Lesions of Peripheral Nerves Caused by Compression and Ischemia: Treatment Tactics

Luzan B., Cimbaluk V., Cimbaluk Yu.

Romodanov Institute of Neurosurgery, Ukrainian Academy of Medical Sciences, Kiev, Ukraine

 

The research goal was to develop an algorithm of rendering care to cases with lesions of peripheral nerves, caused by compression and ischemia, and to improve treatment results.

Material and Methods. The results of examination and treatment of 364 cases with the above lesions of peripheral nerves were analyzed. A character and degree of a nerve trunk lesion was determined on the basis of clinical-and-neurological examination with a score estimation and electroneuromyography (including an intraoperative one). In some cases they were supplemented by Doppler, MRI, CT and X-ray examinations.

Results. The analysis of the obtained results demonstrated considerable efficacy of early (during 1-3 moths) surgical interventions in chronic neuropathy, caused by compression and ischemia. They led to satisfactory restoration of a function, watched during 6 months, in 92% of cases. Criteria of treatment efficacy included reduction of vegetative-and-trophic disorders and pain syndrome, regression of a neurological deficit. Its efficacy was much lower in performing operations in a remote period (more than 12 months); as a rule, observed positive results (42% of cases) concerned improvement of a vegetative-and-trophic function. The results of surgical treatment of entrapment neuropathy were dependent on a duration, character, compression level, degree of neurological deficit, type of a compressed nerve trunk. Acute neuropathies, caused by compression and ischemia, did not demand emergency operations in the majority of cases. In our opinion, a problem of expedient intervention is to be solved during 1-2 months of dynamic follow-up and regular electroneuromyographic control.