Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Jan 2009
Review Case ReportsBrachial plexus injury: the London experience with supraclavicular traction lesions.
In this article, the author details the experiences of his hospital and other London hospitals in treating brachial plexus injury. As noted, important advances have been made in methods of diagnosis and repair. Myelography was replaced by CT scan and later by MRI. ⋯ This is part of a Point-Counterpoint discussion with Dr. David G. Kline's presentation of "A Personal Experience."
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This article is a presentation of personal experience and resultant views by the author on the timing of surgery for nerve injury, especially that for brachial plexus injuries. The author presents arguments for early and delayed surgery based on the type of injury encountered and examines how early nerve repair on all might preclude spontaneous recovery. ⋯ This is part of a Point-Counterpoint discussion with Dr. Rolfe Birch's presentation of "The London Experience."
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Neurosurg. Clin. N. Am. · Jan 2009
ReviewNeurostimulation techniques for painful peripheral nerve disorders.
Disorders of the peripheral nervous system often present a unique challenge to the clinician or surgeon, because the neuropathic pain associated with them can be extremely resistant to typical pain treatments. Painful peripheral nerve disorders often have pain in a particular peripheral nerve distribution, and thus an optimal treatment modality is one that delivers targeted relief to the precise distribution of the pain. ⋯ In this article, PNS techniques are described in detail for the stimulation of the occipital and trigeminal nerves for intractable craniofacial pain, as well as emerging techniques for the selective stimulation of spinal nerve roots and subcutaneous peripheral nerve stimulation. The increasing spectrum of disorders and pain syndromes amenable to PNS also is discussed.
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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.