Department of Neurosurgery, Faculty of Medicine, Tanta University, Egypt.
Department of Neurosurgery, Faculty of Medicine, Tanta University, Egypt.
Clin Neurol Neurosurg. 2024 Jan;236:108083. doi: 10.1016/j.clineuro.2023.108083. Epub 2023 Dec 13.
Peripheral nerve injury refers to any damage or trauma to the nerves located outside the central nervous system. Ultrasonography is a reliable, cheap, and minimally invasive method in clinical practice to give physicians useful information about nerve injury.
to assess the power of ultrasound in determining the presence, localization, and extent of neural damage in patients with clinical evidence of peripheral nerve lesions before surgery.
This cross-sectional study was conducted on 78 patients (56 females and 22 males, aged from 9 to 52 years) who had different pathologies including entrapment, tumoral, post-traumatic, and post-surgical nerve injuries at the Neurosurgery and Physical Medicine, Rheumatology, and Rehabilitation Departments, Tanta University Hospitals. All studied patients had preoperative evaluation; neurological examination, electrodiagnostic studies, and sonographic examinations with linear array transducers (frequencies ranging from 7.5 to 16 MHz).
The most common pathological condition was entrapment neuropathy (39 patients) (50%). Ultrasound complemented the electrodiagnostic studies by determining the site of entrapment manifested by increased mean maximum cross-sectional area of the nerve proximal to the site of entrapment and nerve hypoechogenicity. In post-traumatic and iatrogenic neuropathies (35 patients) (44.9%), the ultrasound finding revealed neuroma in continuity in nine cases (11.5%), complete neurotmesis with stump neuroma in eighteen patients (23.1%), and eight cases (10.3%) showed perineural adhesion. In all cases, the nerve was hypoechoic at the site of injury. The presence of hyperechoic fibrous tissue could indicate perineural adhesion and the necessity for neurolysis. This study also included three (3.8%) cases had schwannoma, and one case (1.3%) had neurofibroma. Ultrasound was used to confirm the diagnosis by determining the tumor's size and vascular supply.
Ultrasonography is a diagnostic and surgical planning tool that is becoming more and more useful for the management of peripheral nerve injuries. Its high resolution and real-time capability provide safe and cost-effective scans that aid in determining the extent of injuries. For patients with peripheral nerve injuries, ultrasound is advised to be added to the routine clinical and neurophysiological evaluation. It is also advised to use ultrasound as a first-line imaging modality for tumors thought to be of nerve origin.
周围神经损伤是指中枢神经系统以外的任何神经损伤。超声检查在临床实践中是一种可靠、廉价且微创的方法，可为医生提供有关神经损伤的有用信息。
评估超声在术前有周围神经病变临床证据的患者中确定神经损伤的存在、定位和程度的能力。
这是一项横断面研究，共纳入 78 名患者（56 名女性和 22 名男性，年龄 9-52 岁），他们分别患有神经外科、物理医学与康复科、风湿病科的不同疾病，包括神经卡压、肿瘤、创伤后和手术后神经损伤。所有研究患者均进行术前评估；包括神经学检查、电诊断研究和线性阵列换能器的超声检查（频率范围为 7.5-16MHz）。
最常见的病理情况是神经卡压性神经病（39 例）（50%）。超声通过确定神经卡压部位来补充电诊断研究，表现为神经卡压部位近端神经的平均最大横截面积增加和神经低回声。在创伤后和医源性神经病（35 例）（44.9%）中，超声发现 9 例（11.5%）神经连续性神经瘤，18 例（23.1%）完全神经断裂伴残端神经瘤，8 例（10.3%）显示神经外膜粘连。在所有病例中，损伤部位的神经呈低回声。高回声纤维组织的存在可能表明神经外膜粘连和神经松解的必要性。本研究还包括 3 例（3.8%）神经鞘瘤和 1 例（1.3%）神经纤维瘤。超声通过确定肿瘤的大小和血管供应来用于确认诊断。
超声检查是一种诊断和手术计划工具，在周围神经损伤的管理中变得越来越有用。其高分辨率和实时能力提供了安全且具有成本效益的扫描，有助于确定损伤的程度。对于周围神经损伤患者，建议将超声检查添加到常规临床和神经生理学评估中。还建议将超声检查作为怀疑为神经源性肿瘤的一线成像方式。
