The following is a summary of “Role of Preoperative Ultrasound in the Management of Peripheral Nerve Injuries,” published in the December 2023 issue of Neurology by Elkholy et al.

Peripheral nerve injuries, encompassing damage occurring outside the central nervous system, pose diagnostic challenges. The utility of ultrasonography in clinical settings as an affordable and minimally invasive technique has emerged, offering valuable insights into nerve injuries. Their objective was to evaluate the efficacy of ultrasound in delineating the presence, location, and severity of nerve damage in patients presenting with peripheral nerve lesions before surgical intervention. This cross-sectional study involved 78 patients (56 females, 22 males, aged 9 to 52 years) exhibiting diverse pathologies, such as entrapment, tumoral, post-traumatic, and post-surgical nerve injuries, at Tanta University Hospitals’ Neurosurgery, Physical Medicine, Rheumatology, and Rehabilitation Departments. 

Preoperatively, patients underwent neurological examination, electrodiagnostic studies, and sonographic evaluations utilizing linear array transducers spanning frequencies from 7.5 to 16 MHz. Entrapment neuropathy emerged as the predominant pathology (39 patients, 50%), with ultrasound revealing the entrapment site by depicting increased nerve cross-sectional area and hypoechogenicity. In post-traumatic and iatrogenic neuropathies (35 patients, 44.9%), ultrasound discerned neuromas in continuity (11.5%), complete neurotmesis with stump neuromas (23.1%), and perineural adhesions (10.3%). Hypoechoic nerve regions were consistently observed at the injury sites. The identification of hyperechoic fibrous tissue suggested perineural adhesion and prompted neurolysis.

Additionally, three cases (3.8%) of schwannoma and one case (1.3%) of neurofibroma were diagnosed via ultrasound, affirming tumor size and vascular supply. Ultrasonography emerged as a pivotal diagnostic and surgical planning tool for peripheral nerve injuries, facilitating precise injury assessment owing to its high resolution and real-time imaging capabilities. The researchers advocate incorporating ultrasound into standard clinical and neurophysiological assessments for patients with peripheral nerve injuries, particularly as a primary imaging modality for suspected nerve-origin tumors.

Source: sciencedirect.com/science/article/abs/pii/S0303846723004997