Malignant schwannoma of the obturator nerve.

Lesions of obturator nerve are rare. Tumours and mainly malignant schwannoma of this nerve are extremely rare. The authors describe an unusual case of a gigantic schwannoma of the obturator nerve in 69 year old woman. Due to tumour expansion in the proximal part of the thigh MRI was performed and demonstrated extensive tumour originating most probably from the obturator nerve. The patient had no neurological symptoms. Biopsy from the lesion was taken at the Department of Orthopaedics with the following conclusion: malignant schwannoma. The patient received neoadjuvant chemotherapy due to diffuse metastatic spread on the chest X ray, after which metastatic spread subsided. The main lesion reduced its size by 1 cm. In 4 months after biopsy the patient was referred for operation to neurosurgery. The tumour was removed along its borders and except of minimal weakness of adduction of the right thigh there was no neurological deterioration. She was subsequently referred for further care to oncology and radiotherapy.The goal of this work is to emphasize the extremely rare occurrence of tumours of this nerve and suggest therapeutic options (Fig. 4, Ref. 11).

[Compressive syndromes of the suprascapular nerve--experience with surgery]. / Kompresivní syndromy n. suprascapularis--zkusenosti s chirurgickou lécbou.

Compression of suprascapular nerve at the suprascapular notch or spinoglenoid notch can be a cause of a rare mononeuropathy. Patients complain of pain in scapula and shoulder, and selective wasting and weakness of the supraspinatus and infraspinatus muscles. Tenderness at the suprascapular notch and pain by forced abduction of arm are typical and useful signs. Electromyographic signs of various grade denervation are regularly found in both muscles. Development of entrapment syndromes is associated with chronic overload, shoulder injuries, with surgical procedures, or with shoulder-arm fixation. The authors present their own group of 10 patients, who were operated on for entrapment syndrome of suprascapular nerve during 7 year period. Direct or indirect traumatic mechanisms of development of nerve compression were disclosed in most patients. During postoperative period there was not only substantial decrease of pain, but also regression of weakness and wasting of both muscles. In discussion, necessity of differential diagnostic procedures in case of pain and muscle wasting, use of appropriate imaging techniques, demand of purposeful EMG examination, and postoperative follow-ups are emphasized.

[The usefulness of carpal tunnel pressure measurement during endoscopic surgery of carpal tunnel syndrome]. / Vyuzití merení tlaku v karpálním tunelu behem operace syndromu karpálního tunelu.

The usefulness of carpal tunnel pressures measurement during surgery of carpal tunnel syndrome is documented by the authors. 31 patients underwent endoscopic uniportal approach, the pressure in different positions (neutral position, flexion and extension in wrist, grip of the fingers) and in different levels (distal forearm, proximal, central and distal part of carpal tunnel, palm) was measured. The significant drop of pressure was observed after dissection of ligament in all levels. The results are presented in the form of several graphs.

[Measurement of carpal tunnel pressure during surgery of carpal tunnel syndrome]. / Merení tlaku v karpálním tunelu pri operacích syndromu karpálního tunelu.

A significance of carpal tunnel pressure measurement during surgery of carpal tunnel syndrome (endoscopic and twin incision technique) was evaluated. The pressure in different levels of palm and in different positions of the hand was measured by ICP sensor Codman during operation of 10 patient. The results are presented in the form of several graphs. In all 10 cases excellent results were obtained.