Department of Neurosurgery, Hospital de León, León, Spain.
Neurological Center, The American British Cowdray Medical Center campus Santa Fe, Mexico City, Mexico.
Adv Tech Stand Neurosurg. 2022;45:245-283. doi: 10.1007/978-3-030-99166-1_8.
This review is intended to describe and actualize the basic knowledge of the three basic entities that affect the peripheral nerve system and can be treated by surgery: nerve trauma, chronic nerve compressions, and tumors.Regarding trauma, emphasis is given on the timing of surgery, given the fact that the moment in which the surgery is performed and the employed microsurgical reconstruction technique are the most important factors in the final result. Open lesions with associated nerve injury should be managed with an early exploration carried out before 7 days. Closed injuries are usually deferred, with few exceptions, from 3 to 6 months after the trauma.In turn, chronic compressions require an appropriate clinical, neurophysiological, and imaging diagnosis. Isolated sensory symptoms can be treated actively though without surgery: motor signs like atrophy should be regarded as a sign for immediate surgery, as a deferred treatment might cause an irreversible nerve and muscular damage. Endoscopic approaches are a valuable tool for treatment in selected neuropathies.Finally, nerve tumors demand a thorough preoperative evaluation, as benign tumors are treated in a very different way when compared to malignant lesions. Benign tumors can usually be safely and completely resected without sacrificing the nerve of origin. When malignancy is confirmed, extensive resection to optimize patient survival is the main objective, potentially at the expense of neurological function. This may then be followed by adjuvant radiation and/or chemotherapy, depending on the nature of the tumor and the completeness of resection attained. The role of nerve biopsy remains controversial, and several modern diagnostic techniques might be helpful.
神经创伤、慢性神经压迫和肿瘤。关于创伤，重点介绍了手术时机，因为手术进行的时间和采用的显微重建技术是最终结果的最重要因素。伴有神经损伤的开放性损伤应在 7 天内进行早期探查。闭合性损伤通常在创伤后 3 至 6 个月内延迟，除非有特殊情况。相反，慢性压迫需要适当的临床、神经生理学和影像学诊断。孤立的感觉症状可以积极治疗，但无需手术：萎缩等运动症状应视为立即手术的迹象，因为延迟治疗可能导致神经和肌肉不可逆转的损伤。内窥镜方法是治疗选定神经病变的有价值工具。最后，神经肿瘤需要进行彻底的术前评估，因为良性肿瘤的治疗与恶性病变有很大不同。良性肿瘤通常可以安全、完整地切除，而不会牺牲起源神经。当确认恶性肿瘤时，主要目标是最大限度地延长患者的生存时间，可能会牺牲神经功能。然后可以根据肿瘤的性质和达到的切除完整性进行辅助放疗和/或化疗。神经活检的作用仍存在争议，一些现代诊断技术可能会有所帮助。
