Presurgical ultrasound-assisted neuroexamination in the surgical repair of peripheral nerve injury

Abstract

In spite of electrodiagnostic examinations, the determination of the precise localization of the injured site along the involved peripheral nerve may remain obscure or uncertain. Before starting the operation, a surgeon should have knowledge about the type of injury, the position of the proximal and distal nerve stumps, and the presence or absence of a neuroma and excessive perilesional scar tissue formation for orientation and planning of the surgical intervention. We hypothesized that real-time ultrasound could be helpful in the determination of the type of injury, the localisation of proximal and distal nerve stumps, as well as for diagnosing a neuroma. Fourteen patients with traumatic peripheral nerve injuries that were verified by neurological examinations and electrodiagnostic tests underwent surgical repair, and were examined by ultrasound before and during the surgical intervention. Visualisation of the injured site, the type of the injury, the position of the nerve stumps and the diagnosis of the neuroma were reliably feasible in all the patients by using ultra sonography. Axonal swelling of a nerve was diagnosed in 4 (29%) patients, a stump neuroma was diagnosed in 3 (21%) patients, a total nerve interruption (neurotmesis in the Seddon classification) was diagnosed in 9 (64%) patients, and surrounding scar tissue was diagnosed in 5 (35%) patients. Presurgical and intraoperative ultrasound-assisted neuroexamination is a useful diagnostic method in the determination of the precise localisation of the injured site, the type of injury, the position of stumps, and the diagnosis of a neuroma. The use of preoperative and intraoperative ultrasound can enhance the orientation of the surgeon to the surgical field. The application of our method to our patients shows that presurgical ultra sonographic neuroexamination can be used in the surgical repair of peripheral nerve injury.