Neurosurgery clinics of North America
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New developments in clinical peripheral nerve imaging with MRI over the past few years, primarily those related to nerve entrapment syndromes, are reviewed. The basic principles of peripheral nerve imaging are described briefly. Relevant current or forthcoming technical innovations are described, and then recent work describing novel findings, organized by anatomic location (brachial plexus, upper extremity, and lower extremity), is reviewed. The review concludes with a summary and suggestions of areas in which future clinical research would be particularly helpful.
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MRI has become the modality of choice for imaging the peripheral nervous system. When technically optimized and customized for individual clinical problems, MRI can provide insight into the underlying causes of neoplastic, inflammatory, and other diseases affecting peripheral nerves with a high degree of accuracy and effectively distinguish benign from malignant processes. With high-resolution imaging techniques targeted fascicular biopsy can be planned to improve diagnostic yield and decrease the risk of surgically sampling primary nerve pathology.
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Neurosurg. Clin. N. Am. · Oct 2008
ReviewThe four medial ankle tunnels: a critical review of perceptions of tarsal tunnel syndrome and neuropathy.
The mechanisms of symptom production (other than a space-occupying lesion) and the diagnosis of tarsal tunnel syndrome remain controversial. To understand the diagnosis and treatment of tarsal tunnel syndrome in the presence of neuropathy, the known anatomy and pathophysiology related to the tarsal tunnel and the existing basic science and clinical evidence base related to these topics are reviewed. ⋯ For patients with tarsal tunnel syndrome and the comorbidity of diabetic polyneuropathy (DPN), it is concluded that a positive Tinel sign at the tarsal tunnel can predict a positive outcome for pain relief and restoration of sensation in 80% of the people who have decompression of the four medial ankle tunnels. With sensation improved, it is concluded that the natural history of DPN can be changed toward prevention of ulcers and amputation.