Chirurgische Therapie entzündlicher peripherer Nervenkonstriktionen – Ergebnisse nach (intraneuraler) Neurolyse ohne Transplantation

Inflammatory processes with subsequent stricture formation may be responsible for poor clinical outcome of motor function following peripheral nerve inflammation such as neuralgic amyotrophy. The aim of this study was to investigate clinical and intraoperative findings in patients with surgically treated peripheral nerve entwinement.

In a retrospective analysis from 2015-2023, 17 nerve constrictions in 14 patients were surgically treated after sonographic diagnosis and included in this analysis. Clinical and diagnostic findings before and after surgery were assessed and the type of surgical procedure was evaluated.

All patients underwent preoperative high-resolution neurosonography, which revealed the presence of a nerve stricture/entwinement. The mean patient age was 53 (±10.5) years. 64.3% of the patients were male, 35.7% were female. The stricture was located in 35.3% (n=6) each at the median and radial nerve, in 17.6% (n=3) at the musculocutaneous nerve and in 11.8% (n=2) at the suprascapular nerve. Neurolysis with epi- and perineurectomy was performed in 53.0% (n=9), epineurectomy in 23.5% (n=4) and neurolysis in 23.5% (n=4). No patient underwent transplantation. In 2 cases no clear constriction was identified intraoperatively. A high-grade paresis (M0-3) was present preoperatively in 88.2% (n=15), postoperatively in 23.5% (n=4); 11.8% (n=2) showed no clinical improvement. Surgery was performed M=6.5 months after symptom onset, the last follow-up was held M=5.5 months postoperatively. There was a significant correlation between type of surgical procedure and degree of postoperative paresis with better results after more aggressive procedures (epi-&perineurectomy > epineurectomy > neurolysis, r=0.73, p=0.007), but not between preoperative clinical status and type of surgery. There was no correlation between the extent of paresis and the location of the lesion.

A reliable diagnosis of peripheral nerve entwinement has only been possible since the establishment of high-resolution neurosonography. Our data show that sonography-guided intraneural neurolysis of the entwinement leads to good clinical results. Perineural neurolysis, on the other hand, often appears to be insufficient. The outcome results shown are comparable with literature reports, which have always included cases undergoing nerve transplantation. Transplantation might not be required if intraneural neurolysis with epi- and perineurectomy is performed.