Bilateral endonasal endoscopic optic nerve decompression in a 7-month-old male patient with osteopetrosis: A case report with review of the literature

Surgical treatment of occipital headaches involves the decompression of the peripheral occipital nerves. While the literature extensively describes the longitudinal midline incision approach, our group initially used the longitudinal approach and switched to the transverse approach. The aesthetic outcomes of both incision techniques remain unexplored. Patients undergoing surgical decompression for occipital headaches were instructed to provide images of their exposed occipital scalp scar. Evaluation was conducted using the Stony Brook Scar Evaluation Scale (SBSES) and the Scar Cosmesis Assessment and Rating (SCAR) scale by 3 independent plastic surgeons. SBSES scores range from 0 to 5 (higher indicating better outcomes), while SCAR scores range from 0 to 15 (higher indicating worse outcomes). Comparisons were made between transverse and longitudinal scars, with factors influencing scores identified. Forty patients (average age: 47; 73% female) participated, with 28% having longitudinal midline scars and 72% having transverse scars. Patients with transverse scars exhibited higher SBSES scores (4.2 vs. 3.6; P = 0.044) and lower SCAR scores (3.0 vs. 4.6; P = 0.016). Longitudinal scar patients displayed more suture marks (SBSES: P =0.018; SCAR P = 0.003) and wider scar spread (SBSES: P = 0.013; SCAR: P = 0.038) compared with transverse scar patients. On regression analysis, higher BMI was associated with worse SCAR scores ( P =0.015), and a transverse scar was associated with improved SCAR scores ( P =0.008). Our study reveals superior aesthetic outcomes with the transverse incision approach for occipital nerve decompression surgery compared with the longitudinal midline technique. Transverse scars exhibited higher SBSES scores and lower SCAR scores, indicating better cosmesis. Notably, longitudinal scars were associated with more prominent suture marks and wider scar spread.

Peripheral nerve injury is a complex condition that significantly impacts quality of life and often affects young and active individuals. Accurate classification of injury severity using the Sunderland grading system is essential for distinguishing cases amenable to conservative management from those that require surgical intervention. While lower-grade injuries are typically managed conservatively at first, persistent or severe symptoms frequently necessitate surgery. Surgical approaches vary depending on the underlying cause of the nerve injury, including compressive neuropathies, trauma, and neoplastic lesions, and may involve nerve decompression, transposition, neurolysis, nerve repair techniques, and tumor resection. Imaging evaluation with high-frequency US and MRI is fundamental for postoperative peripheral nerve assessment, allowing direct nerve visualization, evaluation of the surgical site and persistent signs of nerve injury, identification of secondary changes such as muscle denervation, and differentiation between the expected postoperative findings and complications. These complications include perineural fibrosis, neuroma formation, incomplete decompression, nerve graft failure, and surgical site collections. It is crucial for radiologists to understand the spectrum of normal postoperative changes and recognize abnormal findings to avoid misinterpretation, optimize patient care, and guide clinical decision making after peripheral nerve surgery. The authors aim to provide a comprehensive review of the main peripheral nerve surgical procedures, with a focus on the surgical techniques, expected postoperative imaging appearances, and spectrum of potential complications.

Lower extremity nerve decompression (LEND) for painful diabetic peripheral neuropathy (PDPN) remains controversial, and evidence regarding its long-term effectiveness in real-world clinical practice is limited. This retrospective real-world cohort study included patients with PDPN treated with LEND or medical therapy alone between 2008 and 2011. Ultra-long-term outcomes were assessed after > 10 years of follow-up. Pain intensity was evaluated using the visual analogue scale (VAS). Composite pain burden and functional impact were assessed with the Brief Pain Inventory for Diabetic Peripheral Neuropathy (BPI-DPN). Psychological symptoms were measured using the Hospital Anxiety and Depression Scale (HADS), and analgesic medication burden was quantified by the Medication Quantification Scale III (MQS-III). Exploratory prognostic factor and subgroup analyses based on pain distribution were performed. Seventy-six patients in the LEND group and 31 patients in the medical group were available for ultra-long-term analysis. Compared with medical management, LEND was associated with greater long-term pain relief (mean VAS change - 5.63 ± 2.16 vs - 1.03 ± 1.92; p < 0.001) and higher responder rates (≥ 50% pain reduction: 65.8% vs 9.7%; p < 0.001). Significant long-term improvements were also observed in BPI-DPN pain severity and pain interference (both p < 0.001), anxiety and depression symptoms (both p < 0.001), and medication burden (MQS-III p < 0.001). Within the LEND cohort, younger age at surgery and lower body mass index were independently associated with greater long-term pain improvement. Both focal and diffuse pain subgroups demonstrated significant improvements in pain and functional outcomes after surgery, with no meaningful differences at ultra-long-term follow-up. Diabetic foot ulcer events occurred less frequently after LEND (0% vs 32.3%; p < 0.001). LEND demonstrated long-term efficacy in alleviating pain and concurrently improving the pain-related interference and psychological status of patients with PDPN. A Graphical Abstract is available for this article. This study was retrospectively registrated in Chinese Clinical Trial Registry chictr.org. cn (ChiCTR2500099348), https://www.chictr.org.cn/bin/project/edit?pid=266042 .

Tarsal tunnel syndrome is an entrapment neuropathy caused by the compression of the tibial nerve and its terminal branches in the tarsal tunnel. Electrophysiological examinations are often used to diagnose tarsal tunnel syndrome. Surgical decompression of the tibial nerve is performed in patients who are resistant to conservative treatment. However, the preoperative electrophysiological findings that predict surgical outcomes remain unknown. This study aimed to clarify the preoperative electrophysiological findings that predict the surgical outcomes of tarsal tunnel syndrome. We reviewed 28 feet of 23 patients who underwent preoperative electrophysiological examinations between November 2021 and October 2024, were diagnosed with tarsal tunnel syndrome, and subsequently underwent surgery. Electrophysiological examinations included nerve conduction study and needle electromyography. We reviewed patient characteristics and electrophysiological findings prior to surgery. Sensory plantar symptoms, such as numbness and pain, were evaluated using the Numerical Rating Scale before and after surgery. Patients were divided into the improvement and non-improvement groups based on the Numerical Rating Scale improvement rate after surgery. A comparative analysis of patient characteristics and preoperative electrophysiological findings was performed between the improvement and non-improvement groups. In a motor nerve conduction study of the tibial nerve, the amplitude of the compound motor action potential evoked by stimulation at the ankle was significantly lower in the non-improvement group than in the improvement group. In tarsal tunnel syndrome, a low compound motor action potential amplitude of the tibial nerve on preoperative motor nerve conduction study may indicate poor symptomatic improvement after surgery. Electrophysiological examinations may be useful for predicting the surgical outcomes of tarsal tunnel syndrome.

Intrapelvic entrapment of the sciatic and sacral nerve roots can cause chronic pelvic pain, sciatica, and symptoms such as dysmenorrhea, dyspareunia, dyschezia, dysuria, vulvodynia, coccygodynia, and pudendal neuralgia. Conventional spine-focused approaches often overlook this cause. This study assessed whether laparoscopic nerve decompression improves pain and related outcomes. Between November 2022 and April 2024, 25 women (median age: 36 years) with ≥ 2 years of refractory pelvic neuropathic pain underwent laparoscopic decompression of the sciatic and sacral plexus. Diagnosis was confirmed via neuropelveological exam and 3-Tesla MRI. Patient-reported outcomes-Visual Analogue Scale (VAS) for nine pain domains, SF-36, PHQ-9, and OAB-V8-were collected preoperatively and at 1, 6, and 12 months postoperatively. Operative details and complications were recorded. All surgeries were completed laparoscopically with no conversions or motor deficits. Median operative time was 143.5min. VAS scores decreased by 70-90% at one month (p ≤ 0.001) and remained improved at 6 and 12 months. SF-36 subscales improved significantly by month 1 and peaked at month 6. PHQ-9 dropped from 18.2 to 6.8 at 12 months (p < 0.001). OAB-V8 scores also showed significant improvement (p < 0.05). Laparoscopic decompression of intrapelvic sciatic and sacral nerves appears safe and effective, providing substantial and sustained improvements in pain, quality of life, mood, and bladder symptoms. Further randomized trials are needed to validate these findings.

Varied surgical alternatives for treating cubital tunnel syndromes have been used. A trend of endoscopic ulnar nerve release is emerging. The purpose of this study is to introduce a modified technique of endoscopic ulnar nerve decompression in association with anterior transposition of the ulnar nerve and to assess the feasibility and efficacy of the surgery. We introduced a modified method of endoscopic release and subfascial anterior transposition of the ulnar nerve. The technique was applied to six patients who presented signs, symptoms, and abnormal neurophysiological studies of cubital tunnel syndrome. The patients were classified according to the Dellon classification preoperatively. The Bishop rating system was used to evaluate the postoperative outcomes. Trial registration number for the study is MR-31-25-090620. Preoperatively, all six patients were classified as severe according to the Dellon classification. The endoscopic cubital tunnel release and subfascial anterior ulnar nerve transposition surgeries were performed with no difficulty in all patients. All the patients had improvement in symptoms and scored excellent or good according to the modified Bishop Rating System postoperatively. The modified endoscopic cubital tunnel release and subfascial anterior ulnar nerve transposition technique is technically feasible with satisfactory outcomes in six patients in this study.

Nerve injuries and regeneration after peripheral nerve surgery are time-sensitive, therefore longer waiting times and delayed treatment could impact patient management and functional results. This study aimed to investigate the effects of the COVID-19 pandemic on acute and elective peripheral nerve surgery during the strict first lockdown measures. In this retrospective study 352 patients who underwent peripheral nerve surgery in auniversity-based setting in an academic center during the COVID-19 lockdown (March 2020 to March 2021) were included. The pre-COVID-19 period of March 2018 to March 2019 served as abaseline for peripheral nerve procedures at the same department. Patient demographics, type of peripheral nerve lesion, affected peripheral nerves, operative treatment, postoperative complications and length of hospital stay were assessed. Acute indications and elective peripheral nerve surgery were assessed in 2separate groups to evaluate influences of COVID-19 restrictions during the first lock-down period. Atotal of 198 patients underwent peripheral nerve surgery during the pre-COVID-19 period compared to 154 patients during the COVID-19 period. The most common forms of surgery were peripheral nerve decompression procedures, which were significantly reduced during the COVID-19 period. While an overall reduction of peripheral nerve procedures was found, the proportion of posttraumatic reconstruction and nerve tumor surgery increased during the COVID-19 period. The measures taken during the COVID-19 period altered the number of elective peripheral nerve surgeries. While the overall number of patients treated was reduced, urgent cases were prioritized.

Scapular morphometrics inform anatomic landmark distances for arthroscopic suprascapular nerve decompression: a cadaveric study

Retroauricular hyaluronic acid (HA) injection can enhance the cranio-auricular angle, thereby reducing perceived facial width and enhancing aesthetic appeal. Although this is generally a safe procedure, acute facial nerve paralysis is a rare but devastating complication. The aim of this study is to characterize the MRI features of acute facial paralysis following retroauricular HA injection, including manifestations of nerve injury and the distribution of the injected material, and to infer the potential etiology of the facial paralysis based on imaging findings. 15 patients presenting with acute complete unilateral facial paralysis following retroauricular HA filler injection between December 1, 2023, and August 10, 2025 were identified. No perceivable improvement was seen despite non-surgical interventions for 2 weeks. MRI using a 3.0-T scanner was conducted to acquire gadolinium-enhanced T1-weighted and T2-weighted images. Each segment of the facial nerve was evaluated, and the diffusion range of the HA injection was observed by examining the contralateral side. MRI demonstrated significant enhancement of the facial nerve on the affected side compared to the unaffected side in the tympanic (P = 0.006), mastoid (P = 0.004), and parotid segments (P < 0.001) on contrast-enhanced T1-weighted images. Additionally, the HA filler exhibited extensive diffusion (46.7 ± 12.2 mm horizontally, 53.1 ± 12.2 mm vertically) and infiltrating adjacent tissue spaces. This group of patients showed widespread distribution of HA beyond the injection site. Additionally, persistent facial nerve edema and enhancement were mainly localized to the tympanic segment and its distal end of the facial nerve, indicating a possible need for facial nerve decompression in this cohort. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Introduction: Postpartum neuropathies have long been recognized as potential complications of childbirth. Commonly affected nerves include femoral, sciatic, lumbosacral plexus, lateral femoral cutaneous, and peroneal nerves. Risk factors include prolonged second stage of labor, maternal short stature, fetal macrosomia, instrumental deliveries, hyperflexed positioning, and neuraxial anesthesia. Most reported cases are managed conservatively and ultimately resolve within weeks or months after delivery. Case Report: We describe a case of new-onset foot drop following an uncomplicated spontaneous vaginal delivery. To our knowledge, very few cases of postpartum foot drop secondary to lumbar disc herniation requiring surgical decompression have been reported. Conclusion: Although most postpartum lower extremity neuropathies resolve with time and conservative therapy, clinicians should maintain a high index of suspicion for structural causes when symptoms are severe or progressive. This case underscores the importance of prompt recognition and evaluation of new neurologic symptoms, even after apparently uncomplicated deliveries, to facilitate timely intervention and optimize recovery.

Ultrasonography has become an integral tool in orthopaedic practice, offering real-time, high-resolution imaging for both diagnostic and interventional procedures. Ultrasonography enhances the diagnosis and management of entrapment neuropathies, traumatic nerve injury, tendon and ligament injury, fractures, and a variety of other soft-tissue pathologies. It has high utility in the assessment of joint subluxation or dysplasia in pediatrics. Ultrasonography guidance improves the accuracy and safety of musculoskeletal injections and enables minimally invasive interventions, including nerve decompressions, tenotomies, tendon sheath releases, and fasciotomies. A growing body of literature supports the noninferiority of these techniques, with some demonstrating superior outcomes relative to standard, open procedures. Recent innovations such as elastography and ultrasound tissue characterization (UTC) show potential for increasing its diagnostic utility even further.

Objective This study set occipital pain improvement as the primary endpoint, and overall headache relief, migraine index, medication use and complication rate as secondary endpoints, to evaluate the efficacy and safety of neural combing plus decompression guided by four neurovascular relationship subtypes for drug-resistant occipital neuralgia (ON). Methods We retrospectively reviewed 53 patients with drug-resistant ON who underwent unilateral or bilateral greater occipital nerve (GON) combing and decompression. All had ineffective drug treatment for ≥1 year and follow-up ≥12 months. Efficacy was evaluated by comparing monthly pain days, Visual Analog Scale (VAS), medication use and migraine index pre- and postoperatively. Complications were recorded. Results Postoperatively, 88.7% (47/53) of patients achieved ≥50% ON improvement, and 67.9% (36/53) had complete pain remission. Monthly chronic pain days fell by 72.6%, attack days by 85.0%. Baseline VAS decreased from 2.6 to 1.0, peak attack VAS from 6.4 to 0.8. Medication use dropped by 70%, with significant reductions in NSAIDs, triptans and opioids (P < 0.01). Only one minor complication occurred, with no severe adverse events. Conclusion The combined GON combing and decompression technique guided by the four subtypes of neurovascular relationships enables the precise release of nerve compression points while preserving neural structures. It significantly improves pain symptoms and quality of life in patients with drug-resistant ON, offering minimal trauma and fewer complications. Hence, this technique is a safe and valuable minimally invasive therapeutic option for the invasive treatment of drug-resistant ON, which warrants further prospective comparative studies and wider clinical application.

Bell's palsy impairs social functioning. Conventional prognostic assessment relies on clinical grading and electroneurography (ENoG), but predictive accuracy remains limited. This study introduces a time-continuous probabilistic approach that integrates longitudinal Yanagihara scores and ENoG to enable dynamic, individualized prognostic estimation. We conducted a retrospective longitudinal study of patients with Bell's palsy treated between April 2013 and March 2024. Eligible patients were aged ≥ 15 years, hospitalized within 1 week of onset, and received high-dose corticosteroids. Exclusion criteria included other etiologies, prior facial palsy, facial nerve decompression, treatment discontinuation, or incomplete data. Recovery was defined as a Yanagihara score ≥ 36, and nonrecovery as failure to achieve this within ≥ 6 months. ENoG values obtained within 4 weeks of onset were stratified into five groups. Multivariable logistic regression was performed using ENoG, sex, age, diabetes, hypertension, dyslipidemia, body mass index, and HbA1C as covariates. Logistic curves were fitted to longitudinal scores, and Monte Carlo/Bayesian procedures were applied to generate recovery probability maps. Among 128 eligible patients, ENoG emerged as the only significant predictor of recovery. The probability maps provided a novel visualization of individualized prognosis at any time point. This method estimated recovery likelihood even in patients with follow-up intervals, addressing irregular limitations of prior fixed-timepoint models. Conditional mutual information plateaued around 50 days, indicating stabilization of predictive discrimination beyond that period. Incorporating longitudinal Yanagihara scores obtained during outpatient follow-up enhances recovery prediction accuracy. This practical, dynamic approach facilitates intuitive risk visualization and supports improved prognostic counseling in clinical practice.

Background/Objectives: Superior cluneal nerve entrapment syndrome (SCNES) is an underrecognized cause of chronic low back pain, particularly in adolescents where published experience is limited. This article describes a reproducible open surgical technique for superior cluneal nerve (SCN) decompression. Methods: We outline indications and relative contraindications, required instrumentation, key surface landmarks, and a stepwise operative approach. The nerve is identified where SCN branches traverse the thoracolumbar fascia and fibro-osseous tunnel near the posterior iliac crest. Decompression is performed via limited fasciotomy and release of surrounding soft tissues, with attention given to identifying additional branches requiring release. Results: The technique provides consistent exposure and decompression of the SCN branches using an approximately 5 cm oblique incision centered over the expected crossing point (about 7 cm lateral to the midline and roughly 4 cm lateral to the PSIS). Pearls and pitfalls are provided to reduce peri-incisional numbness and avoid thermal injury to the nerve. Conclusions: Open SCN decompression is a focused procedure that can be considered after confirmation of SCNES by clinical criteria and response to diagnostic block. Standardizing technique and postoperative care may facilitate broader adoption and future outcome studies in pediatric populations.

Endoscopic sinus and skull base surgery has evolved significantly with advances in visualization and powered instrumentation, aiming to improve surgical precision while minimizing complications. Among these innovations, piezoelectric devices represent a valuable addition to modern rhinologic and skull base surgery. This review highlights the principles, mechanisms, and clinical applications of piezoelectric technology in endoscopic sinus and skull base procedures. Piezoelectric devices operate through ultrasonic microvibrations that selectively cut mineralized tissue while preserving adjacent soft tissues such as dura, nerves, blood vessels, and the Schneiderian membrane. This selective action enhances surgical safety, particularly when operating near critical structures including the orbit, optic nerve, internal carotid artery, and anterior skull base. Compared with conventional drills and curettes, piezosurgery provides improved surgical control, reduced bleeding, enhanced visibility, and lower risk of thermal and mechanical injury. Clinical applications include removal of thick bony partitions, skull base osteotomies, optic nerve decompression, management of fibro-osseous lesions, and assistance in endoscopic tumor surgery. Histological and experimental studies suggest improved bone healing and preservation of osteocyte viability following piezoelectric osteotomy. Despite its advantages, piezosurgery is associated with higher cost, longer operative time, and a learning curve that may limit widespread adoption. In conclusion, piezoelectric technology offers a safe and precise alternative to conventional bone-cutting instruments in endoscopic sinus and skull base surgery, particularly in anatomically high-risk areas. Further clinical studies are warranted to better define its cost-effectiveness and long-term outcomes.

Different surgical techniques are used to treat idiopathic meralgia paresthetica. We analyzed the effect of neurolysis of the lateral femoral cutaneous nerve (LFCN) with intraoperative dynamic testing of the completeness of decompression. A retrospective single center study was conducted on a consecutive series of 109 procedures performed between January 2018 and January 2024. Five different postoperative outcome measures were used by an independent neurologist to assess specific meralgia symptoms and overall well-being: (1) pain and (2) skin sensation in the LFCN area, both rated on a 4-point ordinal scale (completely resolved, improved, unchanged, or worsened); (3) reduction of the area with abnormal skin sensation, measured on a 0-100 continuous scale; (4) the Global Perceived Effect, rated on a 7-point ordinal scale (much better, better, somewhat better, the same, somewhat worse, worse, or much worse); and (5) overall decrease in reported complaints rated on a 0-100 continuous scale. The correlation between outcome measures was assessed either by proportional odds model, or by linear-by-linear association test. The effect of time from onset of symptoms to surgery, body mass index, sex, and age on the reduction of complaints was evaluated using a Beta mixed effect regression model. Most of the interventions resulted in either complete or marked overall reduction of complaints (mean 87.9, SD: 17.9). The overall reduction was positively associated with the Global Perceived Effect and strongly associated with greater improvements in postoperative pain and sensory scores (P < .001). No significant impact was found of baseline covariates on the reduction of symptoms. Neurolysis of the LFCN with intraoperative dynamic testing to assess the completeness of decompression yields excellent pain reduction and improvement of sensation in the majority of idiopathic meralgia paresthetica patients. Whether dynamic testing contributes to outcomes requires a comparative study with static decompression alone.

Medial epicondyle fractures account for 11% to 20% of pediatric elbow fractures. While most are managed conservatively, ulnar nerve palsy, present in up to 16% of cases, is an accepted indication for surgical treatment. Neurologic symptoms may begin in a delayed fashion and, in rare cases, persist or progress despite surgical intervention. In adults, distal nerve transfers such as anterior interosseous nerve (AIN) to ulnar motor branch transfer have demonstrated promising outcomes, but their role in pediatric patients remains limited. We report the case of a 13-year-old, right-handed gymnast who developed delayed progressive ulnar nerve palsy after a nondisplaced right medial epicondyle fracture managed conservatively. Despite undergoing anterior ulnar nerve transposition at 8 months after injury, she exhibited persistent motor and sensory deficits, with a QuickDASH score of 90.6. At 31 months after the injury, she underwent further surgery, with ulnar nerve decompression and submuscular transposition, ulnar nerve decompression at Guyon's canal, and supercharged end-to-side (SETS) AIN-to-ulnar motor nerve transfer. Eight months postoperatively, she showed substantial recovery of hand strength, fine motor coordination, and ulnar nerve-mediated sensation. At 4-year follow-up, QuickDASH score was 6.8, indicating near-complete functional recovery. To our knowledge, this is the first reported pediatric case of SETS AIN-to-ulnar motor nerve transfer after failed decompression of the ulnar nerve, following a late ulnar nerve palsy complicating a medial epicondyle fracture of the humerus. Distal nerve transfer may offer a viable strategy for enhancing intrinsic hand function in a pediatric chronic ulnar neuropathy, even beyond the conventional reinnervation window.

Management of Ulnar Nerve Irritation by Pisiformectomy: A Clinical Anatomical Study.

We present a case of a 30-year-old man with severe ulnar nerve neuropraxia and first dorsal interosseous muscle wasting. Intraoperatively, a large venous plexus compressing the terminal division of the deep motor branch of the ulnar nerve was identified as a contributing factor. This is the first documented instance of compression of the terminal branch of the ulnar nerve caused by a venous plexus, resulting in neurapraxia. This rare anatomical variant caused progressive functional impairment and was successfully treated with ligation of vessels distally along with proximal and distal nerve decompression.