Surgical treatment of peripheral nerve injuries: Better outcomes with intraoperative NAP recordings

BACKGROUND: Peripheral nerve injuries are usually not lethal but may cause serious neurological deficits if not treated properly. The aim of this study is to present our patients who underwent surgical treatment for peripheral nerve trauma in the past 10 years and to discuss their results in light of the literature.
METHODS: The clinical and electrophysiological results of 182 patients who underwent surgical treatment in our department between 2010 and 2019 were retrospectively analyzed. All surgeries were performed using intraoperative nerve action potentials (NAP) recordings. Demographic characteristics, etiologies, surgical timing, and results of surgical treatment were recorded.
RESULTS: A total of 199 surgical interventions were performed in 182 patients with peripheral nerve trauma within 10 years. 162 patients were male, 20 were female and the mean age was 29.34 years for males and 30.2 years for females. The sciatic nerve trauma was the most common in men and peroneal nerve injury women. The most common cause of trauma was gunshot wounds in menand blunt/sharp traumas in women. External and internal neurolysis was the most common surgical technique, followed by epineural anastomosis and sural nerve grafting. 155 of 182 patients showed partial neurological improvement within 3 months after surgery, while 27 had no change in their neurological condition.
CONCLUSION: Men are more frequently exposed to peripheral nerve trauma than women. Severe partial nerve lesions mostly benefit from surgical treatment, and neurolysis has become the most preferred method of surgical treatment. Intraoperative NAP recordings provide better clinical outcomes. Neurological improvement may not always be in correlation with electrophysiological improvement.

Periferik sinir yaralanmalarýnýn cerrahi tedavisi: Ýntraoperatif NAP ile daha iyi sonuçlar

AMAÇ: Periferik sinir yaralanmalarý genellikle öldürücü deðildir, ancak uygun þekilde tedavi edilmezse ciddi nörolojik defisitlere neden olabilir. Bu çalýþmanýn amacý son 10 yýlda periferik sinir travmasý nedeniyle cerrahi tedavi gören hastalarýmýzý sunmak ve sonuçlarýný literatür ýþýðýnda tartýþmaktýr.
GEREÇ VE YÖNTEM: 2010–2019 yýllarý arasýnda kliniðimizde cerrahi tedavi uygulanan 182 hastanýn klinik ve elektrofizyolojik sonuçlarý geriye dönük olarak incelendi. Tüm ameliyatlarda intraoperatif sinir aksiyon potansiyelleri kullanýldý. Demografik özellikler, etiyolojiler, cerrahi zamanlama ve cerrahi tedavi sonuçlarý analiz kaydedildi.
BULGULAR: Periferik sinir travmasý olan 182 hastaya 10 yýllýk bir sürede toplam 199 cerrahi giriþim yapýldý. Yüz altmýþ iki hasta erkek, 20 kadýn ve ortalama yaþ erkeklerde 29.34 yýl, kadýnlarda 30.2 yýl idi. Siyatik sinir travmasý erkeklerde ve peroneal sinir hasarý kadýnlarda en yaygýn olanýdýr. Travmanýn en yaygýn nedeni erkeklerde ateþli silah yaralanmalarý ve kadýnlarda ise künt/kesicitravmalar idi. Eksternal ve internal nöroliz en sýk uygulanan cerrahi teknik olup bunu epinöral anastomoz ve sural sinir grefti izlemiþtir. Yüz seksen iki hastanýn 155’inde ameliyattan sonraki üç ay içinde kýsmi nörolojik düzelme görülürken, 27’sinde nörolojik durumlarýnda deðiþiklik olmadý.
TARTIÞMA: Erkekler periferik sinir travmasýna kadýnlardan daha sýk maruz kalmaktadýr. Þiddetli kýsmi sinir lezyonlarý çoðunlukla cerrahi tedaviden yararlanýr ve nöroliz en çok tercih edilen cerrahi tedavi yöntemi haline gelmiþtir. Ýntraoperatif sinir aksiyon potansiyelleri kaydý daha iyi klinik sonuçlar vermektedir. Nörolojik iyileþme her zaman elektrofizyolojik iyileþme ile iliþkili olmayabilir.