• 대한골관절종양학회지
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• 제2권1호
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• pp.88-93
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• 1996

Neurilemmomas are the most common benign tumor of the peripheral nerve trunks, and arises from the cells in the sheath of Schwann. Neurilemmomas are well encapsulated and may be separated easily from surrounding tissue and lie completely within a larger nerve trunk, with bundles of neurofibrils spread out over the surface of the tumor. A careful dissection and retraction of the nerve bundles will allow the tumor to be enucleated from the parent nerve without any significant interference with the function of the nerve. Resection of the involved nerve is seldom necessary and should be avoided if at all possible. Our aim in microscopic excision of neurilemmoma of extremities is to reduce any disturbance of the intact neurofibrils of the parent nerve. Thirteen cases of neurilimmomas were treated by microscopic excision at the Department of Orthopaedic Surgery, Korea University Hospital between January 1990 and March 1995. The results was as follows ; 1. The average age at surgical intervention was 40.1 years. Cases in fourth and fifth decades predominated. 2. In their anatomical distribution, 8 cases were in the upper extremity and 5 cases in the lower extremity. 11 cases were on the flexor surface. 3. On the operative field, all the tumors were well encapsulated, however 1 case of 13 was adherent to the periosteum of fibula. 4. In all cases, the tumor were enucleated from the parent nerve without any injury to nerve under high-power magnification, preserving individual fascicles, and sensory and motor function.

• The Korean Journal of Pain
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• 제24권4호
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• pp.185-190
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• 2011

Background: Spinal nerve ligation (SNL) injury in rats produces a pain syndrome that includes mechanical and thermal allodynia. Previous studies have indicated that proinflammatory cytokines such as tumor necrosis factor-${\alpha}$ (TNF-${\alpha}$) play an important role in peripheral mediation of neuropathic pain, and that altered dorsal root ganglion (DRG) function and degree of DRG neuronal apoptosis are associated with spinal nerve injury. The present study was conducted to evaluate the expression of TNF-${\alpha}$ and the extent of apoptosis in the dorsal root ganglion after SNL in rats. Methods: Sprague-Dawley rats were subjected to SNL of the left L5 and L6 spinal nerves distal to the DRG and proximal to the formation of the sciatic nerve. At postoperative day 8, TNF-${\alpha}$ protein levels in the L5.6 DRG were compared between SNL and naive groups using ELISA. In addition, we compared the percentage of neurons injured in the DRG using immunostaining for apoptosis and localization of activated caspase-3. Results: SNL injury produced significant mechanical and cold allodynia throughout the 7-day experimental period. TNF-${\alpha}$ protein levels were increased in the DRG in rats that had undergone SNL ($12.7{\pm}3.2$ pg/100 ${\mu}g$, P < 0.001) when compared with naive rats ($4.1{\pm}1.4$ pg/100 ${\mu}g$). The percentage of neurons or satellite cells co-localized with activated caspase-3 were also significantly higher in rats with SNL than in naive rats (P < 0.001, P < 0.05, respectively). Conclusions: SNL injury produces mechanical and cold allodynia, as well as TNF-${\alpha}$ elevation and apoptosis in the DRG.

• Archives of Plastic Surgery
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• 제51권2호
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• pp.208-211
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• 2024

Intraneural hematoma is a rare disease that results in an impaired nerve function because of bleeding around the peripheral nerve, with only 20 cases reported. Trauma, neoplasm, and bleeding disorders are known factors for intraneural hematoma. However, here we report atypical features of asymptomatic and spontaneous intraneural hematoma which are difficult to diagnose. A 60-year-old woman visited our clinic with the complaint of a palpable mass on the right calf. She reported no medical history or trauma to the right calf and laboratory findings showed normal coagulopathy. Ultrasonography was performed, which indicated hematoma near saphenous vein and sural nerve or neurogenic tumor. We performed surgical exploration and intraneural hematoma was confirmed on sural nerve. Meticulous paraneuriotomy and evacuation was performed without nerve injury. Histological examination revealed intraneural hematoma with a vascular wall. No neurologic symptoms were observed. In literature review, we acknowledge that understanding anatomy of nerve, using ultrasonography as a diagnostic tool and surgical decompression is key for intraneural hematoma. Our case report may help establish the implications of diagnosis and treatment. Also, we suggested surgical treatment is necessary even in cases that do not present symptoms because neurological symptoms and associated symptoms may occur later.

• Journal of Korean Neurosurgical Society
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• 제29권1호
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• pp.101-107
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• 2000

Objectives : The evaluation of peripheral nerve injuries has traditionally relied on a clinical history, physical examination, and electrodiagnostic studies. The purpose of the present study was to examine serial magnetic resonance image(MRI) changes following acute muscle denervation under experimental conditions and to identify potential advantages and disadvantages of this use of MRI. Methods : An experimental transection of right sciatic nerve on Spargue-Dawley rats was performed. MRI was performed with T1-weighted spin-echo and STIR sequences. The imaging findings were compared with EMG in order to determine its sensitivity relative to this standard procedure. A simultaneous histopathological study provided information about the morphological basis of the imaging findings. Signal intensities were expressed as a ratio of abnormal to normal. Results : The signal intensity ratio of muscles with the STIR sequence was increased significantly at 2 weeks after sciatic nerve transection(p<0.05), although definite signal change was seen as early as 4 days postdenervation in one. EMG revealed significant denervation potential from 3 days after nerve transection. Diffuse cell atrophy was revealed hostologically at 2 weeks after transection, which was at the same time of significant signal change in MRI. Conclusion : MRI signal changes in denervated muscles secondary to nerve injury correlate with the degree of muscle atrophy on histologic examination. In addition to EMG, MRI can document the course of muscle atrophy and mesenchymal abnormalities in denervation. These results indicate that MRI can play a complementary role in the evaluation of patients with denervation.

• 혜화의학회지
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• 제29권1호
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• pp.18-25
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• 2020

Objective: The goal of this study is to investigate whether peripheral axonal regeneration is affected by diabetes in experimental animals. Method: Sprague Dawely rat was injected with 45~50 mg/kg of streptozotocin (STZ) to generate an animal model of diabetes. Three months after STZ injection, sciatic nerve (2 cm length) was removed and the same length of nerve segments from STZ-injected animal or from control animal (CTL) was transplanted into STZ-injected animals (STZ-STZ and STZ-CTL respectively). Similarly, sciatic nerve segments from STZ-injected animal or from control animal were grafted into the control animals (CTL-STZ and CTL-CTL respectively). All animals were sacrificed 2 weeks after transplantation. Sciatic nerve sections were prepared and subjected to immunofluorescence staining analysis. Results: Immunofluorescence staining for NF-200 showed that distal elongation of regenerating axons reached 40~80% of proximal neve in both CTL-STZ and CTL-CTL groups. However, distal elongation in both STZ-STZ and STZ-CTL groups were 20~60% of proximal nerve. Furthermore, measurement of axonal regeneration after immuno-staining with SCG10 showed that the scores of distal elongation relative to proximal nerve were 50~90% in CTL-CTL and CTL-STZ groups and 10-60% in STZ-CTL and STZ-STZ. Conclusions: Our data showed that the levels of axonal regeneration were not affected irrespective of whether they were from STZ- or CTL graft, but were greatly reduced when the nerves were transplanted into the STZ host.

• 대한정형외과 초음파학회지
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• 제5권2호
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• pp.102-105
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• 2012

족근 관절 및 하지 후방의 통증은 비교적 흔히 발생하는 증상으로 이를 유발할 수 있는 질환은 매우 다양하게 존재하며 대표적으로 아킬레스건병증이나 후방 구획을 형성하는 여러 근육 및 힘줄의 염증이나 파열 등이 있다. 신경초종은 신경집 기원의 양성 종양으로 크기 증가에 따른 주변 구조물의 압박으로 인해 여러 임상 증상을 일으킬 수 있다. 만성 아킬레스건병증과 유사한 임상 증상을 유발하는 후방 경골 신경초종은 초음파 등의 영상학적 검사에 의한 감별 진단을 시행치 아니할 경우 간과하기 쉬운 질환으로, 저자들은 이를 경험하였기에 문헌적 고찰과 함께 보고하는 바이다.

• 한국임상수의학회지
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• 제19권3호
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• pp.316-321
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• 2002

The purpose of this study was to examine the effect of Ga-As(Gallium-Arsenide, wave length; 904 nm) infrared laser irradiation on healing of the experimentally crush injured rat sciatic nerves. The bilateral sciatic nerves of 43 adult male Sprague-Dawley rats were compressed surgically with a straight hemostat (1 mm width). The right legs of all the rats were irradiated using a 27 mW Ga-As infrared laser (laser irradiated group). The radiation procedure was administered for 3 minutes every day for 1, 3, 5, and 7 weeks in each group. Left legs were not irradiated and served as the control group. The numbers of total myelinated axon and degenerated myelin in the sciatic nerves of bilateral legs were measured and analyzed with mage analysis system in order to make a morphological analysis of the effect of the Ga-As infrared laser on injured nerves. Total number of myelinated axons was increased with time interval, especially in the 1, 3. and 5 week of irradiated group. Conversely, the number of degenerated myelin was decreased with time interval, especially in the irradiated group. The effects in the irradiated group were more pronounced than those of the control group. In conclusion, the Ga-As infrared laser irradiation is a useful adjuvant therapy to the regeneration of the peripheral nerve injury.

• The Korean Journal of Pain
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• 제36권4호
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• pp.425-440
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• 2023

Background: Muscimol's quick onset and GABAergic properties make it a promising candidate for the treatment of pain. This systematic review and meta-analysis of preclinical studies aimed at summarizing the evidence regarding the efficacy of muscimol administration in the amelioration of nerve injury-related neuropathic pain. Methods: Two independent researchers performed the screening process in Medline, Embase, Scopus and Web of Science extracting data were extracted into a checklist designed according to the PRISMA guideline. A standardized mean difference (SMD [95% confidence interval]) was calculated for each. To assess the heterogeneity between studies, ² and chi-square tests were utilized. In the case of heterogeneity, meta-regression and subgroup analyses were performed to identify the potential source. Results: Twenty-two articles met the inclusion criteria. Pooled data analysis showed that the administration of muscimol during the peak effect causes a significant reduction in mechanical allodynia (SMD = 1.78 [1.45-2.11]; P < 0.0001; I² = 72.70%), mechanical hyperalgesia (SMD = 1.62 [1.28-1.96]; P < 0.0001; I² = 40.66%), and thermal hyperalgesia (SMD = 2.59 [1.79-3.39]; P < 0.0001; I² = 80.33%). This significant amendment of pain was observed at a declining rate from 15 minutes to at least 180 minutes post-treatment in mechanical allodynia and mechanical hyperalgesia, and up to 30 minutes in thermal hyperalgesia (P < 0 .0001). Conclusions: Muscimol is effective in the amelioration of mechanical allodynia, mechanical hyperalgesia, and thermal hyperalgesia, exerting its analgesic effects 15 minutes after administration for up to at least 3 hours.

• The Korean Journal of Pain
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• 제14권1호
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• pp.7-11
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• 2001

Background: Although several mechanisms of causalgia, which results from a partial injury to the peripheral nerve trunk, have been proposed, whether or not antidromic impulses from the injured neurons contribute to the development of the mechanical hyperalgesia has not been studied. The purpose of this experiment is was to investigate the role of antidromic impulses to the peripheral sensory receptor site on the development of mechanical hyperalgesia in a rat model of peripheral neuropathy. Methods: Rats were prepared with tight ligation of by tightly ligating the left fifth and sixth lumbar spinal nerves. The effect of bupivacaine pretreatment on the development of mechanical hyperalgesia was evaluated by injecting 0.5% bupivacaine (0.3 ml) into the plantar surface of the left hind paw before the skin incision was made. For the control group, normal saline (0.3 ml) was injected instead of bupivacaine. To measure the mechanical hyperalgesia, paw withdrawal thresholds were measured using a series of von Frey hairs. Mechanical hyperalgesia was measured a the day before, and 1, 2, 3, 4, 7, and 14 days after the surgery. Results: The control group showed decreased withdrawal thresholds from the day after the surgery (the values were $14.0{\pm}0.5$, $8.9{\pm}1.3$, $8.4{\pm}1.6$, $6.9{\pm}1.2$, $8.8{\pm}1.5$, $10.5{\pm}1.3$, and $8.6{\pm}1.3$ g; at -1, 1, 2, 3, 4, 7, and 14 days after the surgery, respectively). However, withdrawal thresholds of the bupivacaine-pretreated group showed increased withdrawal thresholds for three days after the surgery ($14.5{\pm}0.3$, $12.6{\pm}1.4$, $12.7{\pm}1.1$, $10.5{\pm}1.3$ g; at 1, 1, 2, 3 days after the surgery). Conclusions: Our result suggests that antidromic impulses to the peripheral sensory receptors are at least partly responsible for the initial development of mechanical hyperalgesia in a rat model of peripheral neuropathy.

• 대한한의학회지
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• 제24권3호
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• pp.108-117
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• 2003

Objective : The central opioid mechanism of acupuncture analgesia has been fairly well documented in acute behavioral experiments, but little electrophysiological study has been performed on the peripheral mechanism and subtypes of opioid receptors responsible for acupuncture-induced antinociception in chronic animal models. In the present electrophysiological experiment, we studied the peripheral mechanism and opioid receptor subtypes which Were implicated in electroacupuncture-induced antinociception in the rat with chronic inflammatory and neurogenic pain. Methods : In the rat with complete Freund's adjuvant-induced inflammation and spinal nerve injury, dorsal horn cell responses to afferent C fiber stimulation were recorded before and after electroacupuncture (EA) stimulation applied to the contralateral Zusanli point for 30 minutes. Also studied Were the effects of specific opioid receptor antagonists and naloxone methiodide, which can not cross the blood-brain barrier, on EA-induced inhibitory action. Results : EA-induced inhibitory action was significantly attenuated by naloxone methiodide, suggesting that EA-induced inhibition was mediated through peripheral mechanism. Pretreatment, but not posttreatment of naltrexone and spinal application significantly blocked EA-induced inhibitory actions. In inflammatory and neurogenic pain models, ${\mu}-$ and ${\delta}-opioid$ receptor antagonists (${\beta}-funaltrexamine$ & naltrindole) significantly reduced EA-induced inhibitory action, but ${\kappa}-opioid$ receptor antagonist had weak inhibitory effect on EA-induced antinociception. Conclusion : These results suggest that 2Hz EA-stimulation induced antinoeiceptive action is mediated through peripheral as well as central mechanism, and mainly through ${\mu}-$ and ${\delta}-opioid$ receptors.