Surgery for Peripheral Nerve Injury Peripheral Nerve Injury Neurosurgeon Yoon Seung Hwan Anatomy Connective tissue major tissue componant epineurium, perineurium, endoneurium Nerve tissue axon, schwan.
Peripheral Nerve Injury Neurosurgeon Yoon Seung-Hwan Anatomy • Connective tissue - major tissue componant - epineurium, perineurium, endoneurium • Nerve tissue - axon, schwann cell Peripheral Nerve Injury • Acute injury • Chronic injury (entrapment neuropathy) Classification Neuropraxia • the mildest form, reversible conduction block • loss of function, which persists for hours or days • direct mechanical compression, ischemia, mild burn trauma or stretch Axontmetic • axon continuity is disrupted • fascicular integrity is maintained • Wallerian degeneration occurs Neurotmesis • laceration from sharp or blunt forces • the only important consideration is the timing of repair • acute repair or more bluntly lacerated nerves are repaired 3-4 weeks Factor s for Decision Making • Age • Segment between injury and end organ • Gap of injury • Mechanism of injury • Severity of injury • Presence of pain Axonal Regeneration • Initial delay to the distal stump : 1-2 week delay • Growth rate 1mm/day, inch/month • Terminal delay several weeks-several months Recovery within weeks good prognosis Treatment Conservative Tx • Indications not long history mild-moderate, intermittent reversible cause pregnancy, oral contraceptive, endocrine abnormalities(DM…), type writer • Method nonsteroidal anti-inflammatory drugs splint Treatment Surgical Indications • Failed conservative tx • Typical clinical finding with electrodiagnostic data • Severe sensory loss muscle atrophy motor weakness Entrapment of Thoracic Outlet • 년년 - Cervial rib or anomalous transverse process of C7 - Fibromuscular bands or scalene muscle abnomality • 년 년 - X-ray - NCV & EMG - Angiography – vascular anomaly • Tx : Supraclavicular approach - Best op management scalene anterior and medius M Carpal Tunnel Syndrome thenal atrophy Entrapment of Radial Nerve Entrapment of Ulnar Nerve - Cubital tunnel - Guyon’s canal Motor Deficit of Ulnar Nerve • Bediction posture : clawing of ring & small finger • Froment’s sign : weakness of adductor pollicis, there will be flexion of the interphalangeal joint of the thumb because of substitution of the median innervated flexior pollicus longus for a weak adductor pollicis Meralgia Paresthesia Lateral femoral cutaneous nerve injury (L1-2) Tarsal Tunnel Syndrome ... perineurium, endoneurium • Nerve tissue - axon, schwann cell Peripheral Nerve Injury • Acute injury • Chronic injury (entrapment neuropathy) Classification Neuropraxia • the mildest form, reversible conduction... Injured Peripheral Nerve Evaluation of Closed Injury Conclusions Immediate primary repair in sharp injuries with suspected transsection of nerve Immediate repair is especially important for brachial... start : post -injury month peak : 3rd - 4th month • Segment between injury and end organ 년 (년 Treatment Time of Operation • Open injury Early intervention Delayed intervention • Closed injury Delayed