Neurosurgery (69)

Abstract

Neurovascular decompression for idiopathic tarsal tunnel syndrome: technical note. (Fuji Brain Institute and Hospital, Fujinomiya City, Shizuoka Prefecture, Japan) J Neurol Neurosurg Psychiatry 2000;69:87–90.This study evaluates the efficacy of neurovascular decompression for patients with tarsal tunnel syndrome (TTS). Twelve feet from 9 patients with idiopathic TTS were treated. The patients were aged 52–78 years (mean 64.6 years), and all of them complained of pain or dysaesthesia of the sole of the foot. The posterior tibial nerve was freed from the attached arteriovenous complex (posterior tibial artery and veins). The dissected nerve had a flattened appearance in all of the patients, suggesting nerve compression by the adjacent arteriovenous complex and superficially by the flexor retinaculum. A graft of fat was inserted as both a cushion and an antiadhesive between the vessels and the nerve to achieve neurovascular decompression. Patients on whom neurovascular decompression was performed had resolution or lessening of symptoms in their feet. Neither wound infection nor recurrence of symptoms was found during the follow‐up period (mean 26.8 months). Conclude neurovascular compression syndrome plays a part in idiopathic TTS, and adding neurovascular decompression to resection of the flexor retinaculum is effective. Comment by R. Ruiz‐López, MD.The surgical outcome of idiopathic tarsal tunnel syndrome (TTS) has been reported less than ideal and worse than that attributable to tarsal coalition tumor or ganglion. The authors considered necessary the development of a new technique in the surgical treatment of this syndrome assuming that neurovascular compression plays a part in idiopathic TTS. They treated 12 feet from 9 patients on whom neurovascular depression with a graft of fat adding resection to the flexor retinaculum was effective for the resolution or lessening of pain and paresthesia in all cases during a mean follow‐up period of 26.8 months without complications.