Department of Neurosurgery, Evangelisches Krankenhaus, Campus Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany.
Department of Neurosciences, Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany.
Neurosurgery. 2019 Sep 1;85(3):415-422. doi: 10.1093/neuros/nyy355.
Clinical and electrophysiological assessments prevail in evaluation of traumatic nerve lesions and their regeneration following nerve surgery in humans. Recently, high-resolution neurosonography (HRNS) and magnetic resonance neurography have gained significant importance in peripheral nerve imaging. The use of the grey-scale-based "fascicular ratio" (FR) was established using both modalities allowing for quantitative assessment.
To find out whether FR using HRNS can assess nerve trauma and structural reorganization in correlation to postoperative clinical development.
Retrospectively, 16 patients with operated traumatic peripheral nerve lesions were included. The control group consisted of 6 healthy volunteers. All imaging was performed with a 15 to 6 MHz ultrasound probe (SonoSite X-Porte; Fujifilm, Tokyo, Japan). FR was calculated using Fiji () on 8-bit-images ("MaxEntropy" using "Auto-Threshold" plug-in).
Thirteen of 16 patients required autologous nerve grafting and 3 of 16 extra-intraneural neurolysis. There was no statistical difference between the FR of nonaffected patients' nerve portion with 43.48% and controls with FR 48.12%. The neuromatous nerve portion in grafted patients differed significantly with 85.05%. Postoperatively, FR values returned to normal with a mean of 39.33%. In the neurolyzed patients, FR in the affected portion was 78.54%. After neurolysis, FR returned to healthy values (50.79%). Ten of 16 patients showed clinical reinnervation.
To our best knowledge, this is the first description of FR using HRNS for quantitative assessment of nerve damage and postoperative structural reorganization. Our results show a significant difference in healthy vs lesioned nerves and a change in recovering nerve portions towards a more "physiological" ratio. Further evaluation in larger patient groups is required.
在人类的神经外科手术中，临床和电生理评估在创伤性神经病变及其再生的评估中占主导地位。最近，高分辨率神经超声（HRNS）和磁共振神经成像在周围神经成像中变得越来越重要。这两种模式都使用基于灰度的“束状比”（FR）来进行定量评估。
了解 HRNS 中的 FR 是否可以评估神经创伤，并与术后临床发展相关的结构重组。
回顾性纳入 16 例接受手术治疗的外伤性周围神经病变患者。对照组由 6 名健康志愿者组成。所有成像均使用 15-6MHz 超声探头（SonoSite X-Porte；富士胶片，东京，日本）进行。使用 Fiji（）在 8 位图像上计算 FR（“最大熵”使用“自动阈值”插件）。
16 例患者中有 13 例需要自体神经移植，3 例需要神经外松解术。未受影响的患者神经部分的 FR 为 43.48%，与对照组 FR 为 48.12%，无统计学差异。移植患者的神经瘤神经部分差异显著，为 85.05%。术后，FR 值恢复正常，平均值为 39.33%。在神经松解患者中，受累部位的 FR 为 78.54%。神经松解后，FR 恢复到健康值（50.79%）。16 例患者中有 10 例出现临床再神经支配。
据我们所知，这是首次使用 HRNS 对神经损伤和术后结构重组进行定量评估的 FR 描述。我们的结果表明，健康神经与受损神经之间存在显著差异，恢复中的神经部分向更“生理”的比例变化。需要在更大的患者群体中进行进一步评估。
