Hypertrophic mononeuropathy

Gruen, Peter; Kline, David G.

doi:10.3171/foc.2007.22.6.24

Cited by 9 publications

(5 citation statements)

References 12 publications

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“…60 The treatment of intraneural perineurioma is controversial. Some say that the natural progression of intraneural perineurioma leads to complete functional loss, 65 whereas others describe an initial phase of progressive impairment followed by a stable deficit. 56 Excision of the lesion with autologous nerve graft repair is reasonable if the affected nerve segment is non-functional.…”

Section: Discussionmentioning

confidence: 99%

Nerve biopsy in acquired neuropathies

Sommer

Carroll

Koike

et al. 2021

J Peripheral Nervous Sys

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A diagnosis of neuropathy can typically be determined through clinical assessment and focused investigation. With technological advances, including significant progress in genomics, the role of nerve biopsy has receded over recent years.However, making a specific and, in some cases, tissue-based diagnosis is essential across a wide array of potentially treatable acquired peripheral neuropathies.When laboratory investigations do not suggest a definitive diagnosis, nerve biopsy remains the final step to ascertain the etiology of the disease. The present review highlights the utility of nerve biopsy in confirming a diagnosis, while further illustrating the importance of a tissue-based diagnosis in relation to treatment strategies, particularly when linked to long-term immunosuppressive therapies,

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Section: Discussionmentioning

confidence: 99%

Nerve biopsy in acquired neuropathies

Sommer

Carroll

Koike

et al. 2021

J Peripheral Nervous Sys

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“…Gruen and Kline also recommend that the lesion should be carefully resected until normal appearing fascicles and a bit further both proximally and distally of the lesion and nerve graft should be interposed, if no action potential or if poor amplitude was recorded across the lesion. More extensive nerve resection is made to avoid that the interpositioned nerve graft may eventually deteriorate as well, leading to a longer graft and therefore to poorer results [34]. In our opinion, extensive nerve resection and following nerve grafting has to be considered in patients with more distal located focal lesion without muscle atrophy.…”

Section: Discussionmentioning

confidence: 99%

Modern treatment of perineuriomas: a case-series and systematic review

et al. 2020

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Background: Perineuriomas are rare benign peripheral nerve sheath tumours of perineurial cell origin and can be classified into intraneural and extraneural perineuriomas. They most commonly present a mononeuropathy of gradual onset and slow progression, resulting in progressive neurological deficits like hypoesthesia or motor weakness. Therapy is still variable. Aim of the study was to compare our surgical treatment and our follow-up regime including high-resolution nerve sonography with the current literature to evaluate best treatment of perineuriomas. Methods: Retrospective analysis of our dataset "peripheral nerve lesion" to identify patients suffering from perineuriomas between 01.01.2012 until 31.12.2018. Surgical treatment and the follow-up examination of three patients were described. Additionally, a systematic review including PubMed, the Cochrane Collaboration Library, Scopus and Google Scholar was performed for literature published between January 1, 1990 and October 31, 2019 independently by 2 authors. Results: In the first case, the left ulnar nerve was affected. In the second case, the left peroneal nerve and in the third case the right median nerve was affected. High-resolution nerve sonography was performed in each case. All patients underwent interfascicular neurolysis combined with a targeted fascicular biopsy under electrophysiological monitoring. Neurological deficits improved subsidized by rehabilitation. Surgical therapy and the neurological outcome were compared with literature. Systematic review revealed 22 articles, which met the inclusion criteria. Therefore, demographics, surgical treatment and neurological outcome of 77 patients were analysed. Conclusions: Perineuriomas are rare benign nerve sheath tumours with a slow progression, sometimes difficult to diagnose. Decompression and neurolysis may improve neurological deficits. High resolution nerve sonography might serve as a helpful additional diagnostic tool in this process.

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“…However, it can progress to severe functional disability as some patients with partial nerve involvement can progress to full nerve dysfunction [8]. It has been proven that surgical resection with direct suture for short segment or nerve grafting for the long segment give better outcomes with mixed results in the literatures [10, 13, 14]. Our surgical strategy focused to optimize the functional outcome, as the tumor is benign with special attention to patient's age and the size of the tumor (Figure 3) For the patients below the age of 60 years old with typical clinical presentation and MRI confirmation, one time surgery was proposed.…”

Section: Discussionmentioning

confidence: 99%

Intraneural perineurioma – a retrospective study of 19 patients

Alkhaili¹,

Kishi

Marcheix

et al. 2015

Chirurgie de la Main

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Intraneural perineurioma is a benign neoplasm of peripheral nerve sheath with perineurial cell origin that typically affects teenagers and young adults and tends to result in a motor-predominant neuropathy. The aim of our study is to present the epidemiology, clinical presentation, way of diagnosis and management plan in a consecutive patient series. Ninteen patients diagnosed as having intraneural perineurioma were retrospectively chart reviewed. Diagnosis was done by MRI and/or biopsy with morphological, immunohistochemical staining study confirmation. Patients assessments included gender, age, symptoms, tumor localization, radiological aspect, management and pathological confirmation.Sex ratio was 10 males to 9 females with mean age of 31.2 (15-64). All the patients presented with motor deficit, ten with sensory deficit. Upper limb was involved in 11 cases (among them 4 lesions of brachial plexus), the lower limb in 8 cases. On magnetic resonance imaging, 16 patients showed a nerve enlargement whereas 5 presented with atypical fusiform tumor. Eighteen patients were operated for excision biopsy and/or palliative treatment for their motor deficit. Anatomopathological analysis confirmed the diagnosis in seventeen cases with a morphological pseudo-onion bulb shape and/or specific immunohistochemical assay. One patient had only palliative treatment without excision biopsy. Our data confirmed the equal penetration of intraneural perineurioma to both sex and affected limb. Because of the benignity of the tumor, the surgical treatment focused on optimizing the functional outcome. A prospective study with long term follow-up is required for this under-diagnosed tumor.

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Hypertrophic mononeuropathy

Cited by 9 publications

References 12 publications

Nerve biopsy in acquired neuropathies

Nerve biopsy in acquired neuropathies

Modern treatment of perineuriomas: a case-series and systematic review

Intraneural perineurioma – a retrospective study of 19 patients

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