Intraoperative ultrasound-assisted peripheral nerve surgery

Clayton L. Haldeman, Christopher D. Baggott, Amgad S. Hanna
2015 Neurosurgical Focus  
Case 1: Neurofibroma of the Right Greater Occipital Nerve A 35-year-old woman who previously underwent a craniotomy presented with a painful lump over her right occipital bone. The lesion enlarged over a period of 6 months. Intraoperative US was used to identify the lesion, which appeared to be hypoechoic, elongated, and nodular. The mass was found to be a 2 × 1-cm lesion arising from the right greater occipital nerve. The lesion was excised and the proximal end of the nerve was buried in
more » ... . Pathological examination revealed a neurofibroma (Fig. 1 ). Case 2: Multiple Traumatic Neuromas of the Arm and Hand After a Crush Injury A 54-year-old woman suffered a crush injury, resulting in partial amputation of her left hand 12 years prior to presentation to our clinic. She previously underwent 2 resections of neuroma 2-3 years after her injury. She presented to our clinic with extreme hyperalgesia, allodynia, and AbbRevIATION US = ultrasound. Historically, peripheral nerve surgery has relied on landmarks and fairly extensive dissection for localization of both normal and pathological anatomy. High-resolution ultrasonography is a radiation-free imaging modality that can be used to directly visualize peripheral nerves and their associated pathologies prior to making an incision. It therefore helps in localization of normal and pathological anatomy, which can minimize the need for extensive exposures. The authors found intraoperative ultrasound (US) to be most useful in the management of peripheral nerve tumors and neuromas of nerve branches that are particularly small or have a deep location. This study presents the use of intraoperative US in 5 cases in an effort to illustrate some of the applications of this useful surgical adjunct.
doi:10.3171/2015.6.focus15232 pmid:26323822 fatcat:m3onxcvb2zbcnc6dwb7ajtui2y