Intraoperative Imaging in Traumatic Peripheral Nerve Lesions: Correlating Histologic Cross-Sections with High-Resolution Ultrasound

Abstract

Background: Intraoperative ultrasound (US) has been used as a guide during surgery to better identify deep neuroanatomical structures.

Objective: To correlate histologic cross-sections from nerve samples taken at the time of surgery with axial, high-resolution US images at similar locations and validate this important tool for intraoperative guidance in nerve surgery.

Methods: Three subjects undergoing nerve repair procedures after traumatic nerve injuries were enrolled prospectively. US images captured at the time of surgery were later matched with gross anatomic cross-sections and fascicular anatomy compared across modalities.

Results: In cases 1 and 3, neuromatous tissue spanned the entire cross-section of the common peroneal and upper trunk of the brachial plexus, respectively. In case 2, only a portion of the sciatic nerve was involved with neuroma. Intraoperative US aided in differentiating normal peripheral nerve from neuroma in all 3 cases and helped minimize the disruption of healthy peripheral nerve tissue.

Conclusion: Intraoperative US correlates well with anatomic sections removed at the time of surgery. The ability to noninvasively image the peripheral nerve along with compound nerve action potentials can greatly assist in determining the extent of neurolysis, resection, and grafting and is a useful adjunct for intraoperative decision-making. This report serves to highlight the role of US and validate its use in peripheral nerve surgery for trauma.

Keywords: Histology; Peripheral nerve; Traumatic nerve injury; Ultrasound.