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Determining the Zone of Peripheral Nerve Injury: Intraoperative Nerve Cuff Electrodiagnosis
Daniel Master, M.D., Laura Armbruster, M.S., Katie Polasek, M.S., Dustin Tyler, Ph.D., Harry Hoyen, M.D.
University Hospitals Case Medical Center
2010-03-28
Presenter: Daniel Master, M.D.
Affidavit:
Director Name:
Author Category: Resident/Fellow
Presentation Category: Basic Science Research
Abstract Category: Hand
Introduction
The success of peripheral nerve repair largely depends upon an accurate determination of the zone of injury. The purpose of this study was to test the accuracy of intraoperative SSEP recordings generated from spiral nerve cuff stimulation versus conventional hand-held bipolar hook electrode stimulation in order to determine the zone of injury.
Methods
Patients with neuromas-in-continuity were assessed utilizing intraoperative SSEP recordings. The zone of injury was tested with a conventional hand-held electrode and a spiral nerve cuff electrode. Based upon these recordings, the suspected zone of injury was resected and sent for intra-operative frozen sectioning.
SSEP recording signal-to-noise ratios (SNRs) and waveform amplitudes from hand-held probe stimulation and nerve cuff stimulation were then correlated with frozen section histology to determine their respective accuracies in identifying the zone of injury.
Results
Twelve patients (8 male, 4 female) with neuromas-in-continuity participated in the protocol. Mean SSEP recording SNRs and waveform amplitudes from spiral nerve cuff stimulation were significantly greater (p < 0.01) than those obtained with conventional hand-held probe stimulation. In addition, the percentage of fibrosis found in representative frozen sections from the zone of injury significantly correlated (p < 0.01) with nerve cuff SSEP recordings but not hand-held probe SSEP recordings.
Conclusion
SSEP recordings generated from spiral nerve cuff stimulation demonstrate greater SNRs and greater waveform amplitudes than those associated with conventional hand-held probe stimulation. In addition, recordings obtained from nerve cuff stimulation directly correlate with the percentage of fibrosis present on frozen section.
