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Koueik J, Bethel JA, Lee KS, Tuite MJ, Hanna AS. Preoperative Ultrasound-Guided Localization of the Lateral Femoral Cutaneous Nerve: From Guide Wire to Novel Clip. Oper Neurosurg (Hagerstown) 2024; 27:174-179. [PMID: 38289069 DOI: 10.1227/ons.0000000000001072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/05/2023] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Lateral femoral cutaneous nerve (LFCN) decompression and transposition are surgical treatment options for meralgia paresthetica. Identifying the LFCN during surgery may be challenging, and preoperative localization is a valuable adjunct in this case. The objective of this study was to explore a new technique using preoperative ultrasound-guided clip localization (USCL) of the LFCN. METHODS After Institutional Review Board approval, data were collected on patients who underwent both preoperative ultrasound-guided wire localization (USWL) and USCL over the past 13 years. Skin-to-nerve time was calculated prospectively. RESULTS Fifty-six patients were identified, 51 had USWL and 5 had USCL; the skin-to-nerve median time was 7.5 and 6 minutes, respectively. Six wires were misplaced, and this was at the beginning of utilization of the USWL technique. There were no nerve injury, infection, or bleeding complications related to either wire or clip placement. CONCLUSION USWL or USCL is safe and time-efficient in LFCN surgeries.
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Affiliation(s)
- Joyce Koueik
- Department of Neurological Surgery, University of Wisconsin, Madison , Wisconsin , USA
| | - Jacob A Bethel
- Department of Neurological Surgery, University of Wisconsin, Madison , Wisconsin , USA
| | - Kenneth S Lee
- Department of Radiology, University of Wisconsin, Madison , Wisconsin , USA
| | - Michael J Tuite
- Department of Radiology, University of Wisconsin, Madison , Wisconsin , USA
| | - Amgad S Hanna
- Department of Neurological Surgery, University of Wisconsin, Madison , Wisconsin , USA
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Hanna AS, Schmidt BT, Kanarek AA, Hilger KH, Blankenbaker DG, Medhat H, Moscote-Salazar LR, Hellenbrand DJ. Anatomical Proximity Between Sciatic Nerve and Ischial Spine and its Relationship to the Development of Deep Gluteal Pain Syndrome. World Neurosurg 2024; 188:e367-e375. [PMID: 38796142 DOI: 10.1016/j.wneu.2024.05.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 05/19/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE Deep gluteal syndrome (DGS) is a medical diagnosis in which the pathoanatomy of the subgluteal space contributes to pain. The growing recognition that gluteal neuropathies can be associated with the presence of a bone-neural conflict with irritation or compression may allow us to shed some light on this pathology. This study aims to determine whether the location of the sciatic nerve (SN) in relation to the ischial spine (IS) contributes to the development of DGS. METHODS The SN - IS relationship was analyzed based on magnetic resonance imaging (MRI) in 15 surgical patients (SPs), who underwent piriformis release, and in 30 control patients who underwent MRI of the pelvis for reasons unrelated to sciatica. The SN exit from the greater sciatic foramen was classified as either zone A (medial to the IS); zone B (on the IS); or zone C (lateral to the IS). RESULTS The SN was significantly closer to the IS in SPs than in MRI controls (P = 0.014). When analyzing patients of similar age, SNs in SPs were significantly closer (P = 0.0061) to the IS, and located in zone B significantly more (P = 0.0216) as compared to MRI controls. Patients who underwent surgery for piriformis release showed a significant decrease in pain postoperatively (P < 0.0001). CONCLUSIONS The results from this study suggest that the relationship between the IS and SN may play a role in the development of DGS. This may also help establish which patients would benefit more from surgical intervention.
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Affiliation(s)
- Amgad S Hanna
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin, USA; Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, USA.
| | - Bradley T Schmidt
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Andrew A Kanarek
- Department of Radiology, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
| | - Keegan H Hilger
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Donna G Blankenbaker
- Department of Radiology, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA
| | - Heba Medhat
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin, USA; Department of Neurosurgery, Faculty Of Medicine Kasr Al-Ainy, Cairo University, Cairo, Egypt
| | | | - Daniel J Hellenbrand
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin, USA; Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, USA
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Staniszewski T, Buckley N, Hanna AS. Lateral Femoral Cutaneous Nerve Transposition With Ultrasound-Guided Wire Localization: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:104-105. [PMID: 37747349 DOI: 10.1227/ons.0000000000000903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 07/06/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- Thomas Staniszewski
- Department of Neurological Surgery, University of Wisconsin SMPH, Madison, Wisconsin, USA
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Landriel F, Padilla Lichtenberg F, Ulloque-Caamaño L, Guerra E, Casto F, Hem S. Carbon-Assisted Minimally Invasive Transtubular Approach for Intercostal Nerve Schwannoma. Oper Neurosurg (Hagerstown) 2023; 25:449-452. [PMID: 37668999 DOI: 10.1227/ons.0000000000000859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/07/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The intraoperative localization of an intercostal nerve schwannoma (INS) is extremely difficult because the lesion is generally not palpable, and the fluoroscopic visualization of anatomic landmarks in the ribs is unsatisfactory. Using activated carbon suspension to mark the soft-tissue approach could improve INS localization. We present a novel, simple, reproducible carbon-assisted minimally invasive transtubular approach for an INS. METHODS The patient was a 57-year-old man with a painful 12th left INS arising below the floating rib. A computed tomography image-guided, tumor-to-skin marking with aqueous carbon suspension was performed 48 hours before surgery. A minimally invasive transtubular approach following the carbon path allowed a precise tumor location. RESULTS The INS was completely removed. The patient's thoracic radicular pain was immediately relieved after surgery. He was discharged the following day with residual numbness on the left thoracic side. At the 5-year follow-up, no tumor recurrence was noted in the control MRI. CONCLUSION This article presents an alternative novel technique for resecting an intercostal schwannoma. Using a transtubular approach with carbon-marking assistance allowed a tumor gross total resection with immediate pain relief and a successful outcome.
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Affiliation(s)
- Federico Landriel
- Neurosurgical Department, Spine Unit, Hospital Italiano de Buenos Aires, Buenos Aires , Argentina
| | | | | | - Emily Guerra
- Neurosurgical Department, Spine Unit, Hospital Italiano de Buenos Aires, Buenos Aires , Argentina
| | - Florencia Casto
- Neurosurgical Department, Spine Unit, Hospital Italiano de Buenos Aires, Buenos Aires , Argentina
| | - Santiago Hem
- Neurosurgical Department, Spine Unit, Hospital Italiano de Buenos Aires, Buenos Aires , Argentina
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5
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Finkelstein ER, Buitrago J, Jose J, Levi AD, Xu KY, Burks SS. Lower extremity peripheral nerve pathology: Utility of preoperative ultrasound-guided needle localization before operative intervention. Skeletal Radiol 2023; 52:1997-2002. [PMID: 37060462 DOI: 10.1007/s00256-023-04347-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/23/2023] [Accepted: 04/10/2023] [Indexed: 04/16/2023]
Abstract
Historically, the use of ultrasound (US) in the management of peripheral nervous system (PNS) pathology has been limited to diagnostic confirmation or guidance for interventional injections. This technical case series will demonstrate the utility and versatility of preoperative US-guided needle localization for the excision of lower extremity neuromas and other pathology of the PNS. Five patients with symptomatic lower extremity PNS tumors were retrospectively reviewed. This case series corroborates the technical nuances of localizing lower extremity neuromas by US-guided needle and wire placement prior to operative excision. This was achieved by a multidisciplinary team that included plastic surgery, neurosurgery, and radiology. Five patients had US-guided needle localization of a lower extremity PNS target prior to operative intervention. Three patients had lower extremity neuromas of varying origins, including the lateral femoral cutaneous nerve (LFCN), saphenous nerve, and sural nerve. The remaining two patients had a sciatic nerve sheath Schwannoma and a femoral nerve glomus tumor. Under sonographic visualization, a needle was advanced to the target perimeter and withdrawn, leaving behind a percutaneous guidewire. This technique simplified the marking of the nerve course prior to dissection and led to efficient intraoperative identification of all five PNS tumors without any complications. Preoperative US-guided needle localization led to safe, accurate, and efficient perioperative and intraoperative identification of neuromas and other PNS tumors of the lower extremity prior to excision. By reducing the challenges of nerve identification in a scarred tissue bed, this multidisciplinary approach may decrease postoperative patient morbidity.
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Affiliation(s)
- Emily R Finkelstein
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA.
| | - Joanne Buitrago
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
| | - Jean Jose
- Department of Clinical Radiology, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
| | - Allan D Levi
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
| | - Kyle Y Xu
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
| | - S Shelby Burks
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
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Feng JY, Xu WB, You WJ, Rui G, Wang QX. Compare the clinical value of two minimally invasive approaches to locating radial nerve in the posterior humeral approach. BMC Musculoskelet Disord 2023; 24:188. [PMID: 36915110 PMCID: PMC10009963 DOI: 10.1186/s12891-023-06291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Abstract
PURPOSE To compare the clinical value between locating radial nerve (RN) guided by Color Doppler ultrasonography and posterior antebrachial cutaneous nerve (PACN) in the posterior humeral approach. METHODS The five fresh adult cadavers (ten upper arms) were selected to compare the two methods of locating the RN in the posterior humeral approach (guided by ultrasound and PACN) by measuring the operation time, the length of incision, and the area of subcutaneous free. And the comparison between the two groups was statistically analyzed by paired t-test. RESULTS The results of this study demonstrated that the length of incision and the area of subcutaneous free in the ultrasound group were smaller than that in the PACN group (P < 0.05), while the operation time was just the opposite (P < 0.05). However, after excluding the time of ultrasound location, the operation time in the ultrasound group was shorter than that in the PANC group, and the difference was statistically significant (P < 0.05). CONCLUSION The RN can be quickly and safely exposed by both methods. The ultrasound approach requires a long learning curve, but is more minimally invasive and can help determine whether the intraoperative nerve is compressed by the plate. And the PACN method requires a longer incision and a wider area of subcutaneous free, while specialized equipment and professional training for surgeons are not required. In a word, these two methods have advantages and disadvantages, so they should be selected based on the exact situation.
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Affiliation(s)
- Jin-Yi Feng
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China. .,The Third Clinical Medical College, Fujian Medical University, Fuzhou, China.
| | - Wen-Bin Xu
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Wu-Ji You
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Gang Rui
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China. .,The Third Clinical Medical College, Fujian Medical University, Fuzhou, China.
| | - Qing-Xiang Wang
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China. .,Department of Anesthesiology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
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Greeneway GP, Page PS, Ammanuel SG, Hanna AS. Lateral femoral cutaneous nerve transposition. NEUROSURGICAL FOCUS: VIDEO 2023; 8:V8. [PMID: 36628093 PMCID: PMC9815206 DOI: 10.3171/2022.10.focvid2289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/03/2022] [Indexed: 01/02/2023]
Abstract
Lateral femoral cutaneous neuropathy, also known as meralgia paresthetica, is a pathology commonly encountered by neurosurgeons. Symptoms include numbness, tingling, and burning pain over the anterolateral thigh due to impingement on the lateral femoral cutaneous nerve (LFCN). Surgical treatment has traditionally involved nerve release or neurectomy. LFCN transposition is a relatively new approach that can provide excellent symptomatic relief. In this video, the authors highlight key operative techniques to ensure easy identification, adequate decompression, and transposition of the nerve. Key steps include ultrasound-guided wire localization, superficial decompression, opening of the inguinal ligament, deep decompression, and medial transposition. The video can be found here: https://stream.cadmore.media/r10.3171/2022.10.FOCVID2289.
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Chakravorty A, Jaeger M. Surgical anatomy of the lateral femoral cutaneous nerve for meralgia paraesthetica: A simple technical guide for surgeons and trainees alike. J Clin Neurosci 2022; 101:52-56. [PMID: 35533612 DOI: 10.1016/j.jocn.2022.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/20/2022] [Accepted: 04/28/2022] [Indexed: 11/19/2022]
Abstract
Meralgia paraesthetica is an entrapment neuropathy of the lateral femoral cutaneous nerve, usually due to compression at the inguinal ligament as the nerve passes from the pelvis into the thigh. Surgical decompression of the lateral femoral cutaneous nerve is a simple and effective treatment option, but the surgical anatomy of the area is not always familiar to neurosurgeons and neurosurgical trainees alike. This paper is a simple review of the relevant surgical anatomy and the surgical steps of lateral femoral cutaneous nerve decompression, with the aim of providing the busy surgeon and trainee a quick and easy reference guide to the procedure.
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Affiliation(s)
- Ananya Chakravorty
- Department of Neurosurgery, Wollongong Hospital, Wollongong, NSW, Australia; Department of Medicine, University of New South Wales, Sydney, Australia.
| | - Matthias Jaeger
- Department of Neurosurgery, Wollongong Hospital, Wollongong, NSW, Australia; Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia; Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia
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9
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de Ruiter GCW, Wesstein M, Vlak MHM. Preoperative Ultrasound in Patients with Meralgia Paresthetica to Detect Anatomical Variations in the Course of the Lateral Femoral Cutaneous Nerve. World Neurosurg 2021; 149:e29-e35. [PMID: 33647484 DOI: 10.1016/j.wneu.2021.02.100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 02/20/2021] [Accepted: 02/21/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Sometimes during surgery for meralgia paresthetica, it can be difficult to find the lateral femoral cutaneous nerve (LFCN). The aims of this study were to study the prevalence of different anatomical variations in patients, compare preoperative ultrasound (US) data with intraoperative findings, and investigate the effect of type of anatomical variation on duration of surgery and success rate of localizing the LFCN. METHODS Fifty-four consecutive patients with idiopathic meralgia paresthetica who underwent either a neurolysis or neurectomy procedure were included. All patients preoperatively underwent US of the LFCN. Anatomical variations were categorized into type A, B, C, D, and E using the classification of Aszmann and Dellon. The cross-sectional area of the LFCN at the inguinal ligament and the distance of the LFCN to the anterior superior iliac spine were noted. Correlations with intraoperative findings were investigated, as well as the effect on duration of surgery and success rate of finding the LFCN. Clinical outcome was assessed using the Likert scale. RESULTS The most frequent anatomical variant was type B (79%), followed by type C (9%), D (5%), and E (7%). No type A was encountered. Correlation between preoperative US and intraoperative findings was 100%. During surgery, the LFCN could be identified in all cases. Duration of surgery did not significantly vary for the different anatomical variants. CONCLUSIONS Preoperative US is reliable in detecting anatomical variations of LFCN. This information can be very helpful in identifying the LFCN more frequently and easily during surgery, especially in more medial variants.
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Affiliation(s)
- Godard C W de Ruiter
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands.
| | - Michel Wesstein
- Department of Clinical Neurophysiology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Monique H M Vlak
- Department of Clinical Neurophysiology, Haaglanden Medical Center, The Hague, The Netherlands
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Diaz A, Burks SS, Jose J, Levi AD. Ultrasound-Guided Needle Localization Wires in Peripheral Nerve Injuries With Long Segmental Defects: Technical Case Report. Oper Neurosurg (Hagerstown) 2020; 20:E60-E65. [PMID: 33002107 DOI: 10.1093/ons/opaa297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/12/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND IMPORTANCE In cases of severe nerve trauma with significant local soft tissue damage, identification and subsequent repair of nerve stumps can pose a technical challenge. Ultrasound (US) localization in peripheral nerve surgery has recently become popular. We present a case report illustrating the use of needle-wire localization systems to identify proximal and several distal branches of an injured femoral nerve with a large segmental defect in order to illustrate how such techniques can be used to make surgical repair more efficient, particularly with identifying the distal stump(s). CLINICAL PRESENTATION We illustrate a case of a 16-yr-old female involved in a traumatic accident that lead to a severe injury of the femoral nerve and artery. The patient presented with a 7.3-cm defect between the proximal and distal aspect of the femoral nerve and its branches, respectively. High-resolution US was used to identify the proximal, large femoral nerve, and 3 distal stumps. By enlisting our musculoskeletal radiology team, we were able to trace distal branches of the femoral nerve and see their target muscles. Three separate US flexible needles were used to locate small muscular branches of the femoral nerve and 1 to locate the proximal stump. Intraoperatively, the localization wires allowed for safe and efficient dissection of proximal and distal nerve stumps in a significantly scarred and edematous plane. CONCLUSION US-guided needle-wire localization has shown promise in identifying the distal stumps and minimizing tissue dissection. Preoperative US guidance significantly aided in nerve repair for this severe injury without increasing morbidity.
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Affiliation(s)
- Anthony Diaz
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - S Shelby Burks
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Jean Jose
- Department of Diagnostic Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Allan D Levi
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
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11
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Preoperative Ultrasound-guided Wire Localization of Soft Tissue Masses Within the Musculoskeletal System. Ultrasound Q 2020; 36:357-362. [PMID: 33298773 DOI: 10.1097/ruq.0000000000000523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ultrasound-guided hookwire localization was initially introduced to facilitate the excision of nonpalpable breast lesions by guiding surgical exploration, thereby reducing operative time and morbidity. The same technique has since found utility in a range of other applications outside breast and can be useful within the musculoskeletal system. Despite this, there remains limited literature with respect to its technical aspects and practical utility. We describe our technique and a series of preoperative ultrasound-guided wire localizations in the musculoskeletal system to assist surgical excision of 4 soft tissue masses.
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12
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Xu Z, Tu L, Zheng Y, Ma X, Zhang H, Zhang M. Fine architecture of the fascial planes around the lateral femoral cutaneous nerve at its pelvic exit: an epoxy sheet plastination and confocal microscopy study. J Neurosurg 2018; 131:1860-1868. [PMID: 30544334 DOI: 10.3171/2018.7.jns181596] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/19/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Meralgia paresthetica is commonly caused by mechanical entrapment of the lateral femoral cutaneous nerve (LFCN). The entrapment often occurs at the site where the nerve exits the pelvis. Its optimal surgical management remains to be established, partly because the fine architecture of the fascial planes around the LFCN has not been elucidated. The aim of this study was to define the fascial configuration around the LFCN at its pelvic exit. METHODS Thirty-six cadavers (18 female, 18 male; age range 38-97 years) were used for dissection (57 sides of 30 cadavers) and sheet plastination and confocal microscopy (2 transverse and 4 sagittal sets of slices from 6 cadavers). Thirty-four healthy volunteers (19 female, 15 male; age range 20-62 years) were examined with ultrasonography. RESULTS The LFCN exited the pelvis via a tendinous canal within the internal oblique-iliac fascia septum and then ran in an adipose compartment between the sartorius and iliolata ligaments inferior to the anterior superior iliac spine (ASIS). The iliolata ligaments newly defined and termed in this study were 2-3 curtain strip-like structures which attached to the ASIS superiorly, were interwoven with the fascia lata inferomedially, and continued laterally as skin ligaments anchoring to the skin. Between the sartorius and tensor fasciae latae, the LFCN ran in a longitudinal ligamental canal bordered by the iliolata ligaments. CONCLUSIONS This study demonstrated that 1) the pelvic exit of the LFCN is within the internal oblique aponeurosis and 2) the iliolata ligaments form the part of the fascia lata over the LFCN and upper sartorius. These results indicate that the internal oblique-iliac fascia septum and iliolata ligaments may make the LFCN susceptible to mechanical entrapment near the ASIS. To surgically decompress the LFCN, it may be necessary to incise the oblique aponeurosis and iliac fascia medial to the LFCN tendinous canal and to free the iliolata ligaments from the ASIS.
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Affiliation(s)
- Zhaoyang Xu
- Departments of1Anatomy and
- 2Department of Anatomy and
| | | | - Yanyan Zheng
- 3Ultrasound, Anhui Medical University, Hefei, China; and
| | | | - Han Zhang
- 4School of Medicine, University of Otago, Dunedin, New Zealand
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Ellis J, Schneider JR, Cloney M, Winfree CJ. Lateral Femoral Cutaneous Nerve Decompression Guided by Preoperative Ultrasound Mapping. Cureus 2018; 10:e3652. [PMID: 30723651 PMCID: PMC6351113 DOI: 10.7759/cureus.3652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Injury to the lateral femoral cutaneous nerve (LFCN) from compression or entrapment may result in meralgia paresthetica, a painful mononeuropathy of the anterolateral thigh. Surgical decompression of the LFCN may provide relief when conservative management fails. However, the considerable anatomic variability of this nerve may complicate surgical localization and thus prolong operative time. Herein, we report the use of preoperative high-resolution ultrasonography to map the LFCN in a patient with bilateral meralgia paresthetica. This simple, noninvasive imaging technique was seen to be effective at providing precise localization of the entrapped and, in this case, bilateral anatomically variant nerves. Preoperative high-resolution ultrasound mapping of the LCFN can be used to facilitate precise operative localization in the treatment of bilateral meralgia paresthetica. This is especially useful in the setting of suspected unusual nerve anatomy.
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Affiliation(s)
- Jason Ellis
- Neurosurgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine, New York, USA
| | - Julia R Schneider
- Neurosurgery, Brain Tumor Center, Lenox Hill Hospital, Hofstra Northwell School of Medicine, New York, USA
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Morimoto D, Kim K, Kokubo R, Kitamura T, Iwamoto N, Matsumoto J, Sugawara A, Isu T, Morita A. Deep Decompression of the Lateral Femoral Cutaneous Nerve Under Local Anesthesia. World Neurosurg 2018; 118:e659-e665. [DOI: 10.1016/j.wneu.2018.06.252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
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15
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Walker FO, Cartwright MS, Alter KE, Visser LH, Hobson-Webb LD, Padua L, Strakowski JA, Preston DC, Boon AJ, Axer H, van Alfen N, Tawfik EA, Wilder-Smith E, Yoon JS, Kim BJ, Breiner A, Bland JDP, Grimm A, Zaidman CM. Indications for neuromuscular ultrasound: Expert opinion and review of the literature. Clin Neurophysiol 2018; 129:2658-2679. [PMID: 30309740 DOI: 10.1016/j.clinph.2018.09.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/10/2018] [Accepted: 09/02/2018] [Indexed: 12/11/2022]
Abstract
Over the last two decades, dozens of applications have emerged for ultrasonography in neuromuscular disorders. We wanted to measure its impact on practice in laboratories where the technique is in frequent use. After identifying experts in neuromuscular ultrasound and electrodiagnosis, we assessed their use of ultrasonography for different indications and their expectations for its future evolution. We then identified the earliest papers to provide convincing evidence of the utility of ultrasound for particular indications and analyzed the relationship of their date of publication with expert usage. We found that experts use ultrasonography often for inflammatory, hereditary, traumatic, compressive and neoplastic neuropathies, and somewhat less often for neuronopathies and myopathies. Usage significantly correlated with the timing of key publications in the field. We review these findings and the extensive evidence supporting the value of neuromuscular ultrasound. Advancement of the field of clinical neurophysiology depends on widespread translation of these findings.
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Affiliation(s)
- Francis O Walker
- Department of Neurology at Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, USA.
| | - Michael S Cartwright
- Department of Neurology at Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, USA.
| | - Katharine E Alter
- Department of Rehabilitation Medicine, National INeurolnstitutes of Health, Bethesda, MD 20892, USA.
| | - Leo H Visser
- Departments of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
| | - Lisa D Hobson-Webb
- Department of Neurology, Neuromuscular Division, Duke University School of Medicine, Durham, NC, USA.
| | - Luca Padua
- Don Carlo Gnocchi ONLUS Foundation, Piazzale Rodolfo Morandi, 6, 20121 Milan, Italy; Department of Geriatrics, Neurosciences and Orthopaedics, Universita Cattolica del Sacro Cuore, Rome, Italy.
| | - Jeffery A Strakowski
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, USA; Department of Physical Medicine and Rehabilitation, OhioHealth Riverside Methodist Hospital, Columbus, OH, USA; OhioHealth McConnell Spine, Sport and Joint Center, Columbus, OH, USA.
| | - David C Preston
- Neurological Institute, University Hospitals, Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | - Andrea J Boon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
| | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Jena 07747, Germany.
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Eman A Tawfik
- Department of Physical Medicine & Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Einar Wilder-Smith
- Department of Neurology, Yong Loo Lin School of Medicine, National University Singapore, Singapore; Department of Neurology, Kantonsspital Lucerne, Switzerland; Department of Neurology, Inselspital Berne, Switzerland.
| | - Joon Shik Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Republic of Korea.
| | - Byung-Jo Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Ari Breiner
- Division of Neurology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Canada.
| | - Jeremy D P Bland
- Deparment of Clinical Neurophysiology, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK.
| | - Alexander Grimm
- Department of Neurology, University Hospital Tuebingen, Tuebingen, Germany.
| | - Craig M Zaidman
- Division of Neuromuscular Medicine, Department of Neurology, Washington University in St. Louis, 660 S. Euclid Ave, Box 8111, St. Louis, MO 63110, USA.
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16
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Kokubo R, Kim K, Morimoto D, Isu T, Iwamoto N, Kitamura T, Morita A. Anatomic Variation in Patient with Lateral Femoral Cutaneous Nerve Entrapment Neuropathy. World Neurosurg 2018; 115:274-276. [PMID: 29729473 DOI: 10.1016/j.wneu.2018.04.159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/22/2018] [Accepted: 04/23/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND We report a surgical case of entrapment neuropathy of lateral femoral cutaneous nerve (LFCN) with anatomical variation. CASE DESCRIPTION This 53-year-old man had a 10-year history of paresthesia and pain in the right anterolateral thigh exacerbated by prolonged standing and walking. His symptoms improved completely but transiently by LFCN block. The diagnosis was LFCN entrapment. Because additional treatment with drugs and repeat LFCN block was ineffective, we performed surgical decompression under local anesthesia. A nerve stimulator located the LFCN 4.5 cm medial to the anterior superior iliac spine. It formed a sharp curve and was embedded in connective tissue. Proximal dissection showed it to run parallel to the femoral nerve at the level of the inguinal ligament. The inguinal ligament was partially released to complete dissection/release. Postoperatively, his symptoms improved and the numeric rating scale fell from 8 to 1. CONCLUSION We report a rare anatomical variation in the course of the LFCN.
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Affiliation(s)
- Rinko Kokubo
- Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai, Chiba, Japan.
| | - Kyongsong Kim
- Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai, Chiba, Japan
| | - Daijiro Morimoto
- Department of Neurosurgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Toyohiko Isu
- Department of Neurosurgery, Kushiro Rosai Hospital, Kushiro, Hokkaido, Japan
| | - Naotaka Iwamoto
- Department of Neurosurgery, Teikyo University Hospital, Itabashi-ku, Tokyo, Japan
| | - Takao Kitamura
- Department of Neurosurgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Akio Morita
- Department of Neurosurgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
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17
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Hanna A, Hanna B. Response To: Anatomical considerations on transposition of the lateral femoral cutaneous nerve. Clin Anat 2018. [DOI: 10.1002/ca.23070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Amgad Hanna
- Department of NeurosurgeryUniversity of WisconsinMadison Wisconsin
| | - Barbara Hanna
- Edgewood High School of Sacred HeartMadison Wisconsin
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18
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Hanna A. Letter: Preoperative Ultrasound-Guided Wire Localization of the Lateral Femoral Cutaneous Nerve. Oper Neurosurg (Hagerstown) 2017; 13:E13. [PMID: 28521352 DOI: 10.1093/ons/opx049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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