.

Femoral nerve repair with nerve autografts

1977 ◽  
Vol 47 (5) ◽  
pp. 751-754 ◽  
Author(s):  
Ole Osgaard ◽  
Jakob Husby
Keyword(s):  
Nerve Repair ◽  
Femoral Nerve ◽  
Nerve Lesions ◽  
Content Type ◽  
Pelvic Region ◽  
Femoral Triangle ◽  
Fine Print

✓ Two cases of femoral nerve lesions are reported, one in the pelvic region, and one in the femoral triangle. In both cases, secondary microsurgical autografting resulted in a good functional and electrophysiological recovery.

Intrapelvic and thigh-level femoral nerve lesions: management and outcomes in 119 surgically treated cases

2004 ◽  
Vol 100 (6) ◽  
pp. 989-996 ◽  
Author(s):  
Daniel H. Kim ◽  
Judith A. Murovic ◽  
Robert L. Tiel ◽  
David G. Kline
Keyword(s):  
Femoral Nerve ◽  
Gunshot Wounds ◽  
Nerve Lesion ◽  
Cystic Lesions ◽  
State University ◽  
Nerve Lesions ◽  
Content Type ◽  
Louisiana State University ◽  
Injury Mechanisms ◽  
Fine Print

Object. The authors present a retrospective analysis of 119 surgically treated femoral nerve lesions at intrapelvic and thigh levels seen at the Louisiana State University Health Sciences Center. Methods. Femoral nerve lesions treated between 1967 and 2000, (89 traumatic injuries and 30 tumors and cystic lesions) were evaluated for injury mechanisms, resulting lesions, surgical management, and postoperative functional outcomes by using retrospective chart reviews. The most common injury mechanism was iatrogenic (52 cases), which occurred after hernia and hip operations (10 each), followed by arterial bypass and gynecological procedures (eight each), angiography (seven), abdominal surgery (five), appendectomy (two), a laparoscopy, and a lumbar sympathectomy. Other injury mechanisms included hip or pelvic fractures (19), gunshot wounds (10), and lacerations (eight). The 30 femoral nerve tumors and cystic lesions consisted of neurofibromas (16), schwannomas (nine), ganglionic cysts (two), neurogenic sarcomas (two), and a leiomyosarcoma. Forty-four patients underwent neurolysis. Some had recordable nerve action potentials (NAPs) across their lesions in continuity, despite severe distal loss. Others with recordable NAPs had mild loss, but also experienced a pain problem, which was helped in some by neurolysis. In 36 patients, in whom repairs were performed using long sural grafts for mostly proximal pelvic-level injuries, recovery of useful function occurred. Eight of nine thigh-level suture repairs led to improvement to good functional levels. Most of the tumors and cystic lesions were resected, with preservation of preoperative function. Conclusions. The majority of femoral nerve injuries resulted in lesions in continuity, and intraoperative NAP recordings were essential in evaluating axonal regeneration across these lesions. Despite severe and frequently proximal injury levels requiring repairs with long grafts, femoral nerve lesion repairs resulted in good functional recovery.

Traumatic dislocation of the atlanto-occipital articulation (AOA) with short-term survival

1980 ◽  
Vol 52 (4) ◽  
pp. 541-546 ◽  
Author(s):  
Arthur B. Dublin ◽  
William M. Marks ◽  
David Weinstock ◽  
Thomas H. Newton
Keyword(s):  
Systemic Hypertension ◽  
Nerve Injuries ◽  
Short Term ◽  
Term Survival ◽  
Content Type ◽  
Traumatic Dislocation ◽  
Cranial Nerve Injuries ◽  
Angiographic Evidence ◽  
Fine Print ◽  
Short Term Survival

✓ Three patients with traumatic atlanto-occipital articulation (AOA) dislocation are presented, and an additional 10 well documented cases are reviewed from the literature. Medulla oblongata and/or spinal cord deficits, and evidence of cranial nerve injuries were noted in eight patients. Angiographic evidence of vertebral occlusion or narrowing was demonstrated in four patients. One patient had systemic hypertension, presumably from bilateral traumatic ninth nerve injuries. Five patients ultimately died. A new method for measuring the AOA is introduced.

Surgical management and outcome in patients with radial nerve lesions

2001 ◽  
Vol 95 (4) ◽  
pp. 573-583 ◽  
Author(s):  
Daniel H. Kim ◽  
Andrew C. Kam ◽  
Padmavathi Chandika ◽  
Robert L. Tiel ◽  
David G. Kline
Keyword(s):  
Surgical Management ◽  
Radial Nerve ◽  
Gunshot Wounds ◽  
Suture Repair ◽  
Content Type ◽  
Louisiana State University ◽  
Internal Neurolysis ◽  
End To End ◽  
Grade 3 ◽  
Fine Print

Object. The goal of this paper was to review surgical management and outcomes in patients treated for radial nerve (RN) lesions at Louisiana State University Health Sciences over a period of 30 years. Methods. Two hundred sixty patients with RN injuries were evaluated. The most common mechanisms of injuries involving the RN included fracture of the humerus, laceration, blunt contusions, and gunshot wounds. One hundred and eighty patients (69%) underwent surgery. Lesions not in continuity required primary or secondary end-to-end suture repairs or graft repairs. With the use of direct intraoperative nerve action potential recording, RN injuries in which the lesion was in continuity required external or internal neurolysis or resection of the lesion followed by end-to-end suture or graft repair. A minimum of 1.5 years follow-up review was available in 90% of the patients who underwent surgery. Motor function recovery to Grade 3 or better was observed in 10 (91%) of 11 patients who underwent primary suture repair, 25 (83%) of 30 who underwent secondary suture repair, 43 (80%) of 54 who received graft repair, and 63 (98%) of 64 in whom neurolysis was performed. Sixteen (71%) of 21 patients with superficial sensory RN injury achieved satisfactory pain relief after complete resection of a neuroma or neurolysis. Conclusions. This study clearly demonstrates that excellent functional recovery can be achieved with proper surgical management of RN injuries.

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.

Surgical treatment of lumbosacral plexus injuries

2004 ◽  
Vol 1 (1) ◽  
pp. 64-71 ◽  
Author(s):  
Eva Maria Lang ◽  
Jörg Borges ◽  
Thomas Carlstedt
Keyword(s):  
Cauda Equina ◽  
Femoral Nerve ◽  
Severe Trauma ◽  
Lumbosacral Plexus ◽  
Spinal Root ◽  
Content Type ◽  
Spinal Nerves ◽  
Nerve Grafts ◽  
Nerve Transfers ◽  
Fine Print

Object. The purpose of this study was to analyze therapeutic possibilities and clinical outcomes in patients with lumbosacral plexus injuries to develop surgical concepts of treatment. Methods. In a retrospective investigation 10 patients with injuries to the lumbosacral plexus were evaluated after surgery. The patients were assessed clinically, electrophysiologically, and based on the results of magnetic resonance imaging and computerized tomography myelography. In most patients a traction injury had occurred due to severe trauma that also caused pelvic fractures. In most cases the roots of the cauda equina of the lumbosacral plexus had ruptured. In cases of spinal root ruptures repair with nerve grafts were performed. In cases in which proximal stumps of the plexus could not be retrieved palliative nerve transfers by using lower intercostals nerves or fascicles from the femoral nerve were performed. Conclusions. Lesions of the proximal spinal nerves and cauda equina occur in the most serious lumbosacral plexus injuries. Patients with such injuries subjected to reconstruction of spinal nerves, repair of ventral roots in the cauda equina, and nerve transfers recovered basic lower-extremity functions such as unsupported standing and walking.

Experimental spinal cord injury: quantitation of axonal damage by automated image analysis

1986 ◽  
Vol 64 (2) ◽  
pp. 304-308 ◽  
Author(s):  
Hideaki Iizuka ◽  
Teiji Yamamoto ◽  
Yuzo Iwasaki ◽  
Hidehiko Konno ◽  
Satoru Kadoya
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Voluntary Movement ◽  
Content Type ◽  
Experimental Spinal Cord Injury ◽  
Cord Injury ◽  
Grade 3 ◽  
Silver Grains ◽  
Fine Print ◽  
Degenerating Axons

✓ The severity of acute experimental spinal cord injury in rats was assessed quantitatively with the aid of an automated image analyzer by measuring the amount of degenerating axons that had developed distal to the site of mechanical insult. Spinal cord injury was produced in adult male rats by epidural compression at T-11 with a Biemer vascular clip. On the 7th postoperative day, the animals were graded according to the degree of hindlimb motor deficit, as follows: Grade 0: normal (three rats); Grade 1: crawling with difficulty (10 rats); Grade 2: some voluntary movement (nine rats); and Grade 3: no voluntary movement (nine rats). The rats were then sacrificed. The L-6 segment was chosen for selective silver impregnation of degenerating axons by the Fink-Heimer method. Silver grains, representing degenerating axons and their terminals, were accumulated in the descending tracts and in Rexed's laminae VII and VIII. The extent of axonal damage was expressed by the percentage of the area occupied by silver grains in Rexed's lamina VIII. The area occupied by silver grains was 17.0% (mean) in Grade 0 rats, 22.3% ± 2.63% (mean ± standard deviation) in Grade 1 rats, 28.7% ± 3.35% in Grade 2 rats, and 35.9% ± 2.76% in Grade 3 rats. The severity in Grade 3 rats was close to that of rats with transected cords (37.6% ± 0.89%). The differences among the groups were statistically significant (p < 0.001). This method may serve as a useful tool for the objective assessment of therapeutic modalities in large series of small experimental animals.

Computerized tomography and surgical treatment of femoral compression neuropathy

1982 ◽  
Vol 57 (1) ◽  
pp. 137-139 ◽  
Author(s):  
Alf T. Tysvaer
Keyword(s):  
Surgical Treatment ◽  
Computerized Tomography ◽  
Anticoagulation Therapy ◽  
Femoral Nerve ◽  
Proximal Gastric Vagotomy ◽  
Content Type ◽  
Small Abscess ◽  
Large Hematoma ◽  
Iliacus Muscle ◽  
Fine Print

✓ Two cases of femoral nerve compression are described. In the first, a large hematoma developed in the iliacus muscle while the patient was receiving anticoagulation therapy. In the second, a small abscess developed in the iliacus muscle 4 days after a proximal gastric vagotomy. Both cases were diagnosed by computerized tomography.

Reversal of thalamic hand syndrome by long-term motor cortex stimulation

2000 ◽  
Vol 93 (5) ◽  
pp. 873-875 ◽  
Author(s):  
Angelo Franzini ◽  
Paolo Ferroli ◽  
Domenico Servello ◽  
Giovanni Broggi
Keyword(s):  
Motor Cortex ◽  
Complete Recovery ◽  
Common Mechanism ◽  
Central Pain ◽  
Motor Cortex Stimulation ◽  
Content Type ◽  
Hand Dystonia ◽  
Fine Print

✓ The authors describe a case of complete recovery from the so-called “thalamic hand” syndrome following chronic motor cortex stimulation in a 64-year-old man suffering from poststroke thalamic central pain. As of the 2-year follow-up examination, the patient's dystonia and pain are still controlled by electrical stimulation.It is speculated that a common mechanism in which the thalamocortical circuit loops are rendered out of balance may sustain hand dystonia and central pain in this case of thalamic syndrome. To the authors' knowledge this is the first reported case of its kind.

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