Nerve Neuroma Research Articles

Chronic Postoperative Breast Pain: Danger Zones for Nerve Injuries

Postoperative breast pain is a frequent complaint, reported by 50 percent of women following a breast procedure. Breast pain interferes with sexual activity, as reported by 48 percent of patients, exercise (36 percent), social activity (13 percent), and employment (6 percent). To define neurogenic causes of chronic postoperative breast pain, the authors performed a retrospective review of consecutive patients from a single surgeon and performed 10 anatomical bilateral dissections. The authors evaluated the most commonly injured nerves, based on zone of injury, injury type, and precedent breast procedure. Dissections referenced the zone of injury with the specific procedure and designated the individual nerves at risk. The authors identified 57 patients with chronic breast pain from breast reconstruction (n = 38), reduction (n = 2), mastopexy (n = 2), augmentation (n = 4) and irradiation (n = 11). On the basis of anatomic innervation, the authors designated five zones of nerve injury: superior, medial, inferior, lateral, and central/nipple-areola complex. The lateral zone was most commonly injured (79 percent), followed by inferior (10.5 percent), medial (5 percent), central (3.5 percent), and superior (2 percent) zones. Forty-two patients suffered intercostal nerve neuromas from mechanical nerve trauma/entrapment, with pain at the surgical scar or nearby tissue dissection. Four patients with traction-stretch neuropathy had pain from blunt augmentation pocket dissection. Eleven patients with irradiation-induced neuropathy had diffuse, nonlocalized nerve pain. By shifting the approach to chronic breast pain from "global chronic breast pain" to defined danger zones of nerve injury, the practitioner can identify the type of nerve injury and associate the most common nerve injury to a given breast procedure. This approach should assist in diagnosis and treatment, and ultimately improve patient morbidity.

Chronic blockade of interleukin-1 (IL-1) prevents and attenuates neuropathic pain behavior and spontaneous ectopic neuronal activity following nerve injury

Neuropathic pain is a chronic pain state resulting from peripheral nerve injury, characterized by hyperalgesia and allodynia. We have reported that mice with genetic impairment of IL-1 signaling display attenuated neuropathic pain behavior and ectopic neuronal activity. In order to substantiate the role of IL-1 in neuropathic pain, WT mice were implanted subcutaneously with osmotic micropumps containing either IL-1ra or vehicle. Two days following the implantation, two models of neuropathic pain were used; partial nerve injury (spinal nerve transection, SNT), or complete nerve cut (spinal neuroma model). Mechanosensitivity was assessed seven consecutive days following SNT, and on day 7 recordings of spontaneous ectopic activity were performed. In the spinal nerve neuroma model, autotomy scores were recorded up to 35 days. Vehicle-treated mice developed significant allodynia and autotomy, and clear ectopic activity (4.1 ± 1.1% of the axons); whereas IL-1ra-treated mice did not display allodynic response, displayed delayed onset of autotomy and markedly reduced severity of autotomy scores, and displayed reduced spontaneous activity (0.8 ± 0.4% of the axons). To test whether IL-1 is involved in maintenance of mechanical allodynia, a separate group of WT mice was treated with a single injection of either saline or IL-1ra four days following SNT, after the allodynic response was already manifested. Whereas saline-treated mice displayed robust allodynia, acute IL-1ra treatment induced long-lasting attenuation of the allodynic response. The results support our hypothesis that IL-1 signaling plays an important role in neuropathic pain and in the ectopic neuronal activity that underling its development.

Fat Grafting According to Coleman for the Treatment of Radial Nerve Neuromas

Fat Grafting According to Coleman for the Treatment of Radial Nerve Neuromas

Treatment by collagen conduit of painful post-traumatic neuromas of the sensitive digital nerve: A retrospective study of 10 cases

Objectives The purpose of this retrospective study was to report the results of surgery in painful post-traumatic neuromas of the digital nerves treated by collagen conduits after excision of the neuromas, when two stumps were available. Methods We retrospectively reviewed all patients operated on for painful neuroma in our institution and having undergone repair with collagen conduits. Their files were retrieved by a coding file (CCAM version 10). Ten patients involving nine digital nerves and one common digital nerve were included. Primary outcome data points were static two-point discrimination, Semmes-Weinstein monofilament testing, Quick-Dash outcome survey scores, Cold Intolerance Symptom Severity (CISS) score and recurrence of pain at final follow-up. We set up a minimum follow-up period of 6 months after surgery. Results The patients’ average age was 30 years. The average follow-up duration was 11.8 months. Five patients had excellent or good results (50%) at static two-point discrimination testing. Semmes-Weinstein monofilament testing results were full, diminished light touch or diminished protective sensation in nine digits (80%). The average Quick-Dash survey score was 19.3. The average CISS score was 27.8. There was no recurrence of pain. Conclusions Our findings indicate that collagen conduit is an effective treatment for post-traumatic painful neuromas of digital nerves and common digital nerves.

Traumatic Facial Nerve Neuroma With Facial Palsy Presenting in Infancy

To describe the management of traumatic neuroma of the facial nerve in a child and literature review. Sixteen-month-old male subject. Radiological imaging and surgery. Facial nerve function. The patient presented at 16 months with a right facial palsy and was found to have a right facial nerve traumatic neuroma. A transmastoid, middle fossa resection of the right facial nerve lesion was undertaken with a successful facial nerve-to-hypoglossal nerve anastomosis. The facial palsy improved postoperatively. A traumatic neuroma should be considered in an infant who presents with facial palsy, even in the absence of an obvious history of trauma. The treatment of such lesion is complex in any age group but especially in young children. Symptoms, age, lesion size, growth rate, and facial nerve function determine the appropriate management.

Traumatic Neuroma of the Infraorbital Nerve Subsequent to Inferomedial Orbital Decompression for Graves’ Orbitopathy

To present and discuss the occurrence of a traumatic neuroma subsequent to inferomedial orbital decompression surgery in Graves' orbitopathy. Case report. Approximately 1 month after surgery, a patient who underwent bilateral rehabilitative inferomedial orbital decompression developed a mass with clinical and radiologic characteristics compatible with a traumatic neuroma of the left infraorbital nerve. The lesion, which was thought to be the result of unnoticed nerve trauma at the time of surgical dissection of the infraorbital canal, remained stable in shape and other imaging characteristics during the 39-month follow-up period. Symptoms of trigeminal neuralgia could be only partially controlled with medical therapy (oral pregabalin 75 mg 3 times daily). The second branch of the trigeminal nerve may be damaged in the course of orbital floor removal decompression for Graves' orbitopathy. This may potentially induce the formation of traumatic or amputation neuromas. Such lesions should be included in the potential complications of decompressions when counseling patients about to undergo this type of surgery, as they are difficult to treat and may cause persistent and disabling pain.

Reply to a letter to the editor regarding article “Traumatic neuroma of mental nerve following chin augmentation”

Reply to a letter to the editor regarding article “Traumatic neuroma of mental nerve following chin augmentation”

Cerebellopontine Angle Ganglionic Hamartoma: Case Report

Cerebellopontine angle (CPA) ganglionic hamartomas are rare. We present a case of a 49-year-old woman who presented with left-sided hearing loss of more than 4 years' duration and vertigo since childhood. Magnetic resonance imaging revealed a mass on the intracanalicular segment of cranial nerve VIII on the left side, consistent with acoustic schwannoma. She opted for observation of the tumor. The patient returned 21 months after the initial evaluation with new-onset left facial weakness. At this time, a working diagnosis of facial nerve neuroma was made. The lesion was excised, and pathology confirmed a diagnosis of left-sided CPA ganglionic hamartoma. Otolaryngologists should be familiar with this uncommon tumor and include it in the differential diagnosis of CPA lesions.

Step-by-step education of the retrosigmoid approach leads to low approach-related morbidity through young residents

Neurosurgery requires a profound knowledge of anatomy and surgical skills. The skull base approach is the crucial step for successful intradural performance. Resident training at experienced institutions must consider this background when educating young neurosurgeons. From 2006-2008, 223 retrosigmoid approaches for various cerebellopontine angle pathologies have been performed at the Department of Neurosurgery Eberhard-Karls-University, Tübingen. After a minimum time of 6 months assisting, followed by participation of dissection courses and continuous anatomical training, later performing their first approaches under direct supervision of an experienced surgeon, residents perform their first retrosigmoid approaches autonomously in the operating theatre. With this study, we evaluate the surgical morbidity and the time factor related to the educational level of the surgeon. Comparing surgical-related morbidity between approaches performed by experienced neurosurgeons (>100 procedures) and young residents (<20 procedures), we found no significant differences concerning the incidence of cerebrospinal fluid fistulae, sinus lacerations, wound infections, cranioplasty dislocations, or occipital nerve neuromas. Even the mean time for the procedure (positioning, time-to-dural incision) was not significantly longer in the trainee group. Respecting the stepwise educational levels for skull base surgery, including microanatomical studies, educational courses, and expert guidance at surgery, the retrosigmoid approach can be performed by young residents without increased morbidity at experienced institutions.

Components of arterial systolic pressure and RR-interval oscillation spectra in a case of baroreflex failure, a human open-loop model of vascular control

The baroreflex control of circulation is always operating and modulates blood pressure and heart rate oscillations. Thus, the study of cardiovascular variability in humans is performed in a closed-loop model and the physiology of post-sinoaortic denervation is completely unknown in humans. We dissected for the first time the different components of systolic arterial pressure (SAP) and RR-interval spectra in a patient with 'baroreflex failure' (due to mixed cranial nerve neuroma) who represents a human model to investigate the cardiovascular regulation in an open-loop condition. Interactions among cardiovascular variability signals and respiratory influences were described using the multivariate parametric ARXAR model with the following findings: (1) rhythms unrelated to respiration were detected only at frequencies lower than classical low frequency (LF; Slow-LF, around 0.02 Hz) both in SAP an RR spectra, (2) small high-frequency (HF) modulation is present and related with respiration at rest and in tilt (but for SAP only) and (3) the Slow-LF fluctuations detected both in SAP and RR oscillate independently as the multivariate model shows no relationships between SAP and RR, and these oscillations are not phase related. Thus, we showed that in a patient with impaired baroreflex arc integrity the Slow-LF rhythms for RR have a central origin that dictates fluctuations on RR at the same rhythm but unrelated to the oscillation of SAP (which may be related with both peripheral activity and central rhythms). The synchronization in LF band is a hallmark of integrity of baroreflex arc whose impairment unmasks lower frequency rhythms in SAP and RR whose fluctuations oscillate independently.

Supraorbital Nerve Neuroma Caused by Blind Curettage of an Infected Epidermal Cyst

A 38-year-old woman presented with a tender mass with mild erythematous change above the left eyebrow area. She had received curettage in another clinic after a diagnosis of infected epidermal cyst 5 years previously. On examination, a round, irregular scar and a mass of 1-cm diameter associated with mild erythematous region were observed above the right eyebrow.Exploration disclosed a 1-cm neuroma with mild adhesion to a branch of the supraorbital nerve. The neuroma was completely removed. However, although partial transection of the supraorbital nerve was performed during surgery, the nerve was not repaired. The open wound was repaired securely. A histopathologic examination of the resected specimen resulted in a diagnosis of traumatic neuroma. The patient had no forehead numbness before or after surgery.

TRPA1 expression in human lingual nerve neuromas in patients with and without symptoms of dysaesthesia

The TRPA1 receptor is a member of the ankyrin family and is found in both spinal and trigeminal neurones. There is evidence to suggest that this receptor may be a sensor of noxious thermal stimuli in normal animals. After nerve injury, TRPA1 shows increased expression in uninjured axons, and has been implicated in the development and maintenance of hyperalgesia. We examined expression of TRPA1 in lingual nerve neuromas and investigated any potential correlation with the presence or absence of symptoms of dysaesthesia. Thirteen neuroma-in-continuity specimens were obtained from patients undergoing repair of a lingual nerve that had previously been damaged during lower third molar removal. Visual analogue scales (VAS) were used to record the degree of pain, tingling and discomfort. Tissue was processed for indirect immunofluorescence and the percentage area of PGP 9.5-immunoreactive neuronal tissue also labelled for TRPA1 was quantified. No significant difference between levels of TRPA1 in neuromas from patients with or without symptoms of dysaesthesia and no relationship between TRPA1 expression and VAS scores for pain, tingling or discomfort were observed. TRPA1 expression and the time after initial injury that the specimen was obtained also showed no correlation. These data show that TRPA1 is expressed in lingual nerve neuromas, but, it appears that, at this site, TRPA1 does not play a principal role in the development of neuropathic pain.

Traumatic neuroma of mental nerve following chin augmentation

Traumatic neuromas are relatively rare entities that characteristically arise following surgery or trauma. In this report, a case of a traumatic neuroma of the mental nerve following chin augmentation is described. Magnetic resonance imaging showed a well-defined oval mass. Part of the lesion was removed and histopathological examination confirmed the lesion to be a traumatic neuroma.

Der interessante Fall: Schwannom des Nervus pudendus nach Triple-Osteotomie nach Tönnis

Schwannomas (neurilemmomas) are benign neural sheath tumours which commonly arise from cranial nerves and cutaneous nerves of the head and neck. The most common site is the acoustic neuroma of the 8th cranial nerve. Pelvic schwannomas are rare and often present with non-specific symptoms leading to misdiagnosis and prolonged morbidity. Most cases of pelvic schwannoma have been reported in the gynaecological and urological literature due to their presentation as a pelvic mass or from urinary tract compression. We present a schwannoma of the nervus pudendus with clinical, radiological, MRI scan and intraoperative findings together with a description of the technique of surgical resection.

Heel Neuroma: A Case Study

This article reviews the diagnosis, pathology, and treatment of plantar heel neuroma, an entity that has previously been described and recognized, yet one that we feel warrants further review because of the prevalence of plantar heel pain that does not respond to the usual array of treatments. We feel that neuroma of the medial calcaneal nerve often goes undiagnosed, and may progress to a severely painful condition that requires surgical intervention. In this article, we describe another case of heel neuroma in an otherwise healthy patient with a history of chronic plantar heel pain that was unresponsive to a wide array of nonsurgical treatments. 4.

Posttraumatic neuroma of the radial nerve treated with an autogenous epineural conduit technique. A case report

We present the outcome of the first clinical application of a new technique using an epineural flap to bridge a short nerve defect. A 28-year-old male had suffered a radial nerve laceration at the lower third of the arm, proximal to the brachioradialis branch, 3 weeks before surgery. During surgery, a neuroma-in-continuity was excised preserving the epineural sleeve. Two longitudinal epineural flaps were created, one from the proximal and one from the distal nerve stump and used to bridge a 1-cm-long nerve defect. Each epineurium flap was sutured to the intact epineurium of the other side and additionally to each other. An electromagnetic nerve stimulator was used to enhance the nerve regeneration process. Nerve regeneration was followed up for 17 months with excellent functional results.

Traumatic Neuroma of the Trigeminal Nerve at the Foramen Ovale

The LaryngoscopeVolume 119, Issue S1 p. S181-S181 Triological Society Poster Presentation West Traumatic Neuroma of the Trigeminal Nerve at the Foramen Ovale Andrew Kroeker BS, Andrew Kroeker BSSearch for more papers by this authorJane Weissman MD, Jane Weissman MDSearch for more papers by this authorSteve Cannady MD, Steve Cannady MDSearch for more papers by this authorMark K. Wax MD, Mark K. Wax MDSearch for more papers by this author Andrew Kroeker BS, Andrew Kroeker BSSearch for more papers by this authorJane Weissman MD, Jane Weissman MDSearch for more papers by this authorSteve Cannady MD, Steve Cannady MDSearch for more papers by this authorMark K. Wax MD, Mark K. Wax MDSearch for more papers by this author First published: 30 March 2009 https://doi.org/10.1002/lary.20471AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume119, IssueS1Supplement: Triological Society Poster Presentations from the Eastern, Western, Southern and Middle Section Meetings2009Pages S181-S181 RelatedInformation

P.050 Peripheral giant cell granuloma of the mandible

Traumatic neuroma is a non-neoplastic proliferative disorder of the nerve sheath in response to injury or surgery. Traumatic neuroma most frequently occurs in soft tissues and intraosseous involvement is uncommon. In this paper, we present a rare case of intraosseous traumatic neuroma of the inferior alveolar nerve leading to pain and paresthesia of the lower lip on the left side.

The Use of Low-Energy Radial Shockwave in the Treatment of Entrapment Neuropathy of the Medial Calcaneal Nerve: A Pilot Study

Medial calcaneal nerve entrapment is a well-recognized cause of heel pain. In addition, the development of an amputation neuroma of the medial calcaneal nerve from prior heel surgery via an open incision on the medial aspect of the heel is a serious common postoperative complication and can be extremely difficult to treat. This preliminary pilot study demonstrates that the use of low-energy extracorporeal shockwave is safe and efficacious in the treatment of this disorder without the morbidity associated with denervation surgery, which would be one of the most common methods to treat this complicated situation. Four patients, 2 with bilateral affectation, for a total of 6 medial calcaneal nerves, had a series of treatments with low-energy radial shockwave with the Swiss DolorClast machine. All 4 patients had improvement in their pain scores, to the point that none elected surgical treatment, and there were no complications.

Induced Corneal Astigmatism by Palpebral Spring for the Treatment of Lagophthalmos

To report a patient with decreased vision after insertion of an upper eyelid palpebral spring. Interventional case report. A 44-year-old man presented with decreased vision in his right eye. Several months before presentation, he underwent palpebral spring insertion in his upper eyelid for lagophthalmos. He had developed seventh cranial nerve palsy after removal of the right facial nerve neuroma. Decreased vision was related to induced astigmatism by upper eyelid pressure. Surgical replacement of the spring resulted in less astigmatism and improvement in visual acuity. Ocular rehabilitation surgery with insertion of a palpebral spring to the upper eyelid may induce corneal astigmatism and decrease vision in the normal eye. This may be reversible by replacing or repositioning the spring so that it will imply less corneal pressure.