Natural Openings in the Paraneurium and Epineurium of the Human Sciatic Nerve and Their Relationship to the Entry and Exit of Blood Vessels. A Microanatomical Study.

The microvasculature of peripheral nerve not only is important for the understanding of the development of compression syndromes, but it plays a critical role in the evolution of other nerve pathologies, including, for example, the distribution of intraneural ganglion cysts and lymphoma. We investigated the anatomical course of vessels around the human sciatic nerve and its bifurcation in eight human cadavers. Specifically, the presence of fenestrations on the epineurium and paraneurium's thickness in relation to the intraneural vessels was investigated.

Double Crush Syndrome of the L5 Nerve Root and Common Peroneal Nerve at the Fibular Head: A Case Series and Review of the Literature.

: The co-existence of multiple compression sites on the same nerve can pose a clinical and diagnostic challenge, warranting a different treatment strategy. This so-called double crush syndrome (DCS) has mainly been investigated in the upper limb. Only a few studies have investigated DCS for the lower limb.

Extreme subparaneurial ganglion cysts. Part 2: The geyser theory as a mechanistic explanation for crossover.

Objective: Extreme subparaneurial ganglion cysts are poorly understood. In Part 1, the authors demonstrated that patterns of distribution in the subparaneurial space are consistent with the principles of the articular theory for intraneural ganglion cysts (INGCs). How a cyst transfers from the subepineurial to the subparaneurial compartment remains to be determined.

Extreme subparaneurial ganglion cysts. Part 1: Principles and implications.

Objective: The formation and propagation of intraneural ganglion cysts (INGCs) is being elucidated by the unified articular theory. Its principles include a connection for joint fluid to egress from a synovial joint via an articular branch to a parent nerve and cyst following the path of least resistance, dependent on pressures and pressure fluxes. The occurrence of so-called extreme peroneal or tibial INGCs in the popliteal fossa extending to the sciatic nerve has been reported.

Surgery versus corticosteroid injection for carpal tunnel syndrome (DISTRICTS): an open-label, multicentre, randomised controlled trial.

Background: Surgery and corticosteroid injections are established treatments for carpal tunnel syndrome, but the optimal treatment strategy remains unclear. This study aimed to compare starting treatment with surgery versus starting with a corticosteroid injection.

Methods: We conducted an open-label, randomised controlled trial across 31 hospitals in the Netherlands.

Perioperative complications in spinal trauma patients: does timing matter?

Background: Early surgery in traumatic spinal fracture treatment may facilitate prompt mobilization, encountering affiliated complications. However, the safety and the benefits of early surgery are being questioned in spinal trauma patients. Therefore, the objective of this retrospective study is to investigate the effect of surgical timing on perioperative complications in these patients.

Traumatic neuroma of the medial antebrachial cutaneous nerve treated by targeted muscle reinnervation using the epitrochleoanconeus muscle.

This case shows the feasibility of targeted muscle reinnervation (TMR) in a patient with a traumatic neuroma of the medial antebrachial cutaneous nerve (MABCN). TMR was performed by connecting the proximal stump of the MABCN to the branch innervating the accessory epitrochleoanconeus muscle. Postoperatively, the patient reported significantly less pain.

Long-term Follow-up with MRI Scans After Enucleation of Peripheral Nerve Schwannomas: Results from a Single-center Case Series.

Background: Enucleation is a surgical technique to resect peripheral nerve schwannomas. The procedure has a low risk for postoperative deficit, but a small chance for recurrence, because tumor cells may remain inside the pseudocapsule that is left after resection. Magnetic resonance imaging (MRI) scans are frequently performed after surgery to investigate potential residual tumor, but currently there is little information in the literature on the value of follow-up with MRI.

Tibial intraneural ganglion cysts arising from the tibiofemoral joint: illustrative cases.

Background: Intraneural cysts involving the tibial nerve in the knee region (popliteal fossa) are rare. According to the articular (synovial) theory, which posits a joint origin for this pathology, these cysts originate from either the superior tibiofibular joint (STFJ) or the tibiofemoral (knee) joint. As tibial intraneural cysts arising from the tibiofemoral joint remain poorly understood, the authors present 2 illustrative cases and a review of the world's literature on all tibial intraneural ganglion cysts in the knee region.

Targeted muscle reinnervation for a recurrent traumatic neuroma of the sural nerve: illustrative case.

Background: Traumatic neuromata often recur after resection. Recently, targeted muscle reinnervation (TMR) has been shown to be a promising alternative for the treatment of traumatic neuroma, also in nonamputees. This case shows that TMR can also be applied for this indication in recurrent traumatic neuroma.

Submuscular transposition of the ulnar nerve for persistent or recurrent cubital tunnel syndrome: Results of a prospective case series.

Background: Submuscular transposition (SMT) of the ulnar nerve is frequently performed as secondary procedure in patients with persistent or recurrent cubital tunnel syndrome (CuTS) despite previous surgery. Good results have been reported for this surgical strategy, but mainly in small retrospective case series. The goal of the present study is therefore to analyze the results prospectively using a patient-reported outcome measure (PROM): patient-rated ulnar nerve evaluation (PRUNE).

Dutch injection versus surgery trial in patients with carpal tunnel syndrome (DISTRICTS): protocol of a randomised controlled trial comparing two treatment strategies.

Introduction: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy. The optimal treatment strategy is still unknown. The objective of the Dutch Injection versus Surgery TRIal in patients with CTS (DISTRICTS) is to investigate if initial surgery of CTS results in a better clinical outcome and is more cost-effective when compared with initial treatment with corticosteroid injection.

Randomized Evaluation of Surgery in Elderly with Traumatic Acute SubDural Hematoma (RESET-ASDH trial): study protocol for a pragmatic randomized controlled trial with multicenter parallel group design.

Background: The rapidly increasing number of elderly (≥ 65 years old) with TBI is accompanied by substantial medical and economic consequences. An ASDH is the most common injury in elderly with TBI and the surgical versus conservative treatment of this patient group remains an important clinical dilemma. Current BTF guidelines are not based on high-quality evidence and compliance is low, allowing for large international treatment variation.

Sonographic normal values for the cross-sectional area of the ulnar nerve: a systematic review and meta-analysis.

Purpose: Nerve size is a commonly used sonographic parameter when assessing suspected entrapment of the ulnar nerve. We aimed to create a robust set of normal values, based on a critical review of published normal values.

Methods: We performed a systematic evaluation of studies on normal ulnar nerve sizes, identified in PubMed, Embase, and Cochrane databases.

Safety and efficacy of C1-inhibitor in traumatic brain injury (CIAO@TBI): study protocol for a randomized, placebo-controlled, multi-center trial.

Background: Traumatic brain injury (TBI) is a major cause of death and disability across all ages. After the primary impact, the pathophysiologic process of secondary brain injury consists of a neuroinflammation response that critically leads to irreversible brain damage in the first days after the trauma. A key catalyst in this inflammatory process is the complement system.

A delphi procedure on rehabilitation outcome for patients with moderate to severe traumatic brain injury; first phase of the Neurotraumatology Quality Registry (NET-QURE).

Objective: To select a set of rehabilitation outcome instruments for a national Neurotrauma Quality Registry (Net-QuRe) among professionals involved in the care of patients with traumatic brain injury.

Design: A 3-round online Delphi procedure.

Subjects: Eighty professionals from multiple disciplines working in 1 of the 8 participating rehabilitation centres were invited to participate.

Suprainguinal Re-Resection of the Lateral Femoral Cutaneous Nerve in Persistence or Recurrence of Meralgia Paresthetica After Previous Transection: Results of a Case Series.

Objective: Suprainguinal re-resection of the proximal nerve stump can be performed in case of persistent or recurrent symptoms of meralgia paresthetica after previous transection of the lateral femoral cutaneous nerve (LFCN). Currently, no long-term results for this procedure have been reported in the literature.

Methods: In this study, 20 consecutive patients with persistent (13 cases) or recurrent (7 cases) symptoms of meralgia paresthetica were reoperated at a mean interval of 16 months after the first transection of the LFCN.

Sublaminar bands in oncological spine surgery: illustrative cases.

Background: Sublaminar bands have been used in addition to pedicle screw placement in the correction of idiopathic scoliosis forming a so-called hybrid construct.

Observations: In this article, the authors present several cases that demonstrate the potential applications of sublaminar bands in oncological spine surgery. The potential applications are divided into three categories: (1) as an additional tool in salvage procedures, (2) to correct kyphosis in pathological fractures, and (3) for bone graft anchoring to the spine.

Delayed-onset white cord syndrome after anterior and posterior cervical decompression surgery for symptomatic ossification of spinal ligaments: illustrative cases.

Background: White cord syndrome is an extremely rare complication of cervical decompressive surgery, characterized by serious postoperative neurological deficits in the absence of apparent surgical complications. It is named after the characteristic ischemic-edematous intramedullary T2-hyperintense signal on postoperative magnetic resonance imaging and is believed to be caused by ischemic-reperfusion injury. Neurological deficits typically manifest immediately after surgery, and delayed occurrence has been reported only once.