New Technology: Compound Abnormal Muscle Response During Microvascular Decompression for Hemifacial Spasm.

OBJECTIVE: To discuss effect of intraoperative compound abnormal muscle response (AMR) in patients undergoing microvascular decompression (MVD) for hemifacial spasm (HFS). METHODS: Eighty-six HFS patients were underwent single or compound AMR monitoring during MVD. Single AMR recording was from the frontal muscle by stimulation of the marginal mandibular branch. Compound AMR recordings were obtained from the orbicularis oris and mentalis muscles by electrical stimulation of the temporal branch of the facial nerve, and from the frontal and orbicularis oculi muscles by stimulation of the marginal mandibular branch. Clinical outcome was compared with compound AMR results at the completion of MVD. RESULTS: Forty-two of 45 patients' AMR were recorded by compound AMR monitoring and 34 of 41 patients' AMR were recorded by single AMR monitoring during MVD. Hemifacial spasm resolved completely in 41 patients whose compound AMR was recorded and in 26 patients whose single AMR was recorded. Compound AMR gained a sensitivity of 96.3% and a specificity of 97.2%. Correspondingly, single AMR gained a sensitivity of 97.1% and a specificity of 86.3%. CONCLUSIONS: Our results suggest that compound AMR is more suitable than single AMR in MVD for HFS.

Fully endoscopic microvascular decompression of the hemifacial spasm: our experience.

PURPOSE: Microvascular decompression (MVD) surgery has been accepted as a potentially curative method for hemifacial spasm (HFS). The primary cause of failure of MVD is incomplete decompression of the offending vessel due to inadequate visualization. This study is aimed at evaluating the benefit of endoscopic visualization and the value of fully endoscopic MVD. METHODS: From March 2016 to March 2018, 45 HFS patients underwent fully endoscopic MVD in our department. From opening the dura to preparing to close, the assistant held the endoscope and the surgeon operated. Abnormal muscle response (AMR) and brainstem auditory evoked potentials (BAEP) were monitored. For every patient, the offending vessel was transposed or interposed and achieved complete decompression. AMR was used to evaluate the adequacy of decompression at the end of the surgery. The intra-operative findings and postoperative outcomes and complications were analyzed. RESULTS: Immediately after surgeries, 39 patients (86.7%) achieved excellent result; 2 cases (4.4%) had good result. So the postoperative effective rate was 91.1% (41/45). During 12-36 month follow-up, the outcomes were excellent in 42 cases (93.3%) and good in 2 cases (4.4%), and the effective rate reached to 97.8% (44/45). No recurrence was noted. The postoperative complications were found in 2 patients (4.4%). One patient (2.2%) showed delayed facial palsy on the tenth day but was fully recovered 1 month later. Intracranial infection was noticed in 1 patient (2.2%) and was cured by using intravenous antibiotics for 2 weeks. There was no hearing impairment, hoarseness, or other complications. CONCLUSIONS: Fully endoscopic MVD is both safe and effective in the treatment of HFS. Electrophysiological monitoring is helpful to gain a good result and reduce hearing impairment.

The Relationship Between Basilar Invagination and Chiari Malformation Type I: A Narrative Review.

Basilar invagination (BI) and Chiari malformation type I CM-I) are the most common adult craniovertebral junction malformations, and they are frequently associated with each other and present synchronously. The relationship between BI and CM-I has remained incompletely understood, and the choice of surgical strategy has remained controversial. This brief review focuses on the different aspects of BI and CM-I, and further discusses the relationship between these two concomitant pathologies on the basis of the concepts proposed over the last three decades.

Stable Rat Model of Mechanical Allodynia in Diabetic Peripheral Neuropathy: The Role of Nerve Compression.

BACKGROUND: Preclinical studies involving animal models are essential for understanding the underlying mechanisms of diabetic neuropathic pain. METHODS: Rats were divided into four groups: two controls and two experimental. Diabetes mellitus was induced by streptozotocin (STZ) injection in two experimental groups. The first group involved one sham operation. The second group involved one latex tube encircling the sciatic nerve. The vehicle-injection rats were used as two corresponding control groups: sham operation and encircled nerves. By the third week, STZ-injected rats with encircled nerves were further divided into three subgroups: one involving continuing observation and the other two involving decompression (removal of the latex tube) at different time points (third week and fifth week). Weight and blood glucose were monitored, and behavioral analysis, including paw withdrawal threshold (PWT) and latency, was performed every week during the experimental period (7 weeks). RESULTS: Hyperglycemia was induced in all STZ-injected rats. A significant increase in weight was observed in the control groups when compared with the experimental groups. By the third week, more STZ-injected rats with encircled nerves developed mechanical allodynia than those without (P < 0.05), while no significant difference was noted (P > 0.05) on the incidence of thermal hyperalgesia. Mechanical allodynia, but not thermal hyperalgesia, could be ameliorated by the removal of the latex tube at an early stage (third week). CONCLUSION: With the combined use of a latex tube and STZ injection, a stable rat model of painful diabetic peripheral neuropathy (DPN) manifesting both thermal hyperalgesia and mechanical allodynia has been established.

Dynamic Quantitative Assessment of Motor Axon Sprouting after Direct Facial-Hypoglossal End-To-Side Neurorrhaphy in Rats.

BACKGROUND: End-to-side (ETS) neurorrhaphy is a promising procedure for peripheral nerve repair, yet controversies regarding the efficacy of this repair in facial nerve anastomosis for facial paralysis still exist. MATERIALS AND METHODS: Thirty rats were divided into three groups: intact control group, direct facial-hypoglossal ETS neurorrhaphy, and end-to-end (ETE) neurorrhaphy. Nerve regeneration was assessed with vibrissae motor performance, electrophysiological tests, retrograde labeling, and histomorphological analysis at 4 and 8 months postoperatively. RESULTS: Both ETS and ETE neurorrhaphies resulted in axonal regeneration and functional recovery of the recipient nerve but did not reach the level of intact controls. Significantly higher numbers of myelinated axons and labeled neurons giving regenerating fibers were found in group ETE compared with group ETS at both time points, consistent with the functional and electrophysiological recovery. Group ETS showed significantly smaller fiber diameter and thinner myelin thickness than group ETE at 4 months, but the difference became nonsignificant at 8 months. ETS neurorrhaphy had a very slight effect on the donor nerve, as determined electrophysiologically and histomorphologically. Sparsely distributed double-labeled neurons and relatively large amounts of single-labeled neurons contributing to reinnervation were found through double retrograde neuronal labeling in group ETS. Further quantitative analysis of the percentage of double-labeled neurons showed a pronounced tendency to decline from 19.8% at 4 months to 6.0% at 8 months postoperatively. CONCLUSION: Successful reinnervation after ETS neurorrhaphy could be achieved through both collateral sprouting and terminal sprouting, with the latter seeming to be the principal origin of motor nerve sprouting.

Mechanical Allodynia Predicts Better Outcome of Surgical Decompression for Painful Diabetic Peripheral Neuropathy.

BACKGROUND: To determine the role of mechanical allodynia (MA) in predicting good surgical outcome for painful diabetic peripheral neuropathy (DPN). MATERIALS AND METHODS: Data of 192 patients with painful DPN were collected in this study, with 148 surgical patients and 44 patients in the control group. Both groups were further divided into subgroups based on the presence of MA on admission. Clinical evaluations including the visual analog scale (VAS), the Hospital Anxiety and Depression Scale (HADS), nerve conduction velocity (NCV), and high-resolution ultrasonography (cross-sectional area, CSA) were performed preoperatively and postoperatively. RESULTS: The levels of VAS and HADS and the results of NCV and CSA were improved in the surgical group (p < 0.05). In the surgical subgroups, pain reduction, psychiatric amelioration, improvement in NCVs, and the restoration of the CSA were observed in patients with signs of MA (p < 0.05), whereas only pain reduction, psychiatric amelioration, and restoration of the CSA were noted in patients without signs of MA (p > 0.05). Furthermore, better pain reduction was achieved in patients with MA when compared with those without MA (p < 0.05). CONCLUSIONS: MA is proved to be a reliable predictor of good surgical outcome for painful DPN.

Management of Cerebral Radiation Necrosis: A Retrospective Study of 12 Patients.

BACKGROUND: Cerebral radiation necrosis (RN) is a severe complication of radiotherapy for cerebral pathologies. This study discusses the radiographic and pathological features of 12 patients with RN and investigates the management strategy. METHODS: Eleven patients with brain tumors, and one with cerebral cavernous angioma, treated by surgical resection or Gamma Knife alone before radiotherapy developed RN during follow-up. Surgical resection for the cerebral RN was performed in nine patients, and the other three patients received medical treatment. The clinical features, magnetic resonance imaging (MRI), surgical findings, and pathological sections are reviewed. RESULTS: The diagnosis of RN was confirmed by histological study in all the patients; those with surgical and medical treatment recovered. CONCLUSION: As a major complication of radiotherapy, from the clinical and neuroradiological points of view, RN may simulate tumor recurrence. Due to the increasing number of patients with RN who will need to be treated in future years, the definite diagnosis and appropriate treatment of RN remain critical.

Combination of Magnetic Resonance Imaging and Electrophysiological Studies in Lumbar Disc Herniation.

Objective We aimed to study the clinical value of magnetic resonance imaging (MRI) and electrophysiological studies in the diagnosis of lumbar disc herniation and in the evaluation of the therapeutic effect of discectomy. Methods In this study, 265 patients with LDH were treated with discectomy after assessment by the Japanese Orthopedic Association (JOA) score, MRI, and electrophysiological studies. All the patients were followed-up for 6 years. The effects of the operation were assessed by determining the angle between the nerve root canal and disc protrusion (AN value), the stenotic ratio of the spinal canal, the width of the lateral recess, motor conduction velocity (MCV), sensory conduction velocity (SCV), and nerve action potential (NAP) before and after operation. Results The AN value, stenotic ratio of the spinal canal, and the width of the lateral recess of protruding intervertebral discs showed significant differences from these values for the patients' unaffected intervertebral discs (P < 0.05). The MCV, SCV, and NAP of the affected limb showed significant differences from these values for the patients' unaffected limbs (P < 0.05). In all the patients the values for these indicators showed significant differences before and after operation (P < 0.05). Conclusion MRI and electrophysiological studies can be used in the diagnosis of lumbar disc herniation, and in the evaluation of the effect of surgery.

Use of High-Resolution Ultrasonography in Anterior Subcutaneous Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome.

OBJECTIVES: Cubital tunnel syndrome (CTS) is the most common form of ulnar nerve entrapment. In this study, ultrasonography (US) was used not only for diagnosis but also for operation. US findings could be used to establish the diagnosis of CTS and could demonstrate the pathological anatomy in the cubital tunnel region to guide anterior subcutaneous transposition of the ulnar nerve. METHODS: Sixty-two patients with clinical and electrophysiological evidence of ulnar nerve entrapment were included. All patients received ultrasonographic examination and anterior subcutaneous transposition of the ulnar nerve. The maximal diameter of the ulnar nerve (MDU) was measured in longitudinal views and the range of the hypoechoic area around the nerve was observed. The cross-sectional area (CSA) was also measured on transverse scans. The actual MDU was measured during operation. RESULTS: The actual MDU was 6.4 ± 0.4 mm, measured during operation. The preoperative MDU was 3.1 ± 0.2 mm. The MDU values recorded in CTS patients were greater than those in normal subjects. The range of the hypoechoic area observed on longitudinal US scans was 2.9-5.6 mm (mean, 4.1 ± 0.4 mm). CONCLUSIONS: High-resolution US can be used not only in the diagnosis of CTS, also for providing effective preoperative evaluation for the anterior subcutaneous transposition of the ulnar nerve in CTS.

Treatment of Posterior Inferior Cerebellar Artery Adhesion on Petrous Bone During Microvascular Decompression Procedure for Hemifacial Spasm: Technique Note.

Hemifacial spasm is a hyperactive cranial nerve disease mainly characterized by unilateral facial muscles paroxysmal, involuntary, irregular and clonic convulsion. Standard microvascular decompression is currently the most effective solution. During operation, it is pivotal to conduct a sharp dissection of arachnoid membrane around the caudal cranial nerves and facial, auditory nerves for fully exposure of pontomedullary sulcus, and lateral pontine region. In this article, the authors demonstrate a hemifacial spasm patient who underwent microvascular decompression successfully in their department. But the authors encountered a serious barrier to the exploration of facial nerve and its offending vessels before decompression and found that posterior inferior cerebellar artery tightly adhered to petrous bone and closely attached to a petrosal vein on cerebellar surface at the same time. The petrosal vein was also seriously stuck to petrous bone. To solve this practical difficulty, the authors employed sharp point knife blade and microsurgical scissors boldly to separate posterior inferior cerebellar artery from the dura mater of petrous bone bidirectionally and bipolar coagulation for effective hemostasis. And then the authors moderately dealt with the surface adhesion of cerebellum for smooth exploration instead of processing the petrosal vein attached to petrous bone because the authors did not want to sacrifice this vein. Relative to the routine microvascular decompression for hemifacial spasm, treatments of the adhensions before decompression were the key technology of this operation.

Symptomatic Trigeminal Neuralgia Caused by Cerebellopontine Angle Tumors.

To investigate the characteristics of symptomatic trigeminal neuralgia (TN) caused by tumors and the relationship between anatomicosurgical findings and tumor type, the authors undertook a retrospective review of 35 patients with symptomatic TN between 2006 and 2015. The tumors included 16 meningiomas, 14 epidermoids, 4 vestibular schwannomas, and 1 hemangioblastoma. The studies show that patients with tumor-induced TN were significantly younger than those idiopathic TN (P <0.05). Meningioma-induced TN tended to have responsible vessels, while epidermoid tumor seemed to cause TN by wrapping or compressing the nerve. Additional vascular compression was observed in 15 (42.9%) of these 35 patients. All patients except one showed immediate pain relief following total or subtotal tumor removal with microvascular decompression (if required). Two patients with epidermoid-induced TN experienced symptom relapses caused by tumor regrowth, and one with meningioma-induced TN experienced pain recurrence caused by adhesive arachnoid. The key for operative success is to examine the entire nerve root for possible vascular compression after total or subtotal tumor resection.

Narrow Foramen Ovale and Rotundum: A Role in the Etiology of Trigeminal Neuralgia.

Primary trigeminal neuralgia (TN) may occasionally occur in absence of neurovascular compression. A mechanism other than nerovascular compression may play a role in TN. High-resolution computed tomographies (CTs) of 21 consecutive TN patients without vascular compression during surgery and 30 healthy volunteers were retrospectively performed. Measuring parameters (length, width, and aspect ratio) were obtained in the axial plane for foramen ovale, and in the reconstructed coronal plane for foramen rotundum on both sides in each subject. The right-sided foramen ovale is slightly narrower than the left-sided, but no difference was observed between the sides. No correlation was found between the foramen size and the gender in both groups. The affected side with a narrower ovale foramen (>0.5 mm) and a significantly greater aspect ratio compared with the unaffected side may contribute to TN. Meanwhile, no significant correlation, but more likely a tendency, was found between the right and left sides in size of foramen rotundum (P = 0.09). This study has speculatively suggested that a narrow skull foramen may be etiologically important in a small percentage of TN patients. If recurrent or residual TN was encountered in cases of TN without vascular compression during surgery, high-resolution CT may help to evaluate the anatomical morphology of skull foramen in great detail.

The Role of Percutaneous Radiofrequency Thermocoagulation for Persistent or Recurrent Trigeminal Neuralgia After Surgery.

Therapeutic strategy is controversial and not yet uniform for patients with trigeminal neuralgia (TN) and persistent or recurrent facial pain after microvascular decompression, percutaneous radiofrequency thermocoagulation (PRT), or Gamma Knife surgery. The outcomes and risks of PRT for these patients are not clearly understood. The authors performed a retrospective study of 84 patients with persistent or recurrent TN after surgery who then underwent PRT between 2007 and 2013. Data were obtained with chart review and telephone interviews. The mean follow-up duration was 44.2 months. The immediate pain relief after PRT was 98%. The survival rates of pain free without medications at 1, 2, and 3 years after PRT were 85%, 68%, and 54%, respectively, with a nearly 80% rate for effective pain control (pain free, or pain controlled with medications) during the study period. The previous surgical method for TN did not have a significant effect on pain-free rates (P >0.05). Ninety-five percent of patients benefited from multiple PRT procedures and were satisfied with their pain relief. Fourteen of 17 patients who required retreatment selected additional PRT, resulting in 8 patients (57%) in excellent outcome and 12 (86%) in effective pain control. Two patients had failed all conventional invasive treatments. All patients experienced numbness of varying degrees, with 2 reporting severe and bothersome numbness. The complication rate was 15%, including 6 patients with masseter weakness, 2 patients with impaired taste acuity, 4 patients with absent or decreased corneal reflex, 1 patient with oculomotor paralysis. Percutaneous radiofrequency thermocoagulation is a safe and efficacious therapeutic method for patients with persistent or recurrent TN after surgery. Percutaneous radiofrequency thermocoagulation can serve as an alternative treatment option for these patients.

Depression, caregiver burden and social support among caregivers of retinoblastoma patients in China.

The aim of this study is to examine the burden of family caregivers of patients with retinoblastoma in China and the relationships between depression, caregiver burden and social support. A descriptive and correlational survey was conducted with 117 Chinese family caregivers of outpatient patients with retinoblastoma from the Department of Ophthalmology of a tertiary hospital in Shanghai, China. Family caregivers of outpatient patients with retinoblastoma were asked to respond to four questionnaires including sociodemographic questionnaire, Becker Depression Inventory, Caregiver Burden Inventory and Social Support Rating Scale. The incidence of depression in this study was 51.3%; the average score for social support indicated moderate social support available to the caregivers, although their level of caregiver burden was heavy. Depression scores were significantly positively correlated with caregiver burden scores and significantly negatively correlated with the social support scores. Heavy caregiver burden was associated with lower monthly income, low subjective social support and less use of social support.

Facial-Hypoglossal End-To-Side Neurorrhaphy: Exploration of the Source of Axonal Sprouting.

Background The clinical application of end-to-side (ETS) neurorrhaphy is under debate partly due to a lack of consensus on the source of axonal sprouting. Methods In this study, 24 rats were divided into three groups: sham operation, facial-hypoglossal ETS neurorrhaphy, and end-to-end (ETE) neurorrhaphy. Electrophysiological tests were employed to detect the evoked compound muscle action potentials (CMAPs) in different situations, and the latencies and maximal amplitudes of the CMAPs recorded were compared. Fluorescence retrograde tracing studies, hematoxylin and eosin (HE) staining, and immunohistochemical staining of growth-associated protein 43 (GAP-43) were performed. The number and the diameter of myelinated axons proximal and distal to the coaptation sites were measured. Results Twelve weeks after the surgeries, reinnervation of whisker pad muscles by hypoglossal nerves in both the ETS and ETE groups were confirmed via electrophysiological study. The maximal amplitudes of the CMAPs recorded in different situations and the quantification of myelinated axons supported the coexistence spontaneous collateral sprouting and regenerative sprouting of axons. Double-labeled neurons were found within the hypoglossal nuclear areas in the ETS neurorrhaphy group and HE staining illustrated the axons crossed the coaptation site into the facial acceptor nerve. Although immunohistochemical staining of GAP-43 revealed different timeframes between ETS and ETE neurorrhaphy groups, no significant difference on latency or diameters of the myelinated axons distal to the coaptation sites was noted between ETE and ETS groups. Conclusion Both spontaneous collateral sprouting and regenerative sprouting of axons coexisted following ETS neurorrhaphy, which represents an alternative approach to peripheral nerve reconstruction.

Impact of diabetes mellitus duration on effect of lower extremity nerve decompression in 1,526 diabetic peripheral neuropathy patients.

BACKGROUND: Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes mellitus (DM). The aim of this study was to analyze DM duration in the prognosis of diabetic peripheral neuropathy of the lower extremity. METHODS: A total of 1,526 DPN patients who were treated with DELLON surgical nerve decompression were divided into a short DM duration group and long DM duration group using a length of 5 years as the standard duration. Before and 1.5 years after surgery, high-resolution ultrasound, quantitative sensory testing (QST), and nerve conduction velocity (NCV) were performed and compared to the normal control. RESULTS: Postoperative NCV of all the patients in either treatment group significantly increased (p < 0.05) and postoperative CSA significantly decreased (p < 0.05) compared with that before surgery. The CPT significantly increased compared with the preoperative value (p < 0.05). The postoperative WPT was significantly lower than the preoperative value (p < 0.01), and the postoperative VPT was significantly lower than the preoperative value (p < 0.05). Overall, the postoperative NCV, CSA, CPT, WPT, and VPT values from the short DM duration group were significantly different from that of the long DM duration group (p < 0.05). CONCLUSIONS: The duration of DM is critical to the prognosis of DPN of the lower extremity, and the data from this study suggest that an early diagnosis and subsequent surgery for DPN have important clinical value.

Clinical characteristics and surgical techniques of trigeminal neuralgia caused simply by venous compression.

OBJECTIVE: The objective of this study was to introduce the operation essentials for treatment of patients with vein compression so as to obtain a satisfactory decompression without sacrificing veins. METHODS: We chose 15 patients with trigeminal neuralgia caused by venous from June 15, 2010, through June 15, 2011, and performed microvascular decompression for each patient. By collecting clinical data, such as preoperative magnetic resonance imaging scans, key operative procedures, surgical outcomes, and complications, we explored the operation techniques for these patients and finally summarized our experiences and ideas. RESULTS: For all the 15 patients, 9 cases had excellent remission, 3 cases had delayed excellent remission, 1 case had good remission, and 2 cases had failed result; the total remission rate was 86.7%; 3 cases had facial numbness. CONCLUSIONS: For patients with vein compression, we combine the following 4 procedures together: (1) fully releasing the arachnoid around trigeminal nerve, (2) exploration and decompression of the whole trigeminal root from Meckel cave to pons, (3) cauterization of companioned petrosal vein tributaries by bipolar coagulation, and (4) placing Teflon between trigeminal nerve and offending petrosal vein, thus could acquire a satisfactory effect (remission rate, 86.7%).

Analysis of therapeutic effect of microvascular decompression surgery on idiopathic hemifacial spasm.

OBJECTIVE: The objective of this paper is to study the therapeutic effect of microvascular decompression surgery on idiopathic hemifacial spasm with compression on different zones of facial nerve. METHODS: The clinical data of 348 patients with idiopathic hemifacial spasm treated by microvascular decompression surgery were retrospectively analyzed. Patients were divided into 5 groups according to compression on different zones of facial nerve by offending vessels. Root exit point was compressed in 18 patients (group A), transitional zone of brainstem was compressed in 42 patients (group B), attached segment of brainstem was compressed in 35 patients (group C), distal cisternal portion was compressed in 21 patients (group D), and 2 or more zones were compressed in 232 patients (group E). The therapeutic effect was observed, and outcome of excellent and partial good were regarded as effective. RESULTS: Patients were followed up for 0.5 to 2 years. The effective rates were 94.4%, 95.2%, 97.1%, 95.2%, and 93.9% in group A, group B, group C, group D, and group E, respectively.No death occurred during operation,and there were no severe complications such as complete facial paralysis, intracranial hematoma, and hearing loss after operation. CONCLUSION: Microvascular decompression surgery is the first choice for treatment hemifacial spasm. Proper detection of offending vessels and complete decompression may be the key factors to increase the cure rate.

Surgical skills of adhesions and transposition of trigeminal nerve for primary trigeminal neuralgia.

OBJECTIVE: The aims of this study were to investigate disposal of adhesions and transposition of the trigeminal nerve during microvascular decompression and evaluate its surgical effect. METHODS: By collecting the clinical data of typical trigeminal neuralgia patients we treated from January 2013 to May 2013, we chose 120 patients with adhesions and transposition of trigeminal nerve, analyzed their preoperative imaging features and surgical procedures, and evaluated postoperative effect after 3-month follow-up. RESULTS: Among these 120 patients, 113 cases showed positive effect in magnetic resonance imaging (three-dimensional time-of-flight); the positive rate was 94.2%. During the operation, firstly we proceed to separate the nerve and artery, secondly we released the vascular compression, finally we removed the superior cerebellar artery to the nerve's head end. Postoperative effect evaluation stated that 101 patients showed immediate remission and 13 patients showed delayed remission (3 min after operation) and the surgery was ineffective for 6 patients; the remission rate was 95%. There were no severe complications. CONCLUSIONS: Magnetic resonance imaging (three-dimensional time-of-flight) before operation could clearly display the neurovascular relationship of trigeminal neuralgia patients. It offers great help for preoperative evaluation. Separation between arachnoid, nerve, and artery; vascular decompression; and removal of the superior cerebellar artery to the head end could resolve adhesions and transposition of trigeminal nerve during microvascular decompression, which showed significant effects.

Evaluation of the clinical efficacy of multiple lower-extremity nerve decompression in diabetic peripheral neuropathy.

OBJECTIVE: To evaluate the value of high-resolution ultrasonography and neural electrophysiology in early diagnosis, operative opportunity selection, and clinical effect assessment of DPN. METHODS: Five hundred and sixty patients with diabetic peripheral neuropathy (DPN) were treated with DELLON surgical nerve decompression in our hospital in the past 5 years. Before and after 18 months surgery, the tests of the Toronto clinical scoring system, high-resolution ultrasonography, QST, and Nerve Conduction Velocity (NCV) were evaluated in all cases. The control group included 40 diabetic patients in the same age range but without DPN. RESULTS: Ultrasonographic images revealed an apparently normal proximal common peroneal nerve, tibial nerve marked swelling, enlarged, and hypoechogeneity with loss fascicular pattern. The cross-sectional-area, anteroposterior and transverse diameter were measured preoperative and prooperative, and the differences had statistical significance (P < 0.01). NCV-positive cases amount to 74.9% DPN patients in this study and QST-positive cases amount to 90.9% and had significant differences between them (P < 0.05). Postoperative NCV and cold perception threshold significantly increased (P < 0.05) compared with that of the before surgery. Postoperative warm perception threshold (P < 0.01) and vibration perception threshold (P < 0.05) were significantly lower than the preoperative value. NCV was positively correlated with cold perception threshold (r = 0.395, P < 0.01), and negatively correlated with warm perception threshold (r = - 0.387, P < 0.01) and vibratory perception threshold (r = - 0.367, P < 0.01). The preoperative TCSS score was 19 points for all the cases, and 420 cases (75%) improved to 10-13 points (P < 0.01). CONCLUSION: Ultrasonography is capable of depicting these nerves morphological information, with respect to exact location, course, and extent. QST is suitable for early diagnosis of DPN, and abnormal QST is an indication of lower extremity nerve decompression for DPN. The joint use of QST and NCV testing helps surgeons to grasp the timing of surgery. High-resolution ultrasound, QST and NCV testing can also be used as an outcome index for surgical treatment.