• Archives of Plastic Surgery
• /
• 제37권6호
• /
• pp.839-842
• /
• 2010

Purpose: Ganglion cysts of peripheral nerve are uncommon. Ganglion cysts located within the nerve and extraneural ganglia that cause symptomatic nerve compression have been reported. We report an unusual case of epineural ganglion cyst confined to the epineurium of the sural nerve at the foot. Methods: A 45-year-old woman was referred because of a mass on the foot. She had six months' history of pain and numbness in the right small toe. During the examination of the lesion, multinodular cystic mass was identified arising from the epineurium of the sural nerve. The nerve fascicles were compressed by the cyst, but the cyst wall clearly did not invade the fascicle. With the aid of surgical microscope, the epineural cyst was completely excised along with epineural tissue to which it was attached, and the sural nerve was decompressed. There was no relationship between the cyst and either the joint capsule or tendon sheath. Since the cyst was on the periphery of the nerve it was possible to remove the cyst intact without damaging the underlying fascicles. Results: The postoperative course was uneventful. Pathologic examination showed a ganglion cyst with a degenerated collagen fibers and contained a yellowish, jelly-like mucinous substance. No neural elements were identified within the cystic wall. Her sensory impairment improved progressively. At the 15 months follow-up, she was asymptomatic with no neurological deficits. Conclusion: Rarely, ganglion cysts can involve peripheral nerves, leading to varing degrees of neurological deficits. Intraneural intrafascicular ganglion may be difficult to separate from the neural elements without nerve injury. Epineural ganglion, subcategorized as intraneural extrafascicular ganglion, can be removed without damage to the underlying nerve.

• The Korean Journal of Pain
• /
• 제34권1호
• /
• pp.132-136
• /
• 2021

Local anesthetic (LA) injection outside the sheath in epineural or paraneural connective tissue is considered safe practice among regional anesthesiologists. There is limited evidence as to whether neurological complications occur if LA is injected inside the sheath (subepineural - intraneural). We performed ultrasound guided injections at the level of undivided sciatic nerve in four amputated lower limbs. In two specimens, LA was injected in epineural connective tissue (paraneural tissue) and in another two specimens by penetrating the outer nerve sheath (hyperechoic epineurium). Ultrasonography demonstrated an increase in the size of nerve and macroscopic findings revealed fascicular tracings with sub-epineural injections. Limbs were sent for histological analysis in formalin containers. Pathologist performed the analysis which demonstrated an intact perineurium and a breach in the epineurium. We conclude that sub-epineural injections are unsafe and injection should be done in paraneural tissue to ensure safety and avoid unwanted neurological sequelae after the block.

• 대한치과마취과학회지
• /
• 제10권1호
• /
• pp.20-26
• /
• 2010

This type of neuropathic pain(atypical odontalgia) is seen most often in middle-aged women or men after dentoalveolar operation. Atypical odontalgia probably is caused by deafferentation leading to intraneural changes in the medullary dorsal horn. Treatment of this problem is difficult, but some success has been reported in uncontrolled, open-labeled studies using high doses of tricyclic antidepressants. This is the management report of a patient case, that had a neuropathic atypical odontalgia recognized with the right maxillary lateral incisor. The patient was consulted to the Department of Pain Clinics, ENT & Neurology and diagnosed the adenoid cystic carcinoma on left cerebellum and right paranasal sinus with extension to the cavernous sinus. In spite of the osteoplastic craniotomy, neurosurgical mass removal and radiation therapy were done with chemotherapy, atypical odontalgia was continued. In addition to the consultation to Psychology, stress management and antidepressant medication were done and improved slowly.

• Journal of Korean Neurosurgical Society
• /
• 제30권9호
• /
• pp.1120-1126
• /
• 2001

Objective : The development of magnetic resonance neurography(MRN) has made it possible to produce highresolution images of peripheral nerves themselves, as well as associated intraneural and extraneural lesions. We evaluated the clinical application and utility of high-resolution MRN techniques for the diagnosis and treatment of a variety of peripheral nerve disorder(PND)s. Material and Method : MRN images were obtained using T1-weighted spin echo, T2-weighted fast spin echo with fat suppression, and short tau inversion recovery(STIR) fast spin-echo pulse sequences. Fifteen patients were studied, three with brachial plexus tumors, five with chronic entrapment syndromes, and seven with traumatic peripheral lesions. Ten patients underwent surgery. Results : In MRN with STIR sequences of axial and coronal imagings, signals of the peripheral nerves with various lesions were detected as fairly bright signals and were discerned from signals of the uninvolved nerves. Increased signal with proximal swelling and distal flattening of the median nerve were seen in all patients of carpal tunnel syndrome. Among the eight patients with brachial plexus injury or tumors, T2-weighted MRN showed increased signal intensity in involved roots in five, enhanced mass lesions in three, and traumatic pseudomeningocele in three. Other associated MRI findings were adjacent bony signal change, neuroma, root adhesion and denervated muscle atophy with signal change. Conclusion : MRN with high-resolution imaging can be useful in the preoperative evaluation and surgical planning in patients with peripheral nerve lesions.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제28권6호
• /
• pp.499-510
• /
• 2006

인간 타액선 선양낭성암종 조직 18례에 대한 면역조직화학적 염색을 시행하여 종물 주변의 정상 타액선 조직과 비교, 분석하여 다음과 같은 결과를 도출하였다. 1) EGF는 타액선 도관세포와 암종 조직의 50%에서 발현 되었으며, 정상 타액선 조직과 비교하여 암종 조직에서 발현이 증가되어 있지 않았다. 2) $TGF-{\alpha}$는 타액선 도관세포와 선포세포, 그리고 거의 모든 암종 조직에서 발현되었으며, 정상 타액선 조직과 비교하여 암종 조직에서 그 발현이 유의하게 증가되었다(P<0.05). 3) EGFR은 타액선 도관세포와 대부분의 암종 조직에서 발현되었으나, 발현의 강도에서 정상 타액선 조직과 암종 조직간의 차이는 없었다. 4) pEGFR은 정상 타액선 조직에서는 발현되지 않았으며, 암종 조직의 종양세포에서 그 발현이 증가되었다(P<0.05). 5) ErbB2/HER2는 타액선 도관세포와 거의 모든 암종 조직에서 발현되었으며, 정상 타액선 조직과 비교하여 암종 조직에서 그 발현이 유의하게 증가되었다 (P<0.05). 6) 검색된 인자들 중 $TGF-{\alpha}$와 ErbB2/HER2는 관사상체형 암종 조직에서와는 달리 충실형 암종 조직에서 100% 발현되어, 충실형 선양낭성암종의 증가된 악성도에 중요한 역할을 함을 암시하였다. 7) 종물 내의 종양관련 혈관내피세포에서도 위의 인자들이 모두 발현되어 종양관련 혈관내피세포는 선양낭성암종의 증식과 전이에 중요한 역할을 함을 알 수 있었다. 8) 종양 기질 내의 면역관련 세포들에서도 역시 위의 인자들이 발현되어 이들 세포들이 종양의 증식과 생존에 영향을 미칠 것이라는 추론을 가능하게 하였다. 위의 연구결과들을 종합하면 상피성장인자 신호전달계에 관여하는 인자들 중 $TGF-{\alpha}$, pEGFR, 그리고 ErbB2/HER2가 타액선 선양낭성암종에서 과발현 되었다. 따라서 이들 인자들이 타액선 선양낭성암종의 증식과 생존, 그리고 전이 과정에서 중요한 역할을 할 것이라는 추론을 가능하게 하였다. 추후 면역조직화학적 연구의 한계와 오류를 극복할 수 있는 기법으로 이들 인자들에 대한 재검색이 필요하리라 생각된다. 또한 과연 이들 인자들이 암생물학적으로 뿐만 아니라 임상적으로도 전이 및 환자 생존율과 관계된 인자로서의 가치가 있는지 평가해 보아야 할 것이다.