Management outcome of peroneal nerve injury at knee level: experience of a single military institution.

BACKGROUND AND PURPOSE: We investigated the management outcome of common peroneal nerve decompression at the knee level between the years 2005 and 2009. MATERIAL AND METHODS: Thirty consecutive patients with knee-level peroneal nerve injury who underwent decompression surgery and external neurolysis at our institution were evaluated preoperatively and postoperatively by electrophysiological studies and motor examination (Medical Research Council grading). RESULTS: Twenty-eight of the cases were male and 2 were female. Mean age was 31.1 for males and 57.5 for females. Physical activity during military training (overstretch/contusion) was the cause of nerve lesion in the majority of the patients (n = 28, 93%). Mean time interval between the diagnosis and the surgery was 5 months. Follow-up time ranged from 3 to 48 months (mean: 14 months). Twenty-nine of 30 (97%) patients recovered totally or near totally in foot/toe dorsiflexion. CONCLUSIONS: Early decompression and neurolysis of the common peroneal nerve (CPN) at knee level after strenuous physical activity offers excellent functional recovery. Additionally, for knee-level CPN injuries, in order to minimize the postoperative scar, pain and delay in wound healing, we strictly advocate short 'lazy S-shaped incision' around the fibular head in supine position unlike the classical extensive opening up to the superior border of the popliteal fossa in prone position.

The surgical anatomy of the brachial plexus.

AIM: The brachial plexus (BP) has a complex structure and risky relations with its neighborhoods. This study was designed to investigate and overcome the morphometric features of the BP and the difficulties regarding surgery of BP lesions. MATERIAL AND METHOD: Twelve BP of six adult cadavers were dissected and neural structures, branches, and variations were evaluated. Morphometric measurements were done and surgical approaches were discussed. RESULTS: The length of anterior (ventral) rami of C5-T1 are in decreasing order such as C5 > C6 > C7 > C8 > T1 and the width of them is in decreasing order such as C7 > C8 > C6 > T1 > C5. The length of upper trunk (UT) , middle trunk (MT) and lower trunk (LT) are approximately similar (UT approximately MT approximately LT) , but the width is in decreasing order as LT > UT > MT. The length of the cords are in decreasing order as posterior cord (PC) > lateral cord (LC) > medial cord (MC), whereas their widths are PC > LC > MC . CONCLUSION: From the ventral rami to the cords, BP has a complex and variable anatomic structure. The selection of surgical procedure to the BP needs to be mastered by having the best knowledge of the relevant anatomy.

Endoscopic approaches to the orbit: a cadaveric study.

INTRODUCTION: The role of the endoscopic management of lesions located in the anterior cranial fossa and skull base continues to expand. MATERIALS AND METHODS: An endoscopic anatomic study was conducted on cadaver specimens. 10 orbits from 5 cadaveric heads fixed in formalin were examined after the vascular structures had been perfused with colored latex and silicone. Endoscopic dissections were performed using rigid endoscopes of 4 mm diameter, 18 cm length, and equipped with 0 degrees , and 30 degrees lenses, according to the different steps of the anatomic dissection protocol. RESULTS: We have identified and described three endoscopic approaches to the orbit: 1) an inferolateral endoscopic orbital approach (IL-EOA), 2) an endoscopic endonasal medial orbital approach (EEM-OA), and 3) a transcranial key hole endoscopic orbital approach (TCK-EOA). DISCUSSION: The IL-EOA provides excellent exposure of the temporal compartment of the orbit. In this approach special care should be taken to preserve the ciliary ganglion, the ciliary artery and the ciliary nerves. The EEM-OA offers direct access to the medial and inferomedial orbit, the medial part of the optic nerve and orbital apex through its anteromedial walls. The EEM-OA is simple, relatively quick and has superiority over microsurgical operations by excluding the potential complications of intracranial operations. The EEM-OA is minimally invasive and cosmetically acceptable. The TCK-EOA offers an exposure of the orbital roof and the superior part of the optic nerve as well as other intraorbital structures from above. The TCK-EOA is a potentially safe approach for tumors extending from the orbital wall to the anterior cranial fossa and the parasellar region.