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State of the Art and Advances in Peripheral Nerve Surgery

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Advances and Technical Standards in Neurosurgery

Part of the book series: Advances and Technical Standards in Neurosurgery ((NEUROSURGERY,volume 45))

Abstract

This review is intended to describe and actualize the basic knowledge of the three basic entities that affect the peripheral nerve system and can be treated by surgery: nerve trauma, chronic nerve compressions, and tumors.

Regarding trauma, emphasis is given on the timing of surgery, given the fact that the moment in which the surgery is performed and the employed microsurgical reconstruction technique are the most important factors in the final result. Open lesions with associated nerve injury should be managed with an early exploration carried out before 7 days. Closed injuries are usually deferred, with few exceptions, from 3 to 6 months after the trauma.

In turn, chronic compressions require an appropriate clinical, neurophysiological, and imaging diagnosis. Isolated sensory symptoms can be treated actively though without surgery: motor signs like atrophy should be regarded as a sign for immediate surgery, as a deferred treatment might cause an irreversible nerve and muscular damage. Endoscopic approaches are a valuable tool for treatment in selected neuropathies.

Finally, nerve tumors demand a thorough preoperative evaluation, as benign tumors are treated in a very different way when compared to malignant lesions. Benign tumors can usually be safely and completely resected without sacrificing the nerve of origin. When malignancy is confirmed, extensive resection to optimize patient survival is the main objective, potentially at the expense of neurological function. This may then be followed by adjuvant radiation and/or chemotherapy, depending on the nature of the tumor and the completeness of resection attained. The role of nerve biopsy remains controversial, and several modern diagnostic techniques might be helpful.

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Abbreviations

BNB:

Blood nerve barrier

CN:

Compressive neuropathies

CT:

Connective tissue

EDS:

Electrodiagnostic studies

EMG:

Electromyography

MRI:

Magnetic resonance imaging

NCS:

Nerve conduction studies

PN:

Peripheral nerve

US:

Ultrasonogram

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Authors and Affiliations

  1. Department of Neurosurgery, Hospital de León, León, Spain

    Javier Robla-Costales

  2. Neurological Center, The American British Cowdray Medical Center campus Santa Fe, Mexico City, Mexico

    Carlos Rodríguez-Aceves

  3. Department of Neurosurgery, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay

    Fernando Martínez-Benia

  4. Department of Neurosurgery, Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina

    Mariano Socolovsky

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  1. Javier Robla-Costales
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  2. Carlos Rodríguez-Aceves
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  3. Fernando Martínez-Benia
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  4. Mariano Socolovsky
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Editors and Affiliations

  1. International Neuroscience Institute, Hannover, Germany

    Concezio Di Rocco

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Robla-Costales, J., Rodríguez-Aceves, C., Martínez-Benia, F., Socolovsky, M. (2022). State of the Art and Advances in Peripheral Nerve Surgery. In: Di Rocco, C. (eds) Advances and Technical Standards in Neurosurgery. Advances and Technical Standards in Neurosurgery, vol 45. Springer, Cham. https://doi.org/10.1007/978-3-030-99166-1_8

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