Improved diagnostics and therapeutic decision making in traumatic peripheral nerve lesions using MR-neurography
Improved diagnostics and therapeutic decision making in traumatic peripheral nerve lesions using MR-neurography
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DOI：
10.1055/s-0044-101833
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发表时间：
2018-08-01
影响因子：
0.6
通讯作者：
Schwarz, Daniel
中科院分区：
文献类型：
--
作者：
Bergmeister, Konstantin D.;Schoenle, Philipp;Schwarz, Daniel
前言：周围神经损伤的正确诊断是神经外科选择正确治疗方法的关键。特别是，神经缺陷需要早期诊断，以提供快速的外科重建和防止长期残疾。磁共振神经成像的最新发展为外科医生提供了一种诊断工具，可以提供关于神经结构和可能的功能的准确信息。在这里我们描述了一系列的病例，通过术前磁共振神经成像来确定正确的损伤类型。材料和方法我们展示了5例创伤性神经损伤，这些损伤是通过高分辨率磁共振神经成像进行评估的，结合标准的临床、电生理和超声诊断。我们展示了这种新技术用于神经外科手术的临床可行性、益处以及术前MR神经成像图像与术中情况的相关性(在手术治疗的病例中)。结果尽管病理电生理和超声检查不确定，但2例患者在MR神经成像发现的完整神经完整性的基础上，成功地进行了非手术治疗。在三个病例中，磁共振神经成像能够对神经病变进行准确的诊断和定位。讨论虽然目前还没有系统的临床分析，但我们的数据表明，MR神经成像可以帮助外科医生正确地确定神经损伤的类型，从而在术前确定合适的治疗方法。在出现的病例中，磁共振神经成像正确地诊断了损伤的类型，因此可以在非手术治疗、神经松解或神经重建之间做出适当的计划和决策。我们认为，MR神经成像是神经外科医生提高神经损伤治疗水平的一种新兴工具。结论MR神经成像提供了有关神经损伤的决定性信息，有助于确定手术的必要性和正确的手术治疗。
Introduction The correct diagnosis of peripheral nerve injuries is essential for choosing the correct treatment in nerve surgery. Especially, nerve defects require early diagnosis to provide quick surgical reconstruction and prevent long-term disabilities. Recent developments in MR-neurography provide surgeons with a diagnostic tool delivering precise information on the structure and possibly function of nerves. Here we describe a series of cases, that benefited from preoperative MR-neurography to identify the correct type of injury.Material and Methods We demonstrate five traumatic nerve injuries which were evaluated using high-resolution MR-neurography imaging for therapeutic planning, combined with standard clinical, electrophysiological and sonography diagnostics. We show the clinical feasibility, benefit of this new technique for nerve surgery and the correlation of preoperative MR-neurography images to the intraoperative situation (in surgically managed cases).Results Two cases were successfully treated without surgery based on the intact nerve-integrity found in the MR-neurography, despite pathological electrophysiology and inconclusive sonography. In three cases, the MR-Neurography enabled a precise diagnosis and localization of the nerve lesion. Thereby, a precise surgical reconstruction of the nerve lesion was achieved, confirming the matching of MR-neurography findings and intraoperative situs.Discussion Although, systematic clinical analyses are not available yet, our data suggest that MR-neurography can help surgeons to correctly define the type of nerve injury and thus identify the appropriate treatment preoperatively. In the presented cases, MR-neurography correctly diagnosed the type of injury and therefore allowed adequate planning and decision making between non-surgical treatment, neurolysis or nerve reconstruction. We believe that MR-neurography is an emerging tool for nerve surgeons to improve the treatment of nerve injuries.Conclusion MR-neurography delivers decisive information on the nerve lesion and helps to identify the necessity to operate and the correct surgical treatment.