Plastic and Reconstructive Surgery, Department of Surgical, Oncological, and Oral Sciences, and.
"Clinical Course" Neurophysiology Unit, Palermo, Italy.
J Neurosurg. 2016 Sep;125(3):603-14. doi: 10.3171/2015.6.JNS151001. Epub 2016 Jan 22.
OBJECTIVE The purpose of this study was to evaluate the usefulness of ultrasound in the preoperative workup of peripheral nerve lesions and illustrate how nerve ultrasonography can be integrated in routine clinical and neurophysiological evaluation and in the management of focal peripheral nerve injuries. The diagnostic role and therapeutic implications of ultrasonography for different neuropathies are described. METHODS The authors analyzed the use of ultrasound in 119 entrapment, tumoral, posttraumatic, or postsurgical nerve injuries of limbs evaluated in 108 patients during 2013 and 2014. All patients were candidates for surgery, and in all cases the evaluation included clinical examination, electrodiagnostic studies (nerve conduction study and electromyography), and ultrasound nerve study. Ultrasound was used to explore the nerve fascicular echotexture, continuity, and surrounding tissues. The maximum cross-sectional area (CSA) and the presence of epineurial hyperechogenicity or intraneural hyper- or hypoechogenicity, of anatomical anomalies, dynamic nerve dislocations, or compressions were recorded. The concordance rate of neurophysiological and ultrasonographic data was analyzed, classifying ultrasound findings as confirming, contributive, or nonconfirming with respect to electrodiagnostic data. The correlation between maximum nerve CSA and neurophysiological severity degree in entrapment syndromes was statistically analyzed. RESULTS Ultrasonography confirmed electrodiagnostic findings in 36.1% of cases and showed a contributive role in the diagnosis and surgical planning in 53.8% of all cases; the findings were negative ("nonconfirming") in only 10.1% of the patients. In 16% of cases, ultrasound was not only contributive, but had a key diagnostic role in the presence of doubtful electrodiagnostic findings. The contributive role differed according to etiology, being higher for tumors (100%) and for posttraumatic or postsurgical neuropathies (72.2%) than for entrapment neuropathies (43.8%). CONCLUSIONS Ultrasound is a powerful, noninvasive tool for the examination of peripheral nerve injuries, and can guide diagnosis of and surgical strategy for focal peripheral nerve injuries. It allows direct visualization of the cause and extent of nerve lesions and finds its place between electrodiagnostic tests and exploratory surgery. It can provide invaluable information, such as the presence and extent of a mass, scar compression, or neuromas. The authors recommend it as a complement to routine clinical and neurophysiological evaluation and as the first-line imaging modality for masses of suspected nerve origin.
本研究旨在评估超声在周围神经病变术前评估中的作用，并说明神经超声如何整合到常规临床和神经生理学评估以及局灶性周围神经损伤的治疗中。本文描述了超声在不同神经病变中的诊断作用和治疗意义。
作者分析了 2013 年至 2014 年期间 108 例患者的 119 例四肢压迫性、肿瘤性、外伤性或手术后神经损伤患者的超声应用情况。所有患者均为手术候选者，且所有患者的评估均包括临床检查、电诊断研究（神经传导研究和肌电图）和超声神经研究。超声用于探查神经束的回声纹理、连续性和周围组织。记录最大横截面积（CSA）以及神经外膜高回声或神经内高回声或低回声、解剖异常、动态神经移位或压迫的存在。分析神经生理学和超声数据的一致性率，根据电诊断数据将超声结果分类为证实、辅助或不证实。统计分析了压迫综合征中最大神经 CSA 与神经生理学严重程度的相关性。
超声在 36.1%的病例中证实了电诊断结果，在所有病例中 53.8%的病例中对诊断和手术计划有辅助作用；只有 10.1%的患者的检查结果为阴性（“不证实”）。在 16%的病例中，超声不仅有辅助作用，而且在电诊断结果可疑时具有关键的诊断作用。辅助作用因病因而异，肿瘤（100%）和外伤性或手术后神经病（72.2%）高于压迫性神经病（43.8%）。
超声是一种强大的、非侵入性的周围神经损伤检查工具，可以指导局灶性周围神经损伤的诊断和手术策略。它可以直接观察神经病变的原因和程度，在电诊断检查和探查性手术之间找到了自己的位置。它可以提供有价值的信息，如肿块的存在和范围、疤痕压迫或神经瘤。作者建议将其作为常规临床和神经生理学评估的补充，并作为疑似神经源性肿块的一线成像方式。
