神经脂肪瘤病和过度生长：是否更倾向于影响运动（混合）神经还是感觉神经？
Lipomatosis of nerve and overgrowth: is there a preference for motor (mixed) vs. sensory nerve involvement?
机构信息
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
Department of Neurologic Surgery, University of Utah, Salt Lake City, UT, 84132, USA.
出版信息
Acta Neurochir (Wien). 2019 Apr;161(4):679-684. doi: 10.1007/s00701-019-03854-z. Epub 2019 Feb 23.
BACKGROUND
Lipomatosis of nerve (LN) is a peripheral nerve disorder characterized by fibroadipose proliferation within the epineurium. It has been associated with nerve-territory overgrowth affecting soft tissue and/or bony structures. We sought to understand if there is an anatomical relationship associated with nerve-territory overgrowth.
METHODS
A review of the literature and our institutional LN cases was performed to determine the prevalence of nerve-territory overgrowth. Only cases with sufficient clinical and/or imaging data were selected. The cases were then subdivided into two groups and analyzed: (1) motor (mixed) nerve and (2) predominant sensory nerve, based on the anatomical location of the LN lesion. Subgroup analysis was performed on median nerves affected by LN, for a more homogenous population.
RESULTS
We identified 329 LN cases with sufficient information for analysis. Motor (mixed) nerve group (M) consisted of 287 cases (155 with overgrowth and 132 without overgrowth). Sensory nerve group (S) revealed group of 42 cases (4 cases with overgrowth and 38 without overgrowth). Statistical analysis comparing overgrowth status in the M and S nerve groups showed a statistically significant difference in overgrowth, favoring the M group for overgrowth (p < 0.0001). The analysis of median nerve group consisted of 225 cases in the M group (106 with overgrowth and 119 without overgrowth) and 20 cases in the S group (3 with overgrowth and 17 cases without overgrowth). A statistically significant difference in nerve-territory overgrowth status was present in the M vs. the S group, again favoring the M group for overgrowth. (p = 0.0083). Cases from our institution included 44 cases for this analysis. Forty-two cases in the M group (28 with overgrowth and 14 without overgrowth) and 2 cases in the S group (all 2 without overgrowth).
CONCLUSION
We believe the association of LN and nerve-territory overgrowth might be explained by involvement of mixed motor nerves; however, the exact underlying mechanism is not known.
背景
神经脂肪瘤病（LN）是一种周围神经疾病，其特征是神经外膜内纤维脂肪增生。它与影响软组织和/或骨结构的神经区域过度生长有关。我们试图了解是否存在与神经区域过度生长相关的解剖学关系。
方法
对文献和我们机构的 LN 病例进行了回顾，以确定神经区域过度生长的发生率。仅选择有足够临床和/或影像学数据的病例。然后根据 LN 病变的解剖位置将这些病例分为两组进行分析：（1）运动（混合）神经，（2）主要感觉神经。对受 LN 影响的正中神经进行亚组分析，以获得更同质的人群。
结果
我们确定了 329 例具有足够分析信息的 LN 病例。运动（混合）神经组（M）由 287 例组成（155 例有过度生长，132 例无过度生长）。感觉神经组（S）有 42 例（4 例有过度生长，38 例无过度生长）。比较 M 和 S 神经组过度生长状态的统计学分析显示，过度生长存在统计学显著差异，M 组更倾向于过度生长（p<0.0001）。对 M 组的正中神经组进行分析，包括 225 例（106 例有过度生长，119 例无过度生长）和 S 组的 20 例（3 例有过度生长，17 例无过度生长）。M 组与 S 组的神经区域过度生长状态存在统计学显著差异，再次倾向于 M 组过度生长（p=0.0083）。我们机构的病例包括 44 例用于此分析。M 组的 42 例（28 例有过度生长，14 例无过度生长）和 S 组的 2 例（均无过度生长）。
结论
我们认为 LN 与神经区域过度生长的关联可能是由混合运动神经受累引起的；然而，确切的潜在机制尚不清楚。
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