Ultraschall Med 2018; 39(03): 318-327
DOI: 10.1055/s-0043-121628
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Novel Demonstration of the Anterior Femoral Cutaneous Nerves using Ultrasound

Darstellung der anterioren kutanen Hautäste des Nervus femoralis mittels Ultraschall
Christopher Pivec
1   Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Austria
,
Gerd Bodner
1   Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Austria
,
Johannes A. Mayer
2   Department of Surgery, Division of Plastic and Reconstructive Surgery, Medical University Vienna, Austria
,
Peter C. Brugger
3   Department of Anatomy, Center for Anatomy and Cell Biology, Medical University Vienna, Austria
,
Istvan Paraszti
3   Department of Anatomy, Center for Anatomy and Cell Biology, Medical University Vienna, Austria
,
Veith Moser
4   Department of Trauma Surgery, Lorenz Boehler Hospital, Vienna, Austria
,
Hannes Traxler
3   Department of Anatomy, Center for Anatomy and Cell Biology, Medical University Vienna, Austria
,
Georg Riegler
1   Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Austria
› Author Affiliations
Further Information

Publication History

25 May 2017

11 October 2017

Publication Date:
07 February 2018 (online)

Abstract

Purpose Neuropathy of the intermediate (IFCN) and medial femoral cutaneous nerve (MFCN) is a potential iatrogenic complication of thigh surgery and its diagnosis is limited. This study aimed to evaluate the possibility of the visualization and diagnostic assessment of the IFCN and MFCN with high-resolution ultrasound (HRUS).

Materials and Methods In this study, HRUS with high-frequency probes (15 – 22MHz) was used to locate the IFCN and the MFCN in 16 fresh cadaveric lower limbs. The correct identification of the nerves was verified by ink-marking and consecutive dissections at sites correlating to nerve positions (R1 – 3), namely, the origin, the mid portion, and the distal portion, respectively. 12 cases with suspected IFCN and MFCN lesions referred to our clinic for HRUS examinations were also assessed.

Results Anatomical dissection confirmed the correct identification of the IFCN in 16/16 branches at all of the different locations (100 %). MFCN was correctly identified at R1 + 3, in all cases (16/16; 100 %), and in 14/16 cases (88 %) at (R2). 12 cases of patients with IFCN and MFCN pathologies (all of iatrogenic origin) were identified. 9 instances of structural damage were visible on HRUS, and all pathologies were confirmed by almost complete resolution of symptoms after selective HRUS-guided blocks with 0.5 – 1 ml lidocaine 2 %.

Conclusion This study confirms that the IFCN and the MFCN can be reliably visualized with HRUS throughout the course of these nerves, both in anatomical specimens and in patients.

Zusammenfassung

Ziel Iatrogene Schädigungen der Rami cutanei anteriores des Nervus femoralis, die einen intermediären und einen medialen Ast aufweisen (IFCN und MFCN), können eine schwer zu diagnostizierende Pathologie sein. Ziel dieser Studie ist es, zu untersuchen, ob die bildgebende Darstellung und Diagnostik des MFCN und IFCN, mittels hochauflösendem Ultraschall (HRUS), möglich ist.

Material und Methoden In dieser Studie wurde mittels hochauflösenden Ultraschallsonden (15 – 22MHz) versucht, den IFCN und MFCN bei 16 frischen Kadavern aufzusuchen, und im Verlauf darzustellen. Die korrekte Identifikation des jeweiligen Nervs, wurde durch ultraschallgezielte Farbmarkierung und anschließende anatomische Präparation bestätigt. Hierbei wurde sowohl der IFCN, als auch der MFCN an jeweils drei Stellen (proximal, Mitte und distal, R1 – 3) markiert. Zusätzlich wurden zwölf Patienten unserer Klinik, mit Verdacht auf IFCN und MFCN Pathologien, mittels hochauflösendem Ultraschall untersucht. Die anatomische Präparation bestätigte die korrekte Identifikation des IFCN und MFCN in 16 von 16 Fällen. Der Verlauf des MFCN konnte in allen Fällen (16/16; 100 %) korrekt dargestellt und farbmarkiert werden (R1,2,3). Der Verlauf des IFCN konnte in 14 von 16 Fällen (88 %) korrekt dargestellt und farbmarkiert werden (R2).

Ergebnisse Zwölf Patienten mit iatrogenen IFCN und MFCN Pathologien wurden identifiziert. In neun Fällen konnten morphologische Schädigungen des jeweiligen Nervs mittels HRUS gefunden werden. Diese Schädigungen wurden durch erfolgreiche HRUS-gezielter Blockade mit 0.5 – 1 ml Lidocain 2 % als ursächlich bestätigt.

Schlussfolgerung Diese Studie bestätigt, dass sowohl der IFCN, als auch der MFCN zuverlässig mit hochauflösendem Ultraschall visualisiert und im gesamten Verlauf dargestellt werden können, sowohl an Kadavern als auch an Patienten.

 
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