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Marcos VN, Kulcsar MAV, Hoff AO, Chammas MC, de Freitas RMC. How to Identify Cervical Traumatic Neuromas in the Post-operative Neck Dissection: Brief Review of the Cervical Plexus Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1695-1710. [PMID: 35688708 DOI: 10.1016/j.ultrasmedbio.2022.04.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/29/2022] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
Cervical traumatic neuromas (CTNs) are a non-neoplastic hyperplasia of damaged nerves and may be misinterpreted as metastatic lymph nodes during cervical ultrasound of patients with thyroid cancer after lateral neck dissection, resulting in unnecessary and painful fin-needle aspiration biopsy. The anatomy of the cervical plexus is challenging, and the correct identification and recognition of its neural roots and branches on ultrasound are key to the correct CTN diagnosis. This review outlines the US technique used to characterize CTNs in 10 standardized steps and describes the sonographic features of the cervical plexus, to assist the radiologist in the recognition of CTNs and their differentiation from lymph node metastases.
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Affiliation(s)
- Vinícius Neves Marcos
- Radiology Unit, Instituto do Cancer do Estado de São Paulo (ICESP), São Paulo, Brazil.
| | | | - Ana Oliveira Hoff
- Endocrinology Unit, Instituto do Cancer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - Maria Cristina Chammas
- Department of Radiology, Ultrasound Unit, Instituto de Radiologia do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
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Shao P, Li H, Shi R, Li J, Wang Y. Understanding fascial anatomy and interfascial communication: implications in regional anesthesia. J Anesth 2022; 36:554-563. [PMID: 35697947 DOI: 10.1007/s00540-022-03082-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 05/26/2022] [Indexed: 11/30/2022]
Abstract
With the extensive application of ultrasound in regional anesthesia, there has been rapid development of interfascial plane block techniques recently. Compared with neuraxial anesthesia or nerve plexus blocks, the interfascial plane blocks have many advantages, such as technical simplicity, fewer complications and comparable or better analgesia. The concept of fascial interconnectivity is fundamental in understanding the effects and complications of interfascial plane blocks. Many fascial planes are continuous and communicate with each other without a clear anatomical boundary. The prevertebral fascia of the neck, endothoracic fascia of the chest, transversalis fascia of the abdomen, and the fascia iliaca of the pelvic cavity form a natural fascial continuation. This anatomical feature suggests that the space beneath the cervical prevertebral fascia, the thoracic paravertebral space, the space between transversalis fascia and psoas muscles (psoas major and quadratus lumborum), and the fascia iliaca compartment are a confluent potential cavity. Additionally, the permeability of the fascia at different anatomical locations to local anesthetics is different, which can also influence the block effect and the incidence of complications. This article summarizes the anatomical characteristics and communication relationships of the major fascia which are related to regional anesthesia, and their relationships with block effects and complications.
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Affiliation(s)
- Peiqi Shao
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Huili Li
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Rong Shi
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Jinlei Li
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Yun Wang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
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Murata S, Iwasaki H, Natsumi Y, Minagawa H, Yamada H. Vascular Evaluation around the Cervical Nerve Roots during Ultrasound-Guided Cervical Nerve Root Block. Spine Surg Relat Res 2019; 4:18-22. [PMID: 32039292 PMCID: PMC7002060 DOI: 10.22603/ssrr.2019-0006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 06/04/2019] [Indexed: 02/02/2023] Open
Abstract
Introduction To carry out ultrasound-guided cervical nerve root block (CNRB) safely, we investigated the frequency of risky blood vessels around the target nerve root and within the imaginary needle pathway in the actual injecting position. Methods 30 patients (20 men, 10 women) with cervical radiculopathy who received ultrasound-guided CNRB were included in this study. We defined a risky blood vessel as an artery existing within 4 mm from the center of the target nerve root or located in the range of 2 mm above or below the imaginary needle pathway. Results Using the color Doppler method, the frequency of a risky blood vessel existing around 4 mm from the center of the C5 nerve root was 3.3% (1/30), whereas it was 3.3% (1/30) for the C6 nerve root and 23.3% (7/30) for the C7 nerve root. Hence, the C7 level had more blood vessels close to the target nerve root compared to the C5 and C6 levels, but there was no significant difference (p = 0.0523). On the other hand, the frequency of a risky blood vessel existing within 2 mm above and below the imaginary needle pathway was 3.3% (1/30) for the C5 nerve root, whereas it was 3.3% (1/30) for the C6 nerve root and 10.0% (3/30) for the C7 nerve root. The C7 level had more blood vessels within the needle pathway compared to the C5 and C6 levels, but there was no significant difference (p = 0.301). Conclusions To reduce the risk of unintended intravascular injections, more careful checking for the presence or absence of blood vessels at the C7 level using color Doppler is necessary.
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Affiliation(s)
- Shizumasa Murata
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Iwasaki
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Yuta Natsumi
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, Wakayama, Japan
| | - Hiroshi Minagawa
- Department of Orthopedic Surgery, Johto Orthopedic Clinic, Akita, Japan
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
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Takeuchi M, Wakao N, Kamiya M, Hirasawa A, Murotani K, Takayasu M. Simple presurgical method of predicting C5 palsy after cervical laminoplasty using C5 nerve root ultrasonography. J Neurosurg Spine 2018; 29:365-370. [DOI: 10.3171/2018.2.spine171363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe incidence of C5 palsy after cervical laminoplasty is approximately 5%. Because C5 palsy is related to cervical foraminal stenosis at the C4–5 level, the authors hypothesized that cervical foraminal stenosis can be diagnosed by examining the C5 nerve root (NR) using ultrasonography. The purpose of this study was to investigate whether postoperative C5 palsy could be predicted using ultrasonography.METHODSThis study used a prospective diagnosis design. In total, 140 patients undergoing cervical laminoplasty were examined with ultrasound. The cross-sectional area (CSA) of the C5 NR was measured on both sides before surgery, and the incidence of postoperative C5 palsy was examined. The difference between the CSA of the patients with and without C5 palsy and the lateral differences in the C5 palsy group were determined.RESULTSThe incidence of C5 palsy was 5% (7 cases). Symptoms manifested at a median of 5 days after surgery (range 1–29 days). The CSA of the C5 NR on the affected side was significantly enlarged in the C5 palsy group compared with that in the no–C5 palsy group (p = 0.001). In addition, in the patients who had C5 palsy, the CSA of the C5 NR was significantly enlarged on the affected side compared with that on the unaffected side (p = 0.02). Receiver operating characteristic analysis indicated that the best threshold value for the CSA of the C5 NR was 10.4 mm2, which provided 91% sensitivity and 71% specificity.CONCLUSIONSC5 palsy may be predicted preoperatively using ultrasound. The authors recommend the ultrasonographic measurement of the CSA of the C5 NR prior to cervical laminoplasty.
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Affiliation(s)
- Mikinobu Takeuchi
- 1Spine Center,
- 2Department of Neurological Surgery,
- 5Department of Spine Surgery, Aichi Spine Hospital, Inuyama, Aichi, Japan
| | | | | | | | - Kenta Murotani
- 4Biostatistics and Clinical Research Center, Aichi Medical University Hospital, Nagakute, Aichi, Japan, and
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Takeuchi M, Wakao N, Hirasawa A, Murotani K, Kamiya M, Osuka K, Takayasu M. Ultrasonography has a diagnostic value in the assessment of cervical radiculopathy: A prospective pilot study. Eur Radiol 2017; 27:3467-3473. [PMID: 28050690 PMCID: PMC5491566 DOI: 10.1007/s00330-016-4704-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 11/21/2016] [Accepted: 12/15/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study investigated the diagnostic accuracy of the difference in the cross-sectional areas (CSAs) of affected cervical nerve roots (NRs) for diagnosing cervical radiculopathy (CR). METHODS In total, 102 CR patients and 219 healthy volunteers were examined with ultrasound. The CSA of the cervical NR at each level was measured on the affected side and the contralateral side in CR patients by blinded ultrasonographic technicians. The difference between the CSAs of CR patients and normal volunteers and the difference in the laterality of CSA at the same affected level (ΔCSA) were calculated for each cervical level. RESULTS The CSAs of the affected NRs in CR patients were significantly larger than those of the unaffected NRs in CR patients and those of the control group at the C5, C6 and C7 levels (P<0.005). ΔCSA was also significantly larger in the CR group at all levels (P<0.001). A receiver operating characteristic analysis demonstrated that the threshold values were 9.6 mm2 (CSA) for C5NR and 15 mm2 for both C6NR and C7NR. CONCLUSIONS This study revealed that the CSAs of affected NRs were enlarged and that the laterality of the CSA (ΔCSA) was greater in CR patients than in control patients. KEY POINTS • Cervical radiculopathy is diagnosed through ultrasonographic measurement of the CSAs. • The CSAs of affected nerve roots were significantly enlarged. • The ΔCSA in the CR group was significantly higher than in the control group. • Diagnostic CSA and ΔCSA thresholds were identified.
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Affiliation(s)
- Mikinobu Takeuchi
- Spine Center, Aichi Medical University Aichi Medical University, Nagakute, Aichi, Japan. .,Department of Neurological Surgery, Aichi Medical University Aichi Medical University, Karimata 1-1 Yazako, Nagakute City, Aichi Prefecture, Japan.
| | - Norimitsu Wakao
- Spine Center, Aichi Medical University Aichi Medical University, Nagakute, Aichi, Japan.,Department of Orthopedic Surgery, Aichi Medical University Aichi Medical University, Nagakute, Aichi, Japan
| | - Atsuhiko Hirasawa
- Department of Orthopedic Surgery, Aichi Medical University Aichi Medical University, Nagakute, Aichi, Japan
| | - Kenta Murotani
- Department of Biostatistics and Clinical Research Center, Aichi Medical University Aichi Medical University, Nagakute, Aichi, Japan
| | - Mitsuhiro Kamiya
- Spine Center, Aichi Medical University Aichi Medical University, Nagakute, Aichi, Japan.,Department of Orthopedic Surgery, Aichi Medical University Aichi Medical University, Nagakute, Aichi, Japan
| | - Koji Osuka
- Spine Center, Aichi Medical University Aichi Medical University, Nagakute, Aichi, Japan.,Department of Neurological Surgery, Aichi Medical University Aichi Medical University, Karimata 1-1 Yazako, Nagakute City, Aichi Prefecture, Japan
| | - Masakazu Takayasu
- Spine Center, Aichi Medical University Aichi Medical University, Nagakute, Aichi, Japan.,Department of Neurological Surgery, Aichi Medical University Aichi Medical University, Karimata 1-1 Yazako, Nagakute City, Aichi Prefecture, Japan
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Ultrasound indications for chronic pain management: an update on the most recent evidence. Curr Opin Anaesthesiol 2016; 29:600-5. [PMID: 27388794 DOI: 10.1097/aco.0000000000000369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The ability of ultrasound to provide detailed anatomic visualization while avoiding radiation exposure continues to make it an appealing tool for many practitioners of chronic pain management. This review will present the most recent evidence regarding the use of ultrasound-guidance for the performance of interventional procedures in the treatment of chronic pain. RECENT FINDINGS For a variety of different procedures, studies continue to compare ultrasound-guided techniques to commonly used fluoroscopic or landmark-based techniques. Small, randomized controlled trials are beginning to demonstrate that ultrasound-guided approaches to interventional pain procedures can be as well tolerated and effective as the traditionally used techniques, while providing some potential advantages in terms of decreased radiation exposure, avoidance of vascular structures, and in some cases, improved efficiency and decreased rates of adverse effects. SUMMARY Despite continued interest in ultrasound-guided techniques for chronic pain management procedures, the evidence is still limited mainly to small, randomized trials and case series. For some procedures, such as stellate ganglion block and peripheral joint injections, recent evidence appears to be tilting in favor of ultrasound-guidance as the preferred technique, though fluoroscopy continues to be a much more reliable method for detection of intravascular uptake of injectate.
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