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Kyle R Eberlin - One of the best experts on this subject based on the ideXlab platform.
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long term outcomes after surgical treatment of radial sensory nerve Neuromas patient reported outcomes and rate of secondary surgery
Plastic and Reconstructive Surgery, 2020Co-Authors: Rachel Gottlieb, Neal C Chen, Ritsaart F Westenberg, Henk J Coert, Kyle R EberlinAbstract:AIMS This study aimed (1) to describe long-term patient-reported outcomes of surgically treated symptomatic radial sensory nerve (RSN) Neuromas on function, pain interference, pain intensity, and satisfaction, (2) to assess which factors were associated with worse function, higher pain intensity, and more pain interference, and (3) to describe the secondary surgery rate and factors associated with secondary surgery. METHODS We conducted a retrospective review of patients surgically treated for RSN Neuroma from 2002 to 2016 (n=54). Patients prospectively completed PROMIS Upper Extremity (UE), PROMIS Pain Interference (PI), PROMIS Depression, numerical rating scale (NRS) Pain, NRS Satisfaction, and global rating scale of change (GRS). Twenty-five patients completed follow-up at a mean of 10.7±4.3 years after Neuroma surgery. RESULTS The mean PROMIS UE of 45.0±12.1, mean PROMIS PI of 55.5±10.3, and mean PROMIS Depression of 49.9±10.2 were within one standard deviation of the general population. Eight patients (32%) reported symptoms as unchanged or worse following Neuroma surgery. The median NRS Pain was 3 (IQR 1-6) and the NRS Satisfaction was 10 (IQR 7-10). Older patients (p=0.002) and patients with higher PROMIS PI (p<0.001), higher NRS Pain (p=0.012), and lower GRS score (p=0.01) had worse PROMIS UE. Secondary surgery rate was 20% and was associated with presence of multiple Neuromas (p=0.001). CONCLUSION RSN Neuromas remain difficult to treat. They have a high secondary surgery rate (20%) and only 68% of patients reporting improvement after surgical intervention. Patient-reported outcomes after surgery are similar to the general population, however, the range of outcomes is wide.
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surgery for lower extremity symptomatic Neuroma long term outcomes
Journal of Plastic Reconstructive and Aesthetic Surgery, 2020Co-Authors: Jonathan Lans, Neal C Chen, Navapong Anantavorasakul, Arno A Macken, Ravi F Sood, Kyle R EberlinAbstract:Summary Introduction Traumatic Neuroma caused by injuries or surgery can result in neuropathic pain, functional impairment, and psychological distress, which has an impact on quality of life. The aim of this study was to identify the factors related to successful treatment of symptomatic lower extremity symptomatic Neuromas using patient-reported outcome measures (PROMs). Methods Thirty-two patients with 48 symptomatic Neuromas completed the PROMIS mobility, PROMIS pain interference (PI), Numeric Rating Scale (NRS) for pain (0–10) for both pre- and post-operative pain, and the PROMIS depression at a mean of 8.9±4.5 years following Neuroma surgery. Neuromas were located around the foot and ankle (n=18, 38%), leg (n=14, 29%), around the knee (n=13, 27%), and in the thigh (n=3, 6.3%). Surgical treatment included Neuroma excision and implantation (n=29, 60%) followed by Neuroma excision alone or excision with placement in the subcutaneous tissue (n=12, 25%). We performed multivariable analysis to identify the factors influencing the PROMs. Results Patients reported significant reduction in mean NRS pain after surgery (7.3 vs 4.9, p=0.0013). Higher PROMIS depression scores were independently associated with inferior PROMIS mobility scores (β=–0.38, p=0.001), higher PROMIS PI scores (β=0.68, p Conclusion Surgical treatment of symptomatic Neuromas of the lower extremity provides a long-term improvement in 59% of patients, but 19% of patients still reported severe persistent pain despite surgical treatment. Smoking and negative mood have negative effects on patient-reported outcomes after Neuroma surgery.
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treatment of Neuroma induced chronic pain and management of nerve defects with processed nerve allografts
Plastic and reconstructive surgery. Global open, 2019Co-Authors: Ivica Ducic, Joshua Yoon, Kyle R EberlinAbstract:Symptomatic Neuromas can cause significant chronic pain and negatively impact quality of life. Symptoms often persist despite narcotics and nonoperative interventions, which are largely ineffective. With the opioid crisis, treatments for chronic pain that limit narcotics are needed. Traditional surgical options may result in Neuroma recurrence. Autograft reconstruction often results in donor-site morbidity. Processed nerve allografts facilitate axonal growth, nerve regeneration, and eliminate donor-site morbidity. Methods A literature review was performed to identify studies in which chronic Neuroma pain was treated with excision and processed nerve allograft reconstruction. PubMed was queried, and data from the studies were grouped into treatment effective and ineffective groups. Statistical analyses were performed on these groups, and further subgroup analysis was performed on overall change of preoperative and postoperative pain scores using a paired t test. Results Seven studies fulfilled inclusion criteria yielding 42 patients. Greater than 90% of patients had improvement of pain postoperatively. The preoperative and postoperative pain scores could be determined for 40 patients. The mean preoperative score was 7.9, and the mean postoperative score was 3.54. These results were statistically significant using a paired t test with a P value of <0.001. Conclusions Chronic pain resulting from symptomatic Neuromas can be treated with Neuroma excision and nerve stump reconstruction with processed nerve allograft. This obviates autograft-associated donor-site morbidity and provides a platform to potentially restore sensation to the involved nerve whenever a distal nerve end is available. Addressing the root cause is an important paradigm shift for treating symptomatic Neuromas.
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surgery for symptomatic Neuroma anatomic distribution and predictors of secondary surgery
Plastic and Reconstructive Surgery, 2019Co-Authors: Nicolaas Wolvetang, Jonathan Lans, Svenna H W L Verhiel, Bo J W Notermans, Neal C Chen, Kyle R EberlinAbstract:Background Neuromas are caused by irregular and disorganized regeneration following nerve injury. Many surgical techniques have been described to address Neuroma with varying success. The aim of this study was to evaluate predictive factors for secondary surgery after initial surgical intervention for symptomatic Neuroma along with a description of the anatomical distribution of surgically treated symptomatic Neuromas. Methods Five hundred ninety-eight patients with 641 Neuromas that underwent primary surgery for Neuroma were identified retrospectively. The diagnosis of Neuroma was based on physical examination and patient history in the medical charts. Neuromas were treated by excision, implantation in muscle or bone, excision with direct neurorrhaphy with or without nerve grafting, or other treatments. Results The rate of secondary surgery for Neuroma was 7.8 percent, and secondary operations were performed at a median of 16.1 months. Excision alone or excision with implantation into bone or muscle had higher rates of secondary surgery compared with excision and direct neurorrhaphy with or without nerve graft. Neuromas were located in the upper extremity (49.61 percent), lower extremity (46.65 percent), and the groin/trunk (3.74 percent). Conclusions Symptomatic Neuromas are located predominantly in the extremities, and surgery can improve pain, with low secondary surgery rates. Excision with direct neurorrhaphy with or without nerve grafting was associated with lower reoperation rates. Clinical question/level of evidence Therapeutic, III.
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relocation nerve grafting a technique for management of symptomatic digital Neuromas
Journal of Hand and Microsurgery, 2019Co-Authors: Brian B Freniere, Jonathan Lans, Eric Wenzinger, Kyle R EberlinAbstract:: Digital Neuromas are a common problem following amputation, often severely impairing hand function. Surgical treatment of terminal digital nerve Neuroma is challenging because of the lack of surrounding soft tissue in the hand. To help tackle this problem, we describe a novel technique, "relocation nerve grafting," to relocate the nerve ends into the interosseous muscles at the midcarpal level.
Juerg Hodler - One of the best experts on this subject based on the ideXlab platform.
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morton Neuroma mr imaging in prone supine and upright weight bearing body positions
Radiology, 2003Co-Authors: Dominik Weishaupt, Hanspeter Kundert, Hans Zollinger, Juerg Hodler, Karl Treiber, Patrice Vienne, Jurgen K Willmann, Borut Marincek, M ZanettiAbstract:PURPOSE: To assess the effect of prone, supine, and upright weight-bearing body positions on visibility, position, shape, and size of Morton Neuroma during magnetic resonance (MR) imaging. MATERIALS AND METHODS: Eighteen patients with 20 Morton Neuromas underwent MR imaging of the forefoot in prone (plantar flexion of the foot), supine (dorsiflexion of the foot), and upright weight-bearing positions. Visibility (3 = good, 2 = moderate, 1 = poor), position relative to the metatarsal bone, shape, and transverse diameter of Morton Neuroma were assessed on transverse T1-weighted MR images. Associations between different body positions and variables of interest were calculated with Wilcoxon signed rank test, χ2 test, and paired Student t test. RESULTS: In the prone position, visibility of all 20 Morton Neuromas was rated with a score of 3; visibility in the supine and weight-bearing positions was inferior (mean score, 2.4). All 20 (100%) Morton Neuromas changed their position relative to the metatarsal bone be...
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morton Neuroma effect of mr imaging findings on diagnostic thinking and therapeutic decisions
Radiology, 1999Co-Authors: M Zanetti, Josef K Strehle, Hanspeter Kundert, Hans Zollinger, Juerg HodlerAbstract:PURPOSE: To determine the effect of magnetic resonance (MR) imaging results on diagnostic thinking and therapeutic decisions by orthopedic surgeons in cases of a possible Morton Neuroma. MATERIAL AND METHODS: Orthopedic surgeons completed a questionnaire before and after MR imaging for 54 feet in 49 patients thought to have Morton Neuroma. Clinical diagnosis (Morton Neuroma, differential diagnosis), location, diagnostic confidence, and therapeutic decisions were noted before and after MR imaging. The influence of the size of the Neuroma on therapeutic decisions was analyzed. MR imaging diagnoses were compared with surgical results for 23 revised intermetatarsal spaces. RESULTS: After MR imaging, the clinical diagnosis of Morton Neuroma was withdrawn in 15 of 54 (28%) feet. In 14 of 39 maintained diagnoses, the location or number of Neuromas was changed after MR imaging. Confidence levels for Morton Neuroma increased substantially after MR imaging. In 31 (57%) feet, a change in treatment plan resulted after MR imaging. Diameters of Neuromas on MR images were significantly larger (P = .003) in surgically treated feet than in conservatively treated feet. MR imaging diagnoses were correct in all 23 revised intermetatarsal spaces. CONCLUSION: MR imaging has a major effect on diagnostic thinking and therapeutic decisions by orthopedic surgeons when Morton Neuroma is suspected, especially because MR imaging helps in localization and size assessment of Morton Neuromas.
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efficacy of mr imaging in patients suspected of having morton s Neuroma
American Journal of Roentgenology, 1997Co-Authors: M Zanetti, Hans Zollinger, T Ledermann, Juerg HodlerAbstract:The purpose of our study was to evaluate the role of MR imaging in patients with suspected Morton's Neuroma and to assess the value of various MR sequences in this diagnosis.Thirty-two consecutive patients with suspected Morton's Neuroma were studied using a 1.0-T MR scanner. Axial T1- and T2-weighted spin-echo, short inversion time inversion recovery, and enhanced T1-weighted fat-suppressed spin-echo images were obtained on each patient. Eighteen intermetatarsal spaces in 16 of the 32 patients were evaluated surgically. Contrast-to-noise ratios for Morton's Neuroma versus surrounding fat were calculated and standardized for imaging times.In 15 of 18 intermetatarsal spaces, a Morton's Neuroma was surgically proven. Thirteen true-positive, two false-negative, three true-negative, and no false-positive MR diagnoses were given. In six of 15 proven Neuromas, the clinical examiner was not able to identify the correct intermetatarsal space. The MR diagnoses in the 16 remaining patients who did not undergo surge...
M Zanetti - One of the best experts on this subject based on the ideXlab platform.
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morton Neuroma mr imaging in prone supine and upright weight bearing body positions
Radiology, 2003Co-Authors: Dominik Weishaupt, Hanspeter Kundert, Hans Zollinger, Juerg Hodler, Karl Treiber, Patrice Vienne, Jurgen K Willmann, Borut Marincek, M ZanettiAbstract:PURPOSE: To assess the effect of prone, supine, and upright weight-bearing body positions on visibility, position, shape, and size of Morton Neuroma during magnetic resonance (MR) imaging. MATERIALS AND METHODS: Eighteen patients with 20 Morton Neuromas underwent MR imaging of the forefoot in prone (plantar flexion of the foot), supine (dorsiflexion of the foot), and upright weight-bearing positions. Visibility (3 = good, 2 = moderate, 1 = poor), position relative to the metatarsal bone, shape, and transverse diameter of Morton Neuroma were assessed on transverse T1-weighted MR images. Associations between different body positions and variables of interest were calculated with Wilcoxon signed rank test, χ2 test, and paired Student t test. RESULTS: In the prone position, visibility of all 20 Morton Neuromas was rated with a score of 3; visibility in the supine and weight-bearing positions was inferior (mean score, 2.4). All 20 (100%) Morton Neuromas changed their position relative to the metatarsal bone be...
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morton Neuroma effect of mr imaging findings on diagnostic thinking and therapeutic decisions
Radiology, 1999Co-Authors: M Zanetti, Josef K Strehle, Hanspeter Kundert, Hans Zollinger, Juerg HodlerAbstract:PURPOSE: To determine the effect of magnetic resonance (MR) imaging results on diagnostic thinking and therapeutic decisions by orthopedic surgeons in cases of a possible Morton Neuroma. MATERIAL AND METHODS: Orthopedic surgeons completed a questionnaire before and after MR imaging for 54 feet in 49 patients thought to have Morton Neuroma. Clinical diagnosis (Morton Neuroma, differential diagnosis), location, diagnostic confidence, and therapeutic decisions were noted before and after MR imaging. The influence of the size of the Neuroma on therapeutic decisions was analyzed. MR imaging diagnoses were compared with surgical results for 23 revised intermetatarsal spaces. RESULTS: After MR imaging, the clinical diagnosis of Morton Neuroma was withdrawn in 15 of 54 (28%) feet. In 14 of 39 maintained diagnoses, the location or number of Neuromas was changed after MR imaging. Confidence levels for Morton Neuroma increased substantially after MR imaging. In 31 (57%) feet, a change in treatment plan resulted after MR imaging. Diameters of Neuromas on MR images were significantly larger (P = .003) in surgically treated feet than in conservatively treated feet. MR imaging diagnoses were correct in all 23 revised intermetatarsal spaces. CONCLUSION: MR imaging has a major effect on diagnostic thinking and therapeutic decisions by orthopedic surgeons when Morton Neuroma is suspected, especially because MR imaging helps in localization and size assessment of Morton Neuromas.
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efficacy of mr imaging in patients suspected of having morton s Neuroma
American Journal of Roentgenology, 1997Co-Authors: M Zanetti, Hans Zollinger, T Ledermann, Juerg HodlerAbstract:The purpose of our study was to evaluate the role of MR imaging in patients with suspected Morton's Neuroma and to assess the value of various MR sequences in this diagnosis.Thirty-two consecutive patients with suspected Morton's Neuroma were studied using a 1.0-T MR scanner. Axial T1- and T2-weighted spin-echo, short inversion time inversion recovery, and enhanced T1-weighted fat-suppressed spin-echo images were obtained on each patient. Eighteen intermetatarsal spaces in 16 of the 32 patients were evaluated surgically. Contrast-to-noise ratios for Morton's Neuroma versus surrounding fat were calculated and standardized for imaging times.In 15 of 18 intermetatarsal spaces, a Morton's Neuroma was surgically proven. Thirteen true-positive, two false-negative, three true-negative, and no false-positive MR diagnoses were given. In six of 15 proven Neuromas, the clinical examiner was not able to identify the correct intermetatarsal space. The MR diagnoses in the 16 remaining patients who did not undergo surge...
Robert G. Ojemann - One of the best experts on this subject based on the ideXlab platform.
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retrosigmoid approach to acoustic Neuroma vestibular schwannoma
Neurosurgery, 2001Co-Authors: Robert G. OjemannAbstract:Abstract The retrosigmoid approach for the microsurgical removal of an acoustic Neuroma (vestibular schwannoma) is described, and perioperative medical management of the patient is discussed. The techniques for monitoring facial and cochlear nerve function are presented. The supine-oblique position, skin incision, bone removal, dural opening, and initial exposure are outlined. Important points in the technique for removing acoustic Neuromas and preserving hearing, when possible, are described and illustrated.
Sian Ellard - One of the best experts on this subject based on the ideXlab platform.
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sos1 frameshift mutations cause pure mucosal Neuroma syndrome a clinical phenotype distinct from multiple endocrine neoplasia type 2b
Clinical Endocrinology, 2016Co-Authors: Martina Owens, Emma Kivuva, Anthony G Quinn, Paul Brennan, Richard Caswell, Hana Lango Allen, Bijay Vaidya, Sian EllardAbstract:SummaryBackground Mucosal Neuromas, thickened corneal nerves and marfanoid body habitus are characteristic phenotypic features of multiple endocrine neoplasia type 2B (MEN2B) and often provide an early clue to the diagnosis of the syndrome. Rarely, patients present with typical physical features of MEN2B but without associated endocrinopathies (medullary thyroid carcinoma or pheochromocytoma) or a RET gene mutation; this clinical presentation is thought to represent a distinct condition termed ‘pure mucosal Neuroma syndrome’. Methods Exome sequencing was performed in two unrelated probands with mucosal Neuromas, thickened corneal nerves and marfanoid body habitus, but no MEN2B-associated endocrinopathy or RET gene mutation. Sanger sequencing was performed to confirm mutations detected by exome sequencing and to test in family members and 3 additional unrelated index patients with mucosal Neuromas or thickened corneal nerves. Results A heterozygous SOS1 gene frameshift mutation (c.3266dup or c.3248dup) was identified in each proband. Sanger sequencing showed that proband 1 inherited the c.3266dup mutation from his affected mother, while the c.3248dup mutation had arisen de novo in proband 2. Sanger sequencing also identified one further novel SOS1 mutation (c.3254dup) in one of the 3 additional index patients. Conclusion Our results demonstrate the existence of pure mucosal Neuroma syndrome as a clinical entity distinct from MEN2B that can now be diagnosed by genetic testing.
