Weigel Daniel T, Raasveld Floris V, Liu Wen-Chih, Mayrhofer-Schmid Maximilian, Hwang Charles D, Tereshenko Vlad, Renthal William, Woolf Clifford J, Valerio Ian L, Eberlin Kyle R
Department of Orthopaedic Surgery, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston , Massachusetts , USA.
Maastricht University, Maastricht , The Netherlands.
Neurosurgery. 2025 Mar 1;96(3):545-554. doi: 10.1227/neu.0000000000003166. Epub 2024 Sep 9.
Anatomic features of neuromas have been explored in imaging studies. However, there has been limited research into these features using resected, ex vivo human neuroma specimens. The aim of this study was to investigate the influence that time may have on neuroma growth and size, and the clinical significance of these parameters.
Patients who underwent neuroma excision between 2022 through 2023 were prospectively included in this study. Neuroma specimens were obtained after operative resection. Standardized neuroma size measurements, expressed as a neuroma-to-nerve ratio (NNR), were conducted with ImageJ software. Pain data (numeric rating scale, 0-10) were prospectively recorded during preoperative evaluation, and patient factors were collected from chart reviews.
Fifty terminal neuroma specimens from 31 patients were included, with 94.0% of the neuromas obtained from individuals with amputations. Most neuromas were excised from the lower extremities (n = 44, 88.0%). The neuromas had a median NNR of 2.45, and the median injury to neuroma excision interval was 6.3 years. Larger NNRs were associated with a longer injury to neuroma excision interval and with a smaller native nerve diameter. In addition, sensory nerves were associated with a larger NNR compared with mixed nerves. NNR was not associated with preoperative pain or with anatomical nerve distribution.
This study suggests that neuromas seem to continue to grow over time and that smaller nerves may form relatively larger neuromas. In addition, sensory nerves develop relatively larger neuromas compared with mixed nerves. Neuroma size does not appear to correlate with pain severity. These findings may stimulate future research efforts and contribute to a better understanding of symptomatic neuroma development.
神经瘤的解剖特征已在影像学研究中得到探索。然而，利用切除的离体人类神经瘤标本对这些特征进行的研究有限。本研究的目的是调查时间对神经瘤生长和大小的影响，以及这些参数的临床意义。
前瞻性纳入2022年至2023年间接受神经瘤切除术的患者。手术切除后获取神经瘤标本。使用ImageJ软件进行标准化的神经瘤大小测量，以神经瘤与神经比率（NNR）表示。术前评估期间前瞻性记录疼痛数据（数字评分量表，0 - 10），并从病历回顾中收集患者因素。
纳入了31例患者的50个终末神经瘤标本，其中94.0%的神经瘤来自截肢患者。大多数神经瘤从下肢切除（n = 44，88.0%）。神经瘤的中位NNR为2.45，神经瘤切除间隔的中位损伤时间为6.3年。较大的NNR与较长的神经瘤切除间隔损伤时间和较小的原始神经直径相关。此外，与混合神经相比，感觉神经的NNR更大。NNR与术前疼痛或解剖神经分布无关。
本研究表明，神经瘤似乎会随着时间持续生长，较小的神经可能形成相对较大的神经瘤。此外，与混合神经相比，感觉神经会形成相对较大的神经瘤。神经瘤大小似乎与疼痛严重程度无关。这些发现可能会激发未来的研究工作，并有助于更好地理解有症状神经瘤的发展。
