Nerve anatomy of the upper limbs -- Surgical anatomy and approaches to the nerves of the lower limb -- Nerve injuries : anatomy, pathophysiology, and classification -- Clinical aspects of peripheral nerve lesions in the upper limb -- Clinical aspects of traumatic peripheral nerve lesions in the lower limb -- Electrodiagnostic pre-, intra-, and postoperative evaluations -- Magnetic resonance neurography and peripheral nerve surgery -- Ultrasound in peripheral nerve surgery (compression neuropathy, trauma, tumor) -- Surgical repair of nerve lesions : neurolysis and neurorrhaphy with grafts or tubes -- Timing in traumatic peripheral nerve lesions -- Outcomes in the repair of nerve injuries -- Gunshot and other missile wounds to the peripheral nerves -- Compressive lesions of the upper limb : clinical presentation, timing, and surgical strategies -- Compressive lesions of the lower limb and trunk : clinical presentation and surgical management -- Thoracic outlet syndrome -- Traumatic brachial plexus lesions : clinical aspects, assessment, and timing of surgical repair -- Traumatic brachial plexus injuries : surgical techniques and strategies -- Neonatal brachial plexus lesions : clinical presentation and assessment -- Neonatal brachial plexus lesion : surgical strategies -- Lumbosacral plexus injuries : clinical presentation, assessment, and surgical strategies -- Facial nerve palsy : indications and techniques of surgical repair -- Benign peripheral nerve tumors -- Malignant peripheral nerve sheath tumors
Now in its second edition and featuring a brand-new layout, Atlas of Peripheral Nerve Surgery continues to be the surgical atlas dedicated to the field of peripheral nerves. This neurosurgery reference presents surgical steps laid out step by step in a highly readable and accessible format, making it an ideal resource for trainees and busy surgeons alike. Gain a well-rounded understanding of today's latest knowledge concerning the various types of nerve lesions and their management. Grasp exactly how to proceed through brand-new cadaver dissection photos, full-color illustrations with step-by-step operation notes, and self-explanatory bullet points. Apply the newest advances in nerve transfer surgery with a full section that discusses the transfer of the radial to axillary nerve, the median and ulnar nerve to the musculocutaneous nerve, the femoral branch to the obturator nerve, and more. Access the fully searchable text and downloadable image library online at www.expertconsult.com.
Surgery of Peripheral Nerves: A Case-Based Approach is a concise, single-volume reference for managing the entire spectrum of peripheral nerve pathologies, from brachial plexus injuries to lower extremity nerve entrapments. It features 57 cases that are grouped in sections by anatomic location of the problem to aid rapid reference to topics of interest, with one additional section that addresses the management of nerve tumors, painful nerve conditions, and other injuries and syndromes. Each chapter provides concise descriptions of case presentation, diagnosis, anatomy, characteristic clinical presentation, differential diagnosis, diagnostic tests, management options, and surgical treatment.Highlights: Case-based format thoroughly prepares the reader for managing various problems in the clinical setting Diagnostic guidelines and management strategies from leading experts in the field of peripheral nerve surgery enable clinicians to confidently handle each stage of patient care Pearls and Pitfalls at the end of each chapter highlight critical aspects of treatment and are ideal for at-a-glance review prior to surgery More than 150 illustrations demonstrate key concepts Suggested readings with brief summaries provide valuable reviews of the literature This problem-oriented textbook is ideal for clinicians, fellows, and residents in neurosurgery, orthopaedics, plastic surgery, and hand surgery. It also serves as an indispensable reference for specialists in physical medicine and rehabilitation, neurology, emergency medicine, pain management, and physical and occupational therapy.
Chapter 45. The surgery of peripheral nerves (including tumors)
Author: Kåre Fugleholm
Publisher: Elsevier Inc. Chapters
Surgical pathology of the peripheral nervous system includes traumatic injury, entrapment syndromes, and tumors. The recent significant advances in the understanding of the pathophysiology and cellular biology of peripheral nerve degeneration and regeneration has yet to be translated into improved surgical techniques and better outcome after peripheral nerve injury. Decision making in peripheral nerve surgery continues to be a complex challenge, where the mechanism of injury, repeated clinical evaluation, neuroradiological and neurophysiological examination, and detailed knowledge of the peripheral nervous system response to injury are prerequisite to obtain the best possible outcome. Surgery continues to be the primary treatment modality for peripheral nerve tumors and advances in adjuvant oncological treatment has improved outcome after malignant peripheral nerve tumors. The present chapter provides background knowledge of surgical peripheral nerve disease and some general and practical guidance toward its clinical management.
Peripheral Nerve Injuries: A Clinical Guide is a fully illustrated and informative reference on injuries within the peripheral nervous system. It incorporates new knowledge in molecular and cellular events which underlie the response of nerves to injury, regeneration and neuropathic pain. Written by a leading expert in the field, Peripheral Nerve Injuries: A Clinical Guide, is a valuable resource for surgeons in residence and training.
The introduction of the operating microscope as a surgical tool revolutionized the treatment of peripheral nerve lesions. A new era thus began in the early 1960s, which led to a substantial improvement in the management of nerve lesions. The results of nerve grafting techniques have demonstrated that, independent of the length of the defect, lesions can be successfully bridged. The free tissue transplants with microvascular anastomosis have also opened new, rewarding possibilities for peripheral nerve reconstruction procedures, facilitating the achievement not only of satisfactory anatomical but also of satisfactory fUhctional results. In order to evaluate the state of the art and reflect retrospectively on 25 years of microneurosurgical treatment of peripheral nerves, numerous outstanding scientists and clinicosurgical physicians were invited to Hanover in order to exchange their viewpoints and experiences. An active und fruitful discussion resulted which dealt with the many aspects of anatomy, pathology, clinical and neuro physiology, diagnosis, and with the surgery and physiotherapy which constitute modern-day peripheral nerve lesion treatment. The excit ing ongoing experimental and clinical activities have led us to support the wish and idea to publish the scientific exchange which took place during the Hanover symposium. I truly believe that the articles presented in this book cover so many interesting subjects concerned with peripheral nerve lesions that the book will serve the interested and dedicated physician involved with such cases as a reference work for the basics and also provide him with the therapeutic guidelines to assist him in his daily work.
This book focuses on posttraumatic repair and reconstruction of peripheral nerves. Written by internationally respected specialists, it provides an overview of the challenges and the latest advances in diagnosis and treatment of traumatic peripheral nerve injuries. It presents an outline of state-of the-art procedures from diagnostics, including newest imaging techniques, over conventional and alternative surgical approaches to clinical follow-up and rehabilitation, including the latest concepts to improve functional recovery. The purely clinical topics are preceded by neuroanatomical principles and neurobiological events related to peripheral nerve transection injuries and followed by an outlook on current experimental developments in the area of biomaterials for artificial nerve grafts and peripheral nerve tissue engineering. Peripheral nerve injuries not only affect the nerve tissue at the site of injury, but also target tissue and parts of the central nervous system. They often have dramatic consequences for patients, including loss of sensory and motor functions combined with paresthesia or pain, and a reduced quality of life and ability to work. An adequate understanding of the procedures for proper decision-making and reconstructing peripheral nerves is therefore essential to ensure optimized functional recovery.
The Second World War gave rise to a previously inconceivable number of peripheral nerve injuries. Only later on did these injuries occasion renewed intensive research in this field of neurosurgery. Among the factors which have promoted this development is the operating microscope with more refined surgical techniques. Of course, surgery of peripheral nerve injuries in peacetime is not to be compared with that in wartime. Only rapid wound healing enables a secondary suture to be performed at a favorable time, after about four weeks. Besides in most cases the defect of substance is not as great as in war injuries, in which the so-called "critical resection length" (Seddon) was the cause of the greatest difficulties and consti tuted the crucial obstacle to good success. The experienced surgeons of the Second World War always knew that the specified dimensions were far too great for the critical resection length. They could only resort to attempting a suture even when there was a great gap be tween the ends of the nerves. Precise information was not available on direct damage to the axis cylinder or alteration due to vascular factors when stretching the various nerves, above all during the later mobilization of joint decompressions. In my opinion, the experimental investigations of the author can make a contribution here. The precisely executed and afterwards carefully analyzed experiments appear very likely to be applicable to human conditions as regards their percentages of total nerve length.
This book covers the background of all the different degrees of nerve lesions, the different kinds of nerve recovery, and depending on that, the different microsurgical treatments of traumatic, tumor involved, entrapped, or painful nerve lesions. Practitioners will get all the simple information needed to make their decisions in time and choose the adequate surgical procedure . Reconstructive surgical methods are added to improve patients if the critical time for possible nerve surgery has passed. TOC: I. Common Remarks.- Historial Development of Peripheral Nerve Surgery.- Anatomy and Histo-Reaction of Traumatised Nerves.- Clinical Presentation of Nerve Lesion.-Scientific Outlook.- II. Special Remarks.- Entrapment Syndromes.- Trauma Related Limb Nerve Lesions.- Facial Nerve.- Nerve Tumours.- Pain Related to Nerve Trauma.- References on Peripheral Nerve Surgery. III. Muscle and tendon transfer in peripheral nerve lesions.-
Here is the first book to lead you through operative exposures of all the major peripheral nerves in the body using actual dissections. Covering patient positioning, relevant anatomy, and surgical exposures of both the upper and lower extremities, it provides the step-by-step approach and visual orientation needed to effectively map out a surgical strategy. Special features:The first book to use full-color actual dissections as an operative guide to peripheral nerve surgeryIn-depth coverage of all related anatomyValuable information on nerves such as brachial plexus, axillary, ulnar, femoral, sciatic, tibial, plantar, and many othersPearls and pitfalls that offer valuable tips and insights from the author's extensive clinical experienceCombining the graphic strength of an atlas with the procedural guidelines of a text, this book is ideal for neurosurgeons, orthopedic surgeons, plastic and reconstructive surgeons, and general surgeons who need to refresh their memory on a specific exposure, as well as a useful primer on operative steps for beginners. It is also a valuable board review and course book for neurosurgery residents who are required to have a full understanding of the peripheral nervous system.