Intraoperative high-resolution ultrasound in the managment of traumatic nerve lesions: a new technique

Introduction:

Surgical treatment of nerve lesion in continuity remains difficult even in the most experienced hands. Their regenerative potential is evaluated either by intraoperative electrophysiology and/or intraneural dissection. The values of preoperative ultrasound is often hampered due to low tissue penetration and trauma related artifacts. Therefore the present study for the first time examines feasibility and value of intraoperative high-frequency ultrasound as an imaging tool in the management of traumatic nerve lesions in continuity.

Material and Methods:

After development of intraoperative application of high-frequency ultrasound we examined 19 traumatic or iatrogenic nerve lesions of different extent. The information obtained was correlated to intraoperative electrophysiology, the findings of microsurgical intraneural dissection and histopathology of the resected nerve segments.

Results:

The intraoperative application of high-frequency ultrasound enabled morphological ultrastructural examination of traumatic nerve lesions with excellent imaging quality. The assessment of the severity of the underlying nerve lesion matched perfectly with the judgement obtained from intraoperative electrophysiology. Both, intraneural nerve dissection and neuropathological examination of the nerve segment resected confirmed the sonographic findings. Based on these findings an ultrasound classification scheme could be developed.

Conclusion:

With intraoperative ultrasound for the first time intraoperative morphological ultrastructure examination of nerve lesion became possible. It is a promising method that seems to assess the type (intraneural/perineural) and grade of nerve fibrosis. Therefore on synopsis with intraoperative neurophysiology high-frequency ultrasound may represent a major tool for non-invasive assessment of the regenerative potential of a nerve lesion.