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1.
World Neurosurg ; 135: 171-172, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31870821

RESUMO

Benign peripheral nerve sheath tumors are well known to neurosurgeons and a relatively commonly seen pathology. Intraneural ganglion cysts, once thought to be rare and poorly understood, are increasingly recognized in clinical practice and better understood based on the advent of high-resolution imaging. There are few reports of different nerve lesions in the same anatomic location appearing concurrently. Herein we present a patient with 2 distinct pathologies explaining 2 distinct symptom complexes-sensory changes in the superficial peroneal distribution (from a schwannoma of the superficial peroneal nerve) and mild motor weakness in the tibialis anterior (from an intraneural ganglion cyst arising from the superior tibiofibular joint affecting this motor branch). Recognition of the 2 pathologies allowed targeted surgical approaches, which led to resolution of the symptoms.


Assuntos
Cistos Glanglionares/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Neuropatias Fibulares/diagnóstico por imagem , Idoso , Feminino , Cistos Glanglionares/complicações , Cistos Glanglionares/cirurgia , Humanos , Imagem por Ressonância Magnética , Neurilemoma/complicações , Neurilemoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/complicações , Neoplasias do Sistema Nervoso Periférico/cirurgia , Nervo Fibular/diagnóstico por imagem , Nervo Fibular/cirurgia , Neuropatias Fibulares/complicações , Neuropatias Fibulares/cirurgia
2.
Muscle Nerve ; 60(5): 544-548, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31361339

RESUMO

INTRODUCTION: Ultrasound (US) evaluation of peripheral nerves is a noninvasive, cost-effective approach to diagnosing focal mononeuropathies and guiding surgical management. We used the intranerve ratio to evaluate for possible cut-off values in diagnosis of fibular mononeuropathies (FNs). METHODS: A retrospective analysis of FN confirmed by electrodiagnosis (EDx) was performed to identify intranerve ratio values between affected and unaffected limbs at the fibular head and popliteal fossa. RESULTS: The optimal fibular head/popliteal fossa intranerve ratio to discriminate between limbs with and without disease was 1.25 (sensitivity, 51%; specificity, 71%). There was no statistically significant difference between affected vs unaffected limbs (ratio, 1.13; P = .15) nor in subgroup analyses. However, 25% of patients had structural lesions amenable to surgery. DISCUSSION: The utility of US in diagnosis of FN is limited using intranerve ratio data, but US has a distinct advantage over EDx for identifying treatable structural lesions.


Assuntos
Cistos Glanglionares/diagnóstico por imagem , Neoplasias da Bainha Neural/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Nervo Fibular/diagnóstico por imagem , Neuropatias Fibulares/diagnóstico por imagem , Eletrodiagnóstico , Feminino , Cistos Glanglionares/complicações , Cistos Glanglionares/cirurgia , Humanos , Joelho , Masculino , Pessoa de Meia-Idade , Neoplasias da Bainha Neural/complicações , Neoplasias da Bainha Neural/cirurgia , Condução Nervosa , Tamanho do Órgão , Neoplasias do Sistema Nervoso Periférico/complicações , Neoplasias do Sistema Nervoso Periférico/cirurgia , Nervo Fibular/patologia , Neuropatias Fibulares/etiologia , Neuropatias Fibulares/cirurgia , Estudos Retrospectivos
3.
World Neurosurg ; 129: 210-215, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31203077

RESUMO

BACKGROUND: Sacral schwannomas are very rare nerve sheath tumors. Patients usually present with a variety of nonspecific symptoms, which often lead to a delay in diagnosis. Although most schwannomas are benign, they present surgical challenges owing to their proximity to neurologic and other anatomic structures. CASE DESCRIPTION: This 58-year-old female presented with a 2-month old history of left-sided perineal and radicular pain secondary to a right S2 sacral nerve root schwannoma. The sacral mass demonstrated homogenous enhancement with cystic changes in a T2-weighted magnetic resonance imaging sequence. The patient underwent S1-S3 laminectomy and tumor excision through a posterior surgical approach. Intraoperative monitoring was used to distinguish nonfunctional tissue during tumor resection. The patient had an unremarkable postoperative course. CONCLUSIONS: Sacral schwannomas can present with a variety of nonspecific symptoms. They pose unique challenges given their location, size, and involvement of surrounding structures. Complete surgical resection is the main goal of sacral schwannoma treatment. A combined anterior-posterior surgical approach and a multidisciplinary surgical team are associated with improved outcomes.


Assuntos
Neurilemoma/patologia , Neoplasias do Sistema Nervoso Periférico/patologia , Raízes Nervosas Espinhais/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Neuralgia/etiologia , Neurilemoma/complicações , Neurilemoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/complicações , Neoplasias do Sistema Nervoso Periférico/cirurgia , Região Sacrococcígea , Raízes Nervosas Espinhais/cirurgia
4.
World Neurosurg ; 127: 15-19, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30872204

RESUMO

BACKGROUND: Intraspinal dermoid tumors are usually rare benign growths that occur as a result of defects during neural tube formation. They make up less than 1% of tumors in the spine and are associated with spinal dysraphisms or sinus tracts. Although rare, malignant transformation into squamous cell carcinoma has been previously reported. Malignant transformation into adenocarcinoma, however, represents a novel phenotypic differentiation pattern that is hitherto undescribed. CASE DESCRIPTION: A 45-year-old woman presented with acute symptoms of cauda equina syndrome. Imaging of the spine revealed a large intradural sacral mass. The lesion was surgically resected with pathology revealing a dermoid tumor with malignant transformation into adenocarcinoma. Metastatic workup revealed no other suspicious lesions. The patient had an uneventful postoperative course, gradually regaining micturition control. CONCLUSIONS: Dermoid tumors, also known as benign cystic teratoma or mature teratoma, are usually benign congenital tumors comprising epithelial cells that arise from displaced embryonic ectoderm and mesoderm during neural tube formation. Although extremely rare, malignant transformation into squamous cell carcinoma has been reported. This case represents the first report of an intraspinal dermoid tumor transforming into adenocarcinoma. A comprehensive histopathologic analysis is key to identifying the lesion and guiding postsurgical management.


Assuntos
Adenocarcinoma/complicações , Síndrome da Cauda Equina/complicações , Cauda Equina/patologia , Cisto Dermoide/complicações , Neoplasias do Sistema Nervoso Periférico/complicações , Neoplasias da Coluna Vertebral/complicações , Adenocarcinoma/patologia , Síndrome da Cauda Equina/patologia , Cisto Dermoide/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias do Sistema Nervoso Periférico/patologia , Neoplasias da Coluna Vertebral/patologia
6.
J Clin Neurosci ; 62: 229-231, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30638784

RESUMO

The coexistence of lumbar intervertebral disc (IVD) herniation and cauda equina schwannoma in symptomatic patients is uncommon. We experienced a case with a surgically treated cauda equina schwannoma with concomitant lumbar IVD herniation (L2/L3); both were relatively small but presented with painful symptoms in combination. A 45-year old man complained of low back pain and right anterior thigh pain six months prior to surgery. He underwent conservative treatment; however, his pain suddenly worsened three months before surgery, with abnormal sensations and pain in his right buttock and posterior thigh. A magnetic resonance imaging (MRI) scan revealed an L2/L3 disc herniation extruding to the center of the lumbar spinal canal and compressing the thecal sac. Incidentally, an intrathecal tumor was suspected, and enhanced MRI revealed a round tumor measuring 10-mm in diameter at the L2/L3 intervertebral level, which was uniformly enhanced by gadolinium chelate, radiologically diagnosed as a schwannoma. Microscopic discectomy and tumor resection were performed and the patient's symptoms disappeared immediately. Schwannoma is generally slow-growing, and usually asymptomatic when the tumor size is small. Therefore, we suspected that the tumor occasionally impinged on the left L3 root with L2/3 IVD herniation, leading to acute worsening of the patient's symptoms. Altogether, in case of tumor in patients undergoing conservative treatment for cauda equina schwannoma, we should consider that symptoms can acutely worsen with the occurrence of lumbar IVD herniation.


Assuntos
Deslocamento do Disco Intervertebral/epidemiologia , Neurilemoma/epidemiologia , Neoplasias do Sistema Nervoso Periférico/epidemiologia , Cauda Equina/patologia , Humanos , Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/complicações , Dor Lombar/etiologia , Vértebras Lombares , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurilemoma/complicações , Neoplasias do Sistema Nervoso Periférico/complicações
9.
Br J Neurosurg ; 33(3): 281-282, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28554231

RESUMO

We reported a rare peripheral nerve case, a patient developed carpal tunnel syndrome with a history of floating thumb in right hand. The median nerve was found expanded and spindle-shaped and a plexiform neurofibroma was diagnosed. Our case sheds light on anatomy and possible etiological association which may help clinical management.


Assuntos
Síndrome do Túnel Carpal/etiologia , Síndrome do Túnel Carpal/cirurgia , Neurofibroma Plexiforme/complicações , Neurofibroma Plexiforme/cirurgia , Neoplasias do Sistema Nervoso Periférico/complicações , Neoplasias do Sistema Nervoso Periférico/cirurgia , Adulto , Eletrodiagnóstico , Feminino , Humanos , Imagem por Ressonância Magnética , Nervo Mediano/patologia , Nervo Mediano/cirurgia , Neurofibroma Plexiforme/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Polegar/fisiopatologia , Resultado do Tratamento
10.
Br J Neurosurg ; 33(5): 562-565, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28906149

RESUMO

Intrapelvic sciatic nerve schwannomas are rare causes for non-discogenic sciatica. We describe a 44-year-old female who had a palpable mass on digital rectal examination that exhibited a positive Tinel's sign. The schwannoma was excised by a posterior transgluteal approach. Patients with negative spinal imaging should undergo pelvic scanning to rule out these tumors.


Assuntos
Neurilemoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/cirurgia , Ciática/diagnóstico , Adulto , Exame Retal Digital , Feminino , Humanos , Achados Incidentais , Imagem por Ressonância Magnética/métodos , Imagem Multimodal , Neurilemoma/complicações , Neurilemoma/patologia , Neoplasias do Sistema Nervoso Periférico/complicações , Neoplasias do Sistema Nervoso Periférico/patologia , Nervo Isquiático , Ciática/cirurgia , Tomografia Computadorizada por Raios X
11.
Pan Afr Med J ; 29: 206, 2018.
Artigo em Francês | MEDLINE | ID: mdl-30100960

RESUMO

Chronic hydrocephalus associated with a tumor of the conus medullaris and/or of the cauda equina is extremely rare. We here report two cases of medullary tumor revealed by the triad: dementia, difficulty walking and urinary incontinence. Magnetic resonance imaging (MRI) of the cerebrospinal fluid showed communicating hydrocephalus and intradural spinal tumors at the level of the conus medullaris and of the cauda equina. Surgical resection of a benign schwannoma and of an ependymoma allowed the resolution of the clinical symptomatology due to hydrocephalus without implantation of ventricular shunt. A dozen cases of dementia and hydrocephalus associated to spinal tumor have been reported. A variety of approaches have been proposed to explain this association but the exact pathophysiology is not accurately known.


Assuntos
Cauda Equina/patologia , Neoplasias do Sistema Nervoso Periférico/diagnóstico , Neoplasias da Medula Espinal/diagnóstico , Medula Espinal/patologia , Idoso , Cauda Equina/diagnóstico por imagem , Demência/etiologia , Ependimoma/diagnóstico , Ependimoma/cirurgia , Feminino , Humanos , Hidrocefalia/etiologia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neurilemoma/diagnóstico , Neurilemoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/complicações , Neoplasias do Sistema Nervoso Periférico/cirurgia , Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/cirurgia
12.
Neurosurg Focus ; 44(VideoSuppl1): V7, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29291291

RESUMO

Patients who present with a history of cancer and the new onset of lumbosacral or peripheral neuropathy should be evaluated for the potential of metastasis. Targeted fascicular biopsy can be useful to diagnose atypical lesions within peripheral nerves in patients with major or progressive neurological deficits. In this video, the authors demonstrate the technique of targeted fascicular biopsy of the sciatic nerve in a 63-year-old man with a history of prostate cancer. The video can be found here: https://youtu.be/PTOX9XxNBDU .


Assuntos
Doenças do Sistema Nervoso Periférico/cirurgia , Neoplasias do Sistema Nervoso Periférico/secundário , Neoplasias do Sistema Nervoso Periférico/cirurgia , Neoplasias da Próstata/cirurgia , Nervo Isquiático/cirurgia , Biópsia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Doenças do Sistema Nervoso Periférico/etiologia , Neoplasias do Sistema Nervoso Periférico/complicações , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico por imagem , Nervo Isquiático/diagnóstico por imagem
13.
Neurol Med Chir (Tokyo) ; 58(3): 132-137, 2018 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-29367470

RESUMO

Filum terminale lipoma (FTL) causes various spinal symptoms known as tethered cord syndrome. The treatment for FTL is surgical untethering by sectioning the FTL, which can prevent symptom progression and often results in improvement of symptoms. This report describes a minimally invasive surgical strategy that we have introduced for FTL sectioning. The pediatric patients with FTL since 2007 were treated using this minimally invasive surgical strategy, which we refer to as an interlaminar approach (ILA). In summary, the surgical technique involves: minimal skin incision to expose the unilateral ligamentum flavum in the lower lumbar region; ligamentum flavum incision to expose the dural sac, and dural incision followed by identification and sectioning of the filum. Postoperatively, no bed rest was required. Prior to introducing ILA, we had used standard one level laminectomy/laminotomy (LL) with more than 1 week of postsurgical bed rest until 2007, providing an adequate control group for the benefit of the ILA. A total of 49 consecutive patients were treated using ILA. While 37 patients were treated using LL. Surgical complications that need surgery were seen only in one patient, who developed cerebrospinal fluid (CSF) leak in LL patients. No retethering or additional neurological symptoms were seen during follow-up. All patients complained of minimal postsurgical back pain, but no patients required postoperative bed rest in ILA patients, while LL patients need postsurgical bed rest because of back pain. The ILA strategy provides the advantage of a minimal tissue injury, associated with minimal postoperative pain, blood loss, and bed rest.


Assuntos
Cauda Equina , Lipoma/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Defeitos do Tubo Neural/cirurgia , Neoplasias do Sistema Nervoso Periférico/cirurgia , Vértebras Torácicas , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Lipoma/complicações , Masculino , Defeitos do Tubo Neural/complicações , Neoplasias do Sistema Nervoso Periférico/complicações
14.
Musculoskelet Surg ; 102(3): 261-265, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29270889

RESUMO

INTRODUCTION: Carpal tunnel syndrome (CTS) in children represents a complex challenge for the hand surgeon because of its rarity, poor patient cooperation, frequently associated malformation syndromes and mental retard, atypical symptoms and nuanced and poor sensitivity of instrumental tests. The most frequently associated causes with the CTS in children are rare congenital malformations and diseases, requiring an overall assessment of the young patient and a high degree of suspicion for the potentially associated canalicular syndrome. On the other hand, the associated syndromes may be the main ally for a diagnosis that starts from the knowledge of the literature and the surgeon's suspicion by observing the child wailing. Early diagnosis and decompression treatment is mandatory. MATERIALS AND METHODS: The authors report a case series of 26 children and analyze the etiology and diagnostic algorithms. Patient assessment was based on complete clinical examination and medical history collection of these young patients with the involvement of the family and educators. RESULTS: In all 26 patients treated, along an average period of 23 months (minimum 12, maximum 30), no signs of recurrence or persistence of median nerve disturbances were recorded. CONCLUSIONS: In conclusion, we believe that anamnesis, a careful physical examination and analysis of instrumental examinations, should be accompanied by a thorough knowledge of rare diseases in the context of congenital malformations. The carpal tunnel syndrome, while well known and treated by each orthopedic surgeon, reveals a mysterious aspect in the context of the "fabulous" world of childhood illnesses, even more difficult than rare congenital diseases.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica , Adolescente , Anestesia Geral/métodos , Anestesia Local/métodos , Síndrome do Túnel Carpal/congênito , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/etiologia , Criança , Pré-Escolar , Diagnóstico Precoce , Feminino , Fraturas Ósseas/complicações , Hemangioma/complicações , Humanos , Masculino , Nervo Mediano/fisiopatologia , Mucolipidoses/complicações , Neoplasias do Sistema Nervoso Periférico/complicações , Estudos Retrospectivos
15.
Microsurgery ; 38(3): 264-269, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27731522

RESUMO

INTRODUCTION: None of the existing treatments in the management of painful end-neuromas of the superficial branch of the radial nerve (SBRN) has been proven superior due to high levels of pain relapse. Fat grafts enriched with the stromal vascular fraction (SVF) could act as a mechanic barrier with biological effects decreasing the resorption rate and boosting the graft's regenerative potential. This study describes the novel surgical treatment technique of SVF-enriched fat grafting. PATIENTS AND METHODS: In this clinical study, five consecutive patients treated for painful end-neuromas of the SBRN between 2012 and 2013 were analyzed retrospectively. Microsurgical resection of end-neuromas followed by SVF-enriched fat grafting around the nerve stump was performed in all patients. Five different pain modalities and various predictors were compared pre- and up to 36 months postoperatively. RESULTS: Pain reduction observed at 2 months after surgery was constant over time, though not statistically significant compared to preoperative levels. Spontaneous pain could be reduced from 1.6 ± 0.55 to 1.2 ± 1.1 (p = 0.414), spikes from 2.2 ± 1.3 to 1.4 ± 1.34 (p = 0.180), hyperaesthesia from 1.6 ± 1.14 to 1.2 ± 1.64 (p = 0.713), tap pain from 2.8 ± 0.45 to 1.8 ± 1.3 (p = 0.197) and motion pain from 2.8 ± 0.45 to 1.4 ± 1.34 (p = 0.066). An improvement in overall pain reduction could be observed from 2.2 ± 0.97 to 1.4 ± 1.26 3 years after the surgery (p = 0.104). CONCLUSION: SVF-enriched fat grafting represents another alternative to numerous available treatments of painful end-neuromas of the SBRN. Our preliminary results could not show any significant difference in pain reduction following SVF-enriched fat grafting. Further larger trials are required in order to evaluate the therapeutic potential of SVF-enriched fat grafting.


Assuntos
Neuroma/cirurgia , Neoplasias do Sistema Nervoso Periférico/cirurgia , Nervo Radial/cirurgia , Gordura Subcutânea/transplante , Adulto , Idoso , Seguimentos , Humanos , Lipectomia , Masculino , Pessoa de Meia-Idade , Neuralgia/diagnóstico , Neuralgia/etiologia , Neuralgia/cirurgia , Neuroma/complicações , Medição da Dor , Neoplasias do Sistema Nervoso Periférico/complicações , Estudos Retrospectivos , Gordura Subcutânea/citologia , Resultado do Tratamento
17.
World Neurosurg ; 108: 185-200, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28842238

RESUMO

BACKGROUND: Peripheral neuropathies refer to a group of disorders in which there is damage to the nerves of the peripheral nervous system. Electrophysiologic studies are the main stay for the diagnosis of peripheral neuropathies. However, direct visualization of the nerves is possible with exact localization of site of disease with high-resolution ultrasonography (USG) and 3-Tesla magnetic resonance imaging (MRI) scanner, and newer magnetic resonance (MR) sequences. METHODS: We performed a cross-sectional study including 55 patients and 64 nerves with upper limb peripheral neuropathies. All patients included underwent high-resolution focused USG of the nerves and MR neurography. A nerve conduction velocity study was performed for reference. RESULTS: The diagnostic confidence of the turbo spin echo T2-weighted (T2W) MR sequence was seen to be highest, with a sensitivity of 95.31%, whereas it was 81.25% for USG. Continuity of the nerve in patients with traumatic neuropathy was seen in 65.7% and 62.86% (22/35) nerves on MRI and USG, respectively. T1-weighted and T2W MR sequences were seen to be equally effective in establishing the continuity of the nerve. Increase in the caliber/thickening was seen in 77% of cases on MRI and 73.8% of cases on USG. Neuroma formation was seen equally on both MR and USG in 60.66%. We consistently found low fractional anisotropy (FA) values at the site of disease. CONCLUSIONS: USG is a sensitive technique to diagnose peripheral neuropathies and it should be used as a screening modality for focused MR to be performed later. Turbo spin echo T2W fast spin has the highest sensitivity to identify nerve disease and is comparable with nerve conduction studies. Among the newer sequences, diffusion tensor imaging should be performed to increase diagnostic confidence.


Assuntos
Imagem por Ressonância Magnética/métodos , Condução Nervosa , Neuroma/diagnóstico por imagem , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Ultrassonografia/métodos , Extremidade Superior/inervação , Adolescente , Adulto , Anisotropia , Criança , Estudos Transversais , Imagem de Tensor de Difusão , Feminino , Humanos , Masculino , Neuropatia Mediana/diagnóstico por imagem , Neuropatia Mediana/etiologia , Neuropatia Mediana/fisiopatologia , Neuropatia Mediana/cirurgia , Pessoa de Meia-Idade , Neuroma/complicações , Neuroma/fisiopatologia , Neuroma/cirurgia , Doenças do Sistema Nervoso Periférico/etiologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Doenças do Sistema Nervoso Periférico/cirurgia , Neoplasias do Sistema Nervoso Periférico/complicações , Neoplasias do Sistema Nervoso Periférico/fisiopatologia , Neoplasias do Sistema Nervoso Periférico/cirurgia , Neuropatia Radial/diagnóstico por imagem , Neuropatia Radial/etiologia , Neuropatia Radial/fisiopatologia , Neuropatia Radial/cirurgia , Razão Sinal-Ruído , Neuropatias Ulnares/diagnóstico por imagem , Neuropatias Ulnares/etiologia , Neuropatias Ulnares/fisiopatologia , Neuropatias Ulnares/cirurgia , Ferimentos e Lesões/complicações , Adulto Jovem
18.
A A Case Rep ; 9(4): 112-115, 2017 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-28604466

RESUMO

Spinal cord stimulation can be a valuable treatment option in the management of neuropathic pain in select pediatric patients. We present a unique case of a 16-year-old girl with Klippel-Trenaunay-Weber syndrome and scoliosis who required the placement of a spinal cord stimulator (SCS) for severe sciatic nerve neuropathic pain after a right above-knee amputation. Several attempts at lead placement were required before successful pain coverage was achieved because of late recognition of significant vertebral body rotation. This case highlights important considerations in pediatric SCS placement including a careful review of the spinal cord anatomy before the placement of an SCS.


Assuntos
Neuroma/complicações , Manejo da Dor/métodos , Neoplasias do Sistema Nervoso Periférico/complicações , Neuropatia Ciática/complicações , Estimulação da Medula Espinal/métodos , Adolescente , Feminino , Humanos , Síndrome de Klippel-Trenaunay-Weber/complicações , Neuroma/terapia , Neoplasias do Sistema Nervoso Periférico/terapia , Neuropatia Ciática/terapia
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