Sciatic Nerve Involvement Research Articles

Surgical outcomes of women undergoing radical resection of deep endometriosis of the sacral plexus: A prospective cohort study.

Surgical resection of sacral plexus endometriosis (SPE) is contemplated in severely symptomatic patients not responding to medical or hormonal therapy. However, there is only limited data on the effects of surgery on pain and neurological symptoms. This study aims to report on the surgical outcomes in terms of pain and neurological symptom reduction in women undergoing surgical resection of SPE. Thirty premenopausal patients with histologically confirmed SPE who underwent surgical resection of the disease between 2018 and 2024 were included in this multicenter prospective analysis. The primary outcome was the change in neurological symptoms reflected by sacral radiculopathy including dysaesthesia, paraesthesia, hyperaesthesia, and pain. The secondary outcome was post-surgical morbidity reflected by rates of major intra- and postoperative complications. All patients exhibited DE affecting the sacral roots S1-S4, whereas no case of isolated supracardinal sciatic nerve involvement was observed. Out of 30 patients, one was lost to follow-up leaving 29 patients for final analysis. Six (20%) of the 30 patients underwent partial resection of the sacral root because of endometriotic infiltration of the nerval tissue. In all other patients, dissection and shaving with cold scissors were sufficient to remove DE affecting the sacral root. Dysaesthesia was observed in 13/30 (43.3%), paraesthesia in 16/30 (53.3%), hyperaesthesia in 5/30 (16.7%), and secondary motor dysfunction in 4/30 (13.3%), preoperatively. The mean follow-up interval was 25.5 ± 20.2 months showing an overall improvement in sacral radiculopathy in 93.1% (27/29) of the patients. A significant decrease in numeric rating scale (NRS) scores of dysaesthesia (p = 0.003), paraesthesia (p ≤ 0.001) and hyperaesthesia (p = 0.068) were observed post-surgically. Equally, reduced pain symptoms including dysmenorrhea, dyspareunia and dyschezia (all p ≤ 0.001) with a relevant increase in post-surgical quality of life scores (p ≤ 0.001) were recorded. De novo hyperaesthesia and paraesthesia occurred in 6.8% (2/29) and 3.4% (1/29) of the patients, respectively. Major Clavien-Dindo grade III complications occurred in 13.3% (4/30) of the cases. Radical resection of symptomatic deep endometriosis affecting the sacral plexus reduces neurological and pain symptoms and leads to an increase in quality of life but is associated with high surgical morbidity.

The paraneurium and the tumefactive appearance of peripheral nerve neurolymphomatosis: illustrative case.

Peripheral neurolymphomatosis (NL) is an often-misdiagnosed condition characterized by lymphomatous infiltration within the peripheral nerves. Its rarity and complexity frequently result in delayed diagnosis and suboptimal patient outcomes. This study aims to elucidate the role of the paraneurium (circumneurium) in NL, emphasizing its diagnostic and therapeutic significance. A 72-year-old man presented with lesions on his right lower eyelid. Initial diagnostics were inconclusive until an excisional biopsy confirmed extranodal marginal zone lymphoma. Following a complete metabolic response to rituximab treatment, the patient relapsed 14 months later with progressive lymphoma and bilateral sciatic nerve involvement, as confirmed by positron emission tomography-computed tomography and magnetic resonance imaging. This paper underscores the critical role of the paraneurium in NL, enhancing understanding of its pathophysiology. Integrating advanced imaging techniques have proved essential in accurately identifying neurolymphomatous involvement within the paraneurium. This study paves the way for more effective management strategies in NL and similar conditions, focusing on improving patient care and outcomes.

A case report on a novel use of intraoperative Intrabeam™ radiation therapy for a recurrent malignant peripheral nerve sheath tumor with sciatic nerve involvement

BackgroundMalignant peripheral nerve sheath tumors (MPNST) are sarcomas that arise from peripheral nerves. They generally have a poor prognosis which is exacerbated by high local recurrence rates. This case report discusses the treatment of a patient with a MPNST with local recurrence. This case report is novel due to the use of intraoperative Intrabeam™ (Zeiss, Dublin, CA) radiation therapy use in the protection of neurovascular structures such as the sciatic nerve.Case presentation:The patient was a 65-year-old male who noticed a right posterior thigh mass slowly increasing in size over two months. A planned positive margin wide-resection excision was performed due to sciatic nerve abutment. The mass was determined to be a MPNST via postoperative pathology with positive margins along the sciatic nerve. The patient began adjuvant radiation therapy to the upper and lower thigh fields over a period of three months. Thirty-two months later, the patient was found to have a hypermetabolic mass with venous congestion and hyperemia at the prior surgical site which was confirmed by core needle biopsy to be local recurrence of the MPNST. Re-excision of the tumor was planned and performed followed by intraoperative Intrabeam™ radiation therapy. At two years of follow-up, the patient was doing well with minimal pain in his right buttock region with no new or recurrent neurological deficits. Radiologic imaging was negative for local recurrence of the MPNST.ConclusionWe believe this case report demonstrates a novel treatment strategy for sarcoma management. The unique use of intraoperative Intrabeam™ radiation therapy, which had not previously been used for this indication, may be efficacious in cases involving neurovascular structures. In this case, focal radiation from the intraoperative Intrabeam™ radiation device was used in a way to affect the recurrent tumor yet protect the sciatic nerve.

Sciatic Nerve Involvement in Rosai-Dorfman Disease.

Sciatic Nerve Involvement in Rosai-Dorfman Disease.

Canine Seventh Lumbar Vertebra Fracture: A Systematic Review.

Simple SummaryThe aim of this paper is to review the available literature about canine seventh vertebra lumbar fracture. According to PRISMA guidelines, the authors detected data about the clinical presentation, surgical techniques, and the outcome of this rare traumatic injury that is poorly reported and described. The major problem addressed was the lack of prospective studies with a large study population and univocal data collection about complications, outcome, and post-surgical treatment.(1) Background: Lumbosacral traumatic injuries are reported as 39% of canine vertebral lesions. This area is prone to fracture and luxation. Several surgical techniques were described from 1975 to 2021 to stabilize the traumatic injuries of the lumbosacral junction. This report aims to critically review the available literature focused on clinical presentation, surgical techniques, and follow-up of the lumbar vertebra fracture. (2) Methods: Three bibliographic databases: PubMed, Google Scholar, and Scopus were used with a board search of Lumbosacral junction fracture AND, of L7 fracture AND (canine OR dog). The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for case reports and case series was applied for the studies included. (3) Results: A total of 432 reports yielded only nine that met the inclusion criteria. Non-ambulatory paraparesis/plegia, sciatic nerve involvement, faecal/urinary incontinence, and severe back lumbar pain were the most reported signs. Survey radiographs were the most reported technique to confirm the diagnoses. The surgical treatment was reported in all reports examined with a good long-term prognosis. (4) Conclusions: The seventh lumbar vertebra fracture, despite the different surgical techniques performed, had a favourable prognosis for long-term outcome and neurological recovery.

The management and outcome of large volume liposarcomas encasing the sciatic nerve

This paper outlines the oncological outcomes of patients with large volume liposarcomas of the posterior thigh who underwent nerve-preserving surgery utilising epineural dissection. Thirty-seven consecutive patients (group I) with a mean age of 66.2 (31-96) were surgically treated with a planned marginal resection and epineurectomy for liposarcoma with known sciatic nerve involvement between March 1997 and January 2015. The mean follow-up was 79 months (15-192). All patients underwent multidisciplinary team (MDT) pre-operative assessment and staging, with follow-up in Sarcoma Clinic. Pre-operative function was assessed by applying the Toronto extremity salvage score (TESS). Oncological and functional outcomes were recorded. In grades 1, 2, and 3, 24, 6, and 7 liposarcomas, respectively, were included with mean volume 1859 cm3. Sciatic nerve involvement extended for 13-30 cm; in one case, the nerve was abutting the tumour throughout its length. Soft tissue reconstructive surgery was required in three cases. The remainder underwent direct primary closure. Seventeen patients underwent post-operative adjuvant radiotherapy 46-60 Gy and three received chemotherapy. There was local recurrence of disease in three patients. One patient had post-radiation wound breakdown treated non-operatively. Three patients died of an unrelated cause. When compared to a cohort of 37 patients without sciatic nerve involvement (group II), there were no significant differences in local and systemic recurrence rate or post-operative survival. In conclusion, sciatic nerve-preserving surgery is both possible and safe when using a planned epineural dissection in large volume tumours encasing the sciatic nerve.

Proximal Resection of the Fibula in the Treatment of Proximal Fibular Chondrosarcoma

Introduction: Chondrosarcoma includes several anatomoclinical forms of tumors with cartilaginous histogenesis.It is a malignant tumor whose tumor cells are associated with a cartilage matrix.Case report: We present the case of a patient with stage 1 chondrosarcoma of the proximal part of the left fibula.The patient underwent a proximal fibula resection with a favorable outcome.Conclusion: Resection of tumors of the proximal fibula may cause knee instability, peroneal palsy through involvement of the external popliteal sciatic nerve or with local radiotherapy, a higher risk of delayed healing and the occurrence of fracture. Despite the risks of resection of the proximal fibula, good functional results can be obtained.

Recurrent diffuse large B-cell lymphoma involving the sciatic nerve: A rare case report and review of the literature

Neurolymphomatosis (NL) is an uncommon condition involving lymphomatous invasion of the cranial or spinal nerve roots. Sciatic nerve neuropathy and dysfunction represent a common cause of lower extremity symptoms in clinical practice. However, cases of recurrent lymphoma infiltrating a single peripheral nerve, such as the sciatic nerve, are rare. To date, only one case has been reported in the literature. Isolated lymphomatosis may occur sporadically in patients with lymphoma relapse. Nevertheless, the precise mechanisms underlying such cases remain unclear. The present report describes a patient with recurrent lymphoma who presented with drop foot due to sciatic nerve involvement. In this report, we highlight the importance of ultrasound for diagnosing peripheral neuropathy based on the characteristic nerve enlargement and loss of echogenicity. Our findings, together with existing evidence from the literature, support that ultrasonography, which is relatively rapid, easy, and low risk, can aid in the differential diagnosis of NL.

T28. Neuropathies in haemophylics: Preliminary evaluation of four cases and literature review

Peripheral neuropathy is an uncommon complication in patients with hemophilia, usually characterized by mononeuropathies, caused by hematoma and compartmental syndrome. The femoral nerve is the most affected, but several other locations have been described. The purpose of this article is to describe four cases of peripheral nerve injury in hemophiliacs comparing with data from the literature. This is a descriptive study, carried out by reviewing the medical record of four hemophiliac patients diagnosed with peripheral nerve injury, performed at a hematology and hemotherapy center in the state of Ceara, Brazil. The literature review was performed on the PubMed platform. All four patients underwent imaging and electromyography studies. The data collected were compared with those of the literature. The first case involves a male patient, twenty-nine years old, with a massive hematoma encapsulated in the right thigh (pseudotumor), and associated with paresthesia and a sensory and motor NCS evidencing sciatic nerve involvement. The second case refers to a male patient, forty-seven years old, with chronic hemophilic arthropathy at the right elbow, presenting with tactile-painful hypoesthesia at the medial border of the hand and the fifth finger. The study of nerve conduction revealed ulnar neuropathy at the elbow. In this case, the probable pathophysiology involves the stretching of the ulnar nerve by the pronounced valgus of the elbow. The last two patients were a man of forty-two and a boy of sixteen, both with left iliopsoas hematoma, accompanied by paresthesia in the anterior and lateral aspect of the thigh. The evaluation of the sensory e motor NCS revealed the involvement of the sensory branch of the femoral nerve (saphenous) and acute denervation in quadriceps muscle on needle EMG. Even in a limited sample, the four reported cases are in accordance with the literature data. The main publications on the subject indicate the nerves of the lower limbs as the most affected ones, predominating the femoral nerve, followed by the sciatic nerve.

Limb-Salvage Surgery of Soft Tissue Sarcoma with Sciatic Nerve Involvement.

Background The surgical resection of soft tissue sarcomas (STS) with sciatic nerve involvement presents a significant surgical and oncological challenge. Current treatment strategies pursue a multimodal approach with the aim of limb preservation. We aim to evaluate the outcomes of limb-sparing surgery of STS in a patient cohort and to propose a classification for STS with sciatic nerve involvement. Methods Patients receiving limb-preserving resections for STS with sciatic nerve involvement between 01/2010 and 01/2017 were included. Clinical and oncological data were prospectively collected in a computerized database and retrospectively analyzed. Sciatic nerve involvement in STS was classified preoperatively as follows: type A for nerve encasement; type B for nerve contact; and type C for no nerve involvement. Results A total of 364 patients with STS were treated, of which 27 patients had STS with sciatic nerve involvement. Eight patients with type A tumors (29.6%) underwent sciatic nerve resection, and 19 patients with type B tumors (70.4%) received epineural dissections. Disease progression was observed in 8 patients (29.6%) with a local recurrence of 11.1% and distant metastasis in 29.6%. The type of nerve resection significantly influenced leg function but had no impact on disease recurrence or overall survival. Conclusion In a cohort of carefully selected patients with STS and sciatic nerve involvement, the extent of sciatic nerve resection had no significant impact on disease recurrence or survival. Precise classification of neural involvement may therefore be useful in selecting the appropriate degree of nerve resection, without compromising oncological outcome or unnecessarily sacrificing leg function.

Accuracy of 3 Clinical Tests to Diagnose Proximal Hamstrings Tears With and Without Sciatic Nerve Involvement in Patients With Posterior Hip Pain

To determine the diagnostic accuracy of the active hamstring test at 30° (A-30) and 90° (A-90) of knee flexion, the long stride heel strike (LSHS) test, and combination of the 3 tests for individuals with hamstring tendon tears, with and without sciatic nerve involvement. A retrospective review of 564 consecutive clinical records identified 42 subjects with a mean age of 50.31 ± 15years who underwent a standard physical examination prior to magnetic resonance imaging (MRI) evaluation and diagnostic injection for posterior hip. The physical examination included the A-30, A-90, and LSHS tests. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculated to determine the diagnostic accuracy of these 3 tests. Forty-two subjects (female= 32 and male= 10) with a mean age of 50.31years (range 15-77, ± SD 14.52) met the inclusion criteria and were included in the review. Based on MRI and/or injection, 64.28% (27/42) of subjects were diagnosed with hamstring tear. Fourteen (51.85%) presented with sciatic nerve involvement. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio for each test were as follows: A-30 knee flexion: 0.73, 0.97, 23.43, 0.28, and 84.73; A-90 knee flexion: 0.62, 0.97, 20.00, 0.39, and 51.67; LSHS: 0.55, 0.73, 2.08, 0.61, and 3.44. The most accurate findings were obtained when the results of the A-30 and A-90 were combined, with sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of 0.84, 0.97, 26.86, 0.17, and 161.89, respectively. The combination of the active hamstring A-30 and A-90 tests proved to be a highly accurate and valuable tool to diagnose proximal hamstring tendons tears with or without sciatic nerve involvement in subjects presenting with posterior hip pain. Level III, diagnostic study.

Sciatic Nerve Involvement as an Unusual Presentation of Deep Endometriosis

Introduction Endometriosis affecting the sciatic nerve is extremely uncommon. Its main symptom is catamenial sciatica but it can result in neuropathy. The diagnosis is usually delayed for years. Our objective is to communicate our experience in the diagnosis, management and treatment of this pathology by presenting two patients. Methods Retrospective revision of medical charts of all sciatic endometriosis cases treated in the Endometriosis Unit of the University Hospital, La Paz, Spain. Results Two nulliparous patients 35 and 39 years old, with unilateral sciatica related to sciatic nerve endometriosis are presented. The lag time between the onset of symptoms and diagnosis was 8 and 5 years. Both patients had problems with locomotion and muscle atrophy, so laparoscopic neurolysis was performed with success in pain control but not total recovery of deambulation defect. Conclusions Directed anamnesis and magnetic resonance imaging (MRI) are good tools for diagnosis of endometriosis affecting sciatic nerve. In absence of neuropathy, hormonal pharmacotherapy can be used to control symptoms, but when it is present, surgical nerve decompression must not be delayed, and laparoscopic approach is feasible for trained surgeons. In our cases, neurolysis improved pain but complete recovery of motor function has not been reached. Physicians responsible for primary care need to be aware of the catamenial sciatica due to the nerve damage caused by endometriosis, even when it is very uncommon, because the consequences of the delay in assessment and treatment by a specialized multidisciplinary team in dedicated units may be irreversible.

A Modified Buttockectomy as a Limb Salvage Procedure in Ischium Osteosarcoma: a Case Report

Osteosarcoma, which rarely originates from the axial bones such as pelvis, presents a major challenge in limb preservation. We report a 9-year-old girl with osteosarcoma on her buttock. She underwent wide excision modified buttockectomy to resect the tumour with sciatic nerve involvement. One year after surgery, she was able to walk and no recurrence was found.

Sciatic schwannoma: A rare entity

Schwannomas are one of few truly encapsulated neoplasms of human body. These are composed of Schwann cells. In general, schwannomas have a predilection for the head, neck, mediastinum, and retroperitoneal regions, sciatic nerve involvement is rare. The patient presents with pain in hip region radiating along the lateral side of leg, may be associated with other neurological signs and symptoms. Treatment of symptomatic schwannomas consists of marginal excisional resection with emphasis on identification of the nerve fascicles and excision of the tumor stalk. Here, we present a case of sciatic schwannoma in a young female, which was diagnosed on histopathology.

Spontaneous Fingertip Endometriosis: A Rare Case Report.

Here is a young unmarried girl of 18 y with bleeding from right index finger tip below nail bed, during menstruation for the last 3 months. She had attained menarche at the age of 13 y. She had regular menstrual cycles, where duration of flow was 4 to 5 days. There was no history of any comorbid illness or surgical intervention in the past. General examination revealed no abnormalities except mild pallor. Abdomen was soft, non-tender, with no palpable mass or free fluid. Per rectal examination was done and was normal. Examination of respiratory, cardiovascular and central nervous system was normal. On examination of the right index finger, there was a lesion with reddish discoloration of size 1 cm2 with slight swelling and tenderness just below the nail bed [Table/Fig-1]. There was a bleeding point within the lesion from where there was continuous oozing of blood during periods. USG of abdomen and pelvis showed no abnormality. MRI and diagnostic laparoscopy could not be done due to financial constraints. Biopsy of the bleeding site was done. Histological features revealed endometrial glands and stroma suggestive of endometriosis [Table/Fig-2]. Complete surgical excision was done with relief of the presenting symptoms thereafter. This is a very rare site of extra pelvic endometriosis reported till date. [Table/Fig-1]: Spontaneous bleeding from fingertip during menstruation [Table/Fig-2]: Histology of finger tip tissue showing features of endometriosis Extrapelvic endometriosis accounts up to 15% of all cases of endometriosis [1]. The most common sites in extrapelvic endometriosis include sites of previous surgical scars like cesarean scars, hysterectomy scars, episiotomy wounds and laparoscopic port sites. The other sites include bowel, omentum, urinary system, lungs, pleura, nasal mucosa, lymph nodes, umbilicus and undersurface of diaphragm. Nerve involvement of conus medullaris and sciatic nerve and muscle involvement of gluteal, adductors and rectus abdominis are rare sites that have been described in the literature previously [2,3]. This case is one of such rare spontaneous extrapelvic endometriosis described till date. The pathogenesis is probably due to vascular or lymphatic dissemination of endometrial cells [4]. The diagnosis and management of extrapelvic endometriosis pose a real big challenge to clinicians. The cyclical nature of symptoms is sometimes the only clue to reach the diagnosis. As up to 50% of these affected women may have concomitant pelvic endometriosis, further pre-operative diagnostic investigation is advisable. The gold standard for definitive diagnosis is laparoscopy and biopsy, but MRI can be recommended as the best non-invasive investigation. These tests could not be performed in our case due to financial constraints. Surgical excision only, brought complete relief of symptoms in this case.

Unique Occurrence of Mucosa-Associated Lymphoid Tissue Lymphoma Disseminated to Peripheral Nerves

Lymphomatous spread to peripheral nerves is a rare but long recognized complication, most commonly involving aggressive B-cell lymphomas. A 67-year-old woman with a history of a low-grade, gastric mucosa-associated lymphoid tissue (MALT) lymphoma, which was in remission, presented with a left-sided forearm mass and numbness over the dorsolateral aspect of the thumb. Magnetic resonance imaging revealed a mass associated with the superficial radial sensory nerve in the distal forearm, which demonstrated fluorodeoxyglucose avidity on positron emission tomography. An ultrasound-guided needle biopsy was performed yielding a diagnosis of low-grade lymphoma, consistent with extranodal marginal zone lymphoma. Subsequently, she was found to have bilateral sciatic nerve involvement. This case describes the first known reported spread of MALT lymphoma to peripheral nerves in the limbs.

Prevalence of Piriformis Syndrome in Chronic Low Back Pain Patients. A Clinical Diagnosis with Modified FAIR Test

Piriformis syndrome is a collection of symptoms and signs of pain from piriformis muscle and is characterized by pain in buttock with variable involvement of sciatic nerve. This syndrome is often overlooked in clinical practice because its presentation has similarities with other spine pathologies. A major problem with the clinical diagnosis of piriformis syndrome is the lack of consistent objective findings and an absence of single test that is specific for piriformis syndrome. Therefore, a precise and reliable clinical method of diagnosing piriformis syndrome should be developed by clinicians. This is a prospective observational study involving 93 consecutive patients who attended the pain management unit for chronic low back pain. The diagnosis of piriformis syndrome was made using the modified flexion adduction internal rotation (FAIR) test, which is a combination of Lasègue sign and FAIR test. Prevalence of piriformis syndrome based on this technique was compared with the previous data using other techniques. Chi square (χ2) analysis was performed to detect the relationship between piriformis syndrome and the potential risk factors. On the basics of our diagnostic criteria, the prevalence of piriformis syndrome was 17.2% among low back pain patients. All the patients diagnosed with piriformis syndrome responded well with piriformis muscle injections. No significant associations were detected between piriformis syndrome and spine disorders. Piriformis syndrome is a painful condition that is often overlooked in the differential diagnosis of chronic buttock or low back pain. The modified FAIR test together with piriformis muscle injection is potentially a reliable method for the clinical diagnosis of piriformis syndrome.

Leiomyosarcoma involving the sciatic nerve: Case report and review of the literature

Soft tissue sarcomas (STSs) represent 1% and 15% of adult and pediatric tumors, respectively, and almost 75% of all sarcomas; primary STSs occur commonly in the lower extremities. Leiomyosarcomas originate from the malignant transformation of a smooth muscle cell, which in turn may arise from a pluripotent mesenchymal stem cell. The present case report describes a patient with a leiomyosarcoma arising from the posterior thigh musculature, which invaded all layers of the left sciatic nerve's tibial division. Only two similar case reports exist in the literature, documenting sciatic nerve involvement by a leiomyosarcoma. The current patient underwent preoperative fractionated external beam radiation therapy (FEBRT) to the tumor and then had its removal which resulted in a 12 cm resection of the tibial division of the sciatic nerve. This defect was repaired with an intrafascicular sural nerve graft. Postoperatively, she had weakness of left hip flexion, dorsi- greater than plantar flexion, and left eversion, all of which reverted to normal after approximately two years. After surgery, the patient received further FEBRT, developed pulmonary involvement by leiomyosarcoma and underwent bilateral thoracotomies with removal of all nodules. She underwent chemotherapy (CTX) with ifosfamide and doxorubicine, the latter switched to epirubicin, but developed a new pulmonary nodule five months after CTX completion. Other CTX trials were unsuccessful, and she succumbed five years after her original extremity tumor complete resection.

Vascular Malformations, Rare Causes of Sciatic Neuropathy: A Case Series

Sciatica is typically a clear-cut symptom complex commonly related to an impingement at the spinal nerve level. Etiologies of sciatic neuropathy outside the neural foramina are uncommon. To describe 4 patients presenting with radiating leg pain due to sciatic nerve involvement, all with a vascular etiology. Four patients presenting with neuropathic pain were retrospectively reviewed. Preoperative 3 Tesla magnetic resonance imaging was used to identify these lesions, which most commonly showed diffuse T2 changes with nerve enhancement upon administration of contrast. Exploration revealed vascular lesions. All patients went on to external and limited internal neurolysis of the involved sciatic nerve segment. Intraoperative histological study confirmed the presence of a venous angioma, an arteriovenous malformation, a venous malformation associated with Klippel-Trenaunay syndrome, and a capillary hemangioma. Follow-up demonstrated stable neurological examinations with reduction in pain at 1 year or greater. In patients with sciatic distribution symptoms and signs, after initial negative spine imaging, high-resolution imaging of the sciatic nerve itself should be undertaken to address rarer causes such as vascular abnormalities. In these cases, exploration and fascicular biopsy provided a diagnosis; external and limited internal neurolysis improved pain.

Complete Femoral Nerve Resection with Soft Tissue Sarcoma: Functional Outcomes

The functional consequences of resecting the femoral nerve in conjunction with soft tissue sarcoma management are not well described. In comparison, sciatic nerve involvement by sarcoma was once considered an indication for amputation, but sciatic resection is now commonly performed as part of a limb-salvage approach. We compared functional outcomes following resection of either the femoral or sciatic nerve in patients with soft tissue sarcoma. We also compared both groups with patients with large thigh sarcomas without nerve involvement. The prospectively collected database from a tertiary referral center for sarcomas was retrospectively reviewed to identify all patients with resection of the femoral nerve performed during wide excision of a soft tissue sarcoma. Patient demographics, treatment, complications, and functional outcomes in the form of the Musculoskeletal Tumor Society (MSTS) 1987 score, MSTS 1993 score, and Toronto Extremity Salvage Score (TESS) were collected. Control groups of sarcoma patients with sciatic nerve resection in the thigh as well as similarly sized tumors in the quadriceps requiring no nerve resections were also analyzed. Ten patients with femoral nerve resections were identified, all women, aged 47-78 years, with large soft tissue sarcomas of varied subtypes. All patients received adjuvant radiotherapy, most preoperatively. Six patients developed fractures during long-term follow-up, four in nonirradiated portions of the skeleton but directly from falls related to absent active knee extensors, and two at least partially attributable to sequelae of radiation. MSTS 1987 hip scores demonstrated one excellent, four good, and five fair results. MSTS 1993 hip scores averaged 71.4 +/- 17.2% and TESS averaged 61.7 +/- 21.8. There were no significant differences between the functional scores for patients with femoral or sciatic nerve resections (P = 1.0). Femoral nerve resection appears more morbid than anticipated. The falls to which patients were prone, even years after surgery, subject them to ongoing long-term risks for fractures and other injuries. These nerve-specific functional implications should be considered when counseling patients in preparation for possible resection of the femoral nerve when it is directly involved by a soft tissue sarcoma.