Nerve allotransplantation following severe tibial nerve injury

1996 ◽  
Vol 84 (4) ◽  
pp. 671-676 ◽  
Author(s):  
Susan E. Mackinnon
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Clinical Experience ◽  
Tibial Nerve ◽  
Posterior Tibial Nerve ◽  
Content Type ◽  
Posterior Tibial ◽  
Successful Recovery ◽  
Fine Print

✓ The successful recovery of sensibility across a long peripheral nerve allograft in a 12-year-old boy who sustained a severe posterior tibial nerve injury is reported. The historical clinical experience with nerve allotransplantation is also reviewed. It is concluded that in the carefully selected patient with severe nerve injury, consideration for nerve allotransplantation can be given.

Ganglion of the posterior tibial nerve

1974 ◽  
Vol 40 (1) ◽  
pp. 120-124 ◽  
Author(s):  
Moses Stephen Mahaley
Keyword(s):  
Tibial Nerve ◽  
Posterior Tibial Nerve ◽  
Content Type ◽  
Posterior Tibial ◽  
Fine Print

✓ A unique instance of ganglion of a posterior tibial nerve is described, and the histology and nature of this lesion evaluated.

Trigeminal evoked potentials in somatosensory cortex of the Macaca mulatta

1995 ◽  
Vol 82 (6) ◽  
pp. 1015-1020 ◽  
Author(s):  
Gregory McCarthy ◽  
Truett Allison
Keyword(s):  
Somatosensory Cortex ◽  
Macaca Mulatta ◽  
Hard Palate ◽  
Tibial Nerve ◽  
Posterior Tibial Nerve ◽  
Lateral Region ◽  
Content Type ◽  
Posterior Tibial ◽  
Fine Print ◽  
Stimulation Of

✓ Somatosensory evoked potentials (SEPs) obtained in response to stimulation of the median nerve, posterior tibial nerve, lips, tongue, palate, and pharynx were recorded in four monkeys (Macaca mulatta) under light barbiturate anesthesia. In agreement with the results of SEP recordings in humans and single-unit recordings in monkeys, there is a medial-to-lateral representation in somatosensory cortex of the hand, lips, and tongue. There is a discontinuity in the representation of the upper mouth: the tongue representation is interposed between a medial region (near the lip representation), usually representing the lateral hard palate and gum, and a lateral region (near the lateral sulcus), usually representing the central hard palate. For all types of trigeminal stimulation, root mean square (RMS) voltage maps show maxima over somatosensory cortex. Laminar recordings demonstrated that trigeminal SEPs recorded from the cortical surface are generated in somatosensory cortex in areas 1, 2, and 3b. Median nerve and posterior tibial nerve stimulation did not evoke SEPs in the surface cortex near the lateral sulcus, suggesting that the most lateral portion of the postcentral gyrus is not a part of the second somatosensory area (SII). This lateral region may contain the representation of posterior intraoral structures, but it was not possible to confirm this assumption by stimulation of the soft palate or pharynx.

scholarly journals WHAT NEUROMONITORING CHANGES CAN BE EXPECTED DURING HIP ARTHROSCOPY IN THE PEDIATRIC POPULATION?

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0001
Author(s):  
Trevor J. Shelton ◽  
Akash R. Patel ◽  
Lauren Agatstein ◽  
Brian Haus
Keyword(s):  
Risk Factors ◽  
Sciatic Nerve ◽  
Nerve Injury ◽  
Hip Arthroscopy ◽  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Pediatric Population ◽  
Labral Tear ◽  
Posterior Tibial Nerve ◽  
Posterior Tibial

Background: Hip arthroscopy continues to evolve for treating hip pathologies disorders. With this evolution, comes an awareness of its associated complications. One potential side effect is damage to the nerves about the hip, usually affecting the pudendal or sciatic nerve. In one study of 60 adults, 58% of the patients had intraoperative nerve dysfunction and 7% sustained a clinical nerve injury. It has been reported that the rate of pediatric pudendal nerve palsy ranges from < 1% to 6% following hip arthroscopy. However, the rate of sciatic nerve injury during hip arthroscopy in the pediatric population is unknown. As such, the objectives of this study were to determine the 1) prevalence, pattern, and predisposing factors for sciatic, femoral, and obturator nerve injury during hip arthroscopy in the pediatric population, and 2) were there any risk factors associated with nerve injury during hip arthroscopy in the pediatric population? Methods: We retrospectively reviewed charts of all pediatric patients who underwent hip arthroscopy with neuromonitoring from 2013 until May 2018. Neuromonitoring included when traction was applied and removed, and somatosensory evoked potentials (SSEP) in the peroneal and posterior tibial nerves and electromyography (EMG) signal for the obturator, femoral, and peroneal and posterior tibial branch of the sciatic nerves. Each report was reviewed for total traction time, EMG changes, SSEP changes more than 50% after traction application, and the time for SSEPs to return to baseline. Demographic data and postoperative notes were reviewed for any signs of clinical nerve injury and if/when recovery occurred. We determined the rate of SSEP and EMG changes, time from traction onset to SSEP and EMG changes, time after traction released until SSEP returns to baseline, rate of neuropraxia and any potential risk factors, and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of SSEP changes in predicting neuropraxia. Risk factors for neuropraxia were assessed using a Wilcoxon Rank Sums test between those who sustained a neuropraxia and those who did not. Results: We identified 78 patients who underwent hip arthroscopy (16±2 years of age; 24 males, 54 females; BMI 26 ± 6 kg/m2). Reasons for hip arthroscopy included femoral acetabular impingement (37%, N=29), hip dysplasia with labral tear (27%, N=21), slipped capital femoral epiphysis (23%, N=18), labral tear (5%, N=4), snapping hip (3%, N=2), diagnostic scope (3%, N=2), Perthes with labral tear (1%, N=1), and trauma (1%, N=1). Average traction time was 64±30 min. SSEPs decreases of less than 50% occurred in 76% of patients (N=59) in the peroneal branch of the sciatic nerve, and 69% of patients (N=54) in the posterior tibial branch of the sciatic nerve. In the contralateral limb, there was a 50% drop in SSEPs in the peroneal branch of the sciatic nerve in 13% of patients (N=10) and in the posterior tibial branch of the sciatic nerve in 8% of patients (N=6). For the peroneal nerve, this drop in signal occurred 23±11 min after traction was applied and returned intraoperatively at a rate of 74% 29±23 min after traction removal. For the posterior tibial nerve, this drop in signal occurred 22±12 min after traction was applied and returned intraoperatively at a rate of 83% 24±15 min. after traction removal. EMG activity was observed after traction application in 10% of patients in the obturator nerve at 36 ± 34 min., 9% of patients in the femoral nerve at 22 ± 15 min., 14% of patients in the peroneal nerve at 19±27 min, and 5% of patients in the posterior tibial nerve at 42±42 min. The rate of clinical neuropraxia postoperatively was 18% (N=14), manifesting as sensory disruption in the peroneal nerve in 11 patients, sensory and motor disruption of the peroneal nerve in 2 patients, sensory disruption in the posterior tibial nerve in 1 patient, and 1 patient with combined sensory peroneal and posterior tibial nerve disruption. Thus, the drop in SSEPs in predicting a postoperative clinical neuropraxia of the peroneal nerve yields a sensitivity of 64%, a specificity of 28%, a PPV of 20%, and a NPV value of 95%. For the posterior tibial nerve, the sensitivity is 100%, specificity is 21%, PPV is 4%, and NPV is 100%. In all cases, the neuropraxia resolved before the first postoperative visit. Those who sustained a neuropraxia had on average a 54 min. longer surgery (p = 0.0053) and a trend towards a 14 min. longer traction time (p = 0.0955). Conclusion: Hip arthroscopy continues to have more uses in the pediatric population. As such, it is important to understand the potential risks with this surgery. The important findings of this study are that neuromonitoring changes occur in more than 70% of patients and nearly 20% of patients will have some decreased sensation in either their peroneal nerve or posterior tibial nerve that resolves within 1-2 days after surgery. Another important finding is that there is a low risk of neuropraxia if there are no neuromonitoring changes during surgery. Finally, longer surgery and traction time appear to be the only risk factors for neuropraxia in hip arthroscopy in pediatric patients.

Spatial pattern of type I collagen expression in injured peripheral nerve

1997 ◽  
Vol 86 (5) ◽  
pp. 866-870 ◽  
Author(s):  
Rahul K. Nath ◽  
Susan E. Mackinnon ◽  
John N. Jensen ◽  
William C. Parks
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Collagen Type ◽  
Collagen Type I ◽  
Type I ◽  
Collagen Production ◽  
Content Type ◽  
Spatial Expression ◽  
Sciatic Nerves ◽  
Fine Print

✓ The authors studied the spatial expression and regulation of messenger RNA for the a 1 subunit of collagen type I in crushed rat sciatic nerve to provide a basis for future therapeutic manipulation. Sciatic nerves in 20 male or female adult Lewis rats were crushed for 60 seconds; the unharmed contralateral sciatic nerves served as controls. Twenty-one days after injury the experimental animals were killed and their tissue was harvested. The spatial expression of collagen type I was determined by using in situ hybridization techniques. Quantification of fibroblast number and total signal was performed through computerized morphometry. Collagen upregulation was evident in epineurial and perineurial layers, with the epineurium displaying higher activity. The cells responsible for procollagen type I production were fibroblasts. No activity was seen in the endoneurium. Morphometric findings indicated that collagen upregulation in the epineurium and perineurium occurred at both pretranscriptional and posttranslational levels when compared to controls; a paired t-test analysis confirmed statistical significance for all comparisons between injured and control tissues. Epineurial fibroblasts are responsible for the collagen production associated with crushed peripheral nerve injury in the rat. Regulation occurs pretranscriptionally as well as posttranslationally. It is interesting to speculate that the delivery of agents directed against collagen production (such as neutralizing antibodies to growth factors) into epineurial tissues proximate to the time and location of clinical nerve injury might mitigate later deleterious effects of excess collagen production in axonal regeneration.

Tarsal Tunnel Surgery for Treatment of Tarsal Ganglion

2005 ◽  
Vol 95 (5) ◽  
pp. 459-463 ◽  
Author(s):  
Gedge D. Rosson ◽  
Robert J. Spinner ◽  
A. Lee Dellon
Keyword(s):  
Nerve Injury ◽  
Tibial Nerve ◽  
Posterior Tibial Artery ◽  
Tarsal Tunnel ◽  
Posterior Tibial Nerve ◽  
Intraneural Ganglion ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Guiding Principles

Three patients who originally presented with a mass in the tarsal tunnel are described to develop an algorithm for management of the tarsal ganglion. All three patients had complications from ganglion excision, including complete division of the posterior tibial nerve, injury to the posterior tibial artery, and ganglion recurrence. The guiding principles relating to the presence of an extraneural versus an intraneural ganglion are developed. An example of a posterior tibial intraneural ganglion is presented. (J Am Podiatr Med Assoc 95(5): 459–463, 2005)

scholarly journals An Argument for Salvage in Severe Lower Extremity Trauma with Posterior Tibial Nerve Injury

2015 ◽  
Vol 136 (6) ◽  
pp. 1337-1352 ◽  
Author(s):  
Adeyiza O. Momoh ◽  
Senthil Kumaran ◽  
Daniel Lyons ◽  
Hari Venkatramani ◽  
Sanjai Ramkumar ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Nerve Injury ◽  
Tibial Nerve ◽  
Posterior Tibial Nerve ◽  
Lower Extremity Trauma ◽  
Posterior Tibial ◽  
Extremity Trauma

Thermographic imaging of cutaneous sensory segment in patients with peripheral nerve injury

1985 ◽  
Vol 62 (5) ◽  
pp. 716-720 ◽  
Author(s):  
Sumio Uematsu
Keyword(s):  
Peripheral Nerve ◽  
Skin Temperature ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Cost Effective ◽  
Subjective Assessment ◽  
The Body ◽  
Content Type ◽  
Thermographic Imaging ◽  
Fine Print

✓ Sensory examination based on the patient's subjective assessment of symptoms may raise difficult questions about whether the individual's expressed complaint is based on organic nerve damage, psychogenic factors, or even malingering. A prototype computerized telethermograph has allowed clinical quantification of peripheral nerve injury. The system makes possible mapping and imaging of the damaged area, as well as skin temperature measurements. In normal persons, the skin temperature difference between sides of the body was only 0.24° ± 0.073°C. In contrast, in patients with peripheral nerve injury, the temperature of the skin innervated by the damaged nerve deviated an average of 1.55°C (p < 0.001). The new technique requires further refinement, but it appears that use of this method may be cost-effective in helping to resolve medicolegal conflicts concerning peripheral nerve injury.

A Case of Posterior Tibial Nerve Injury After Arthroscopic Calcaneoplasty

2018 ◽  
Vol 57 (3) ◽  
pp. 587-592 ◽  
Author(s):  
Helene Retrouvey ◽  
Jeremy Silvanathan ◽  
Robert R. Bleakney ◽  
Dimitri J. Anastakis
Keyword(s):  
Nerve Injury ◽  
Tibial Nerve ◽  
Posterior Tibial Nerve ◽  
Posterior Tibial

Convection-enhanced delivery in intact and lesioned peripheral nerve

2001 ◽  
Vol 95 (6) ◽  
pp. 1001-1011 ◽  
Author(s):  
John K. Ratliff ◽  
Edward H. Oldfield
Keyword(s):  
Spinal Cord ◽  
Peripheral Nerve ◽  
Nerve Regeneration ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Extracellular Space ◽  
Clinical Applications ◽  
Convection Enhanced Delivery ◽  
Content Type ◽  
Fine Print

Object. Although the use of multiple agents is efficacious in animal models of peripheral nerve injury, translation to clinical applications remains wanting. Previous agents used in trials in humans either engendered severe side effects or were ineffective. Because the blood—central nervous system barrier exists in nerves as it does in the brain, limited drug delivery poses a problem for translation of basic science advances into clinical applications. Convection-enhanced delivery (CED) is a promising adjunct to current therapies for peripheral nerve injury. In the present study the authors assessed the capacity of convection to ferry macromolecules across sites of nerve injury in rat and primate models, examined the functional effects of convection on the intact nerve, and investigated the possibility of delivering a macromolecule to the spinal cord via retrograde convection from a peripherally introduced catheter. Methods. The authors developed a rodent model of convective delivery to lesioned sciatic nerves (injury due to crush or laceration in 76 nerves) and compared the results to a smaller series of five primates with similar injuries. In the intact nerve, convective delivery of vehicle generated only a transient neurapraxic deficit. Early after injury (postinjury Days 1, 3, 7, and 10), infusion failed to cross the site of injury in crushed or lacerated nerves. Fourteen days after crush injury, CED of radioactively-labeled albumin resulted in perfusion through the site of injury to distal growing neurites. In primates, successful convection through the site of crush injury occurred by postinjury Day 28. In contrast, in laceration models there was complete occlusion of the extracellular space to convective distribution at the site of laceration and repair, and convective distribution in the extracellular space crossed the site of injury only after there was histological evidence of completion of nerve regeneration. Finally, in two primates, retrograde infusion into the spinal cord through a peripheral nerve was achieved. Conclusions. Convection provides a safe and effective means to deliver macromolecules to regenerating neurites in crush-injured peripheral nerves. Convection block in lacerated and suture-repaired nerves indicates a significant intraneural obstruction of the extracellular space, a disruption that suggests an anatomical obstruction to extracellular and, possibly, intraaxonal flow, which may impair nerve regeneration. Through peripheral retrograde infusion, convection can be used for delivery to spinal cord gray matter. Convection-enhanced delivery provides a promising approach to distribute therapeutic agents to targeted sites for treatment of disorders of the nerve and spinal cord.

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