Partial tibial nerve transfer for foot drop from deep peroneal palsy: Lessons from three pediatric cases

Microsurgery ◽  
2020 ◽  
Author(s):  
Christopher S. Crowe ◽  
Vincent S. Mosca ◽  
Marisa B. Osorio ◽  
Sarah P. Lewis ◽  
Raymond W. Tse
Keyword(s):  
Tibial Nerve ◽  
Nerve Transfer ◽  
Foot Drop ◽  
Peroneal Palsy

Surgical Treatment of Complete Foot Drop: Partial Tibial Nerve Transfer to the Motor Branch of the Tibialis Anterior: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Themistocles S Protopsaltis ◽  
Yesha H Parekh
Keyword(s):  
Surgical Treatment ◽  
Tibialis Anterior ◽  
Tibial Nerve ◽  
Donor Site ◽  
Tibialis Anterior Muscle ◽  
Nerve Transfer ◽  
Ankle Dorsiflexion ◽  
Foot Drop ◽  
Great Toe ◽  
Motor Branch

Abstract This video will be demonstrating the surgical treatment of complete foot drop with partial tibial nerve transfer to the motor branch of the tibialis anterior. Foot drop occurs when there is injury to the deep peroneal nerve that results in the paralysis of the tibialis anterior muscle and subsequent loss of ankle dorsiflexion.1-5 The patient who is the subject of this video is a 27-yr-old female with a 6-mo history of foot drop. She presented with complete loss of ankle dorsiflexion and great toe extension due to traumatic fall on her left knee while running. Upon physical examination, she had all the features of complete foot drop with loss of ankle dorsiflexion and ankle eversion. She also had decreased sensation to light touch over left dorsal foot, left great toe, and left lateral lower leg. The patient has consented to this procedure. The partial tibial nerve transfer to the motor branch of tibialis anterior muscle is the preferred treatment option for foot drop as it restores ankle dorsiflexion with minimal donor site complications. At 12 mo postsurgery, she has regained 4/5 for ankle dorsiflexion on motor testing compared to the 0/5 she had preoperatively.

Obturator Nerve Transfer to the Branch of the Tibial Nerve Innervating the Gastrocnemius Muscle for the Treatment of Sacral Plexus Nerve Injury

Neurosurgery ◽  
2015 ◽  
Vol 78 (4) ◽  
pp. 546-551 ◽  
Author(s):  
Gang Yin ◽  
Huihao Chen ◽  
Chunlin Hou ◽  
Jianru Xiao ◽  
Haodong Lin
Keyword(s):  
Nerve Injury ◽  
Gastrocnemius Muscle ◽  
Tibial Nerve ◽  
Nerve Transfer ◽  
Obturator Nerve ◽  
Surgical Reconstruction ◽  
Sacral Plexus ◽  
Medial Head ◽  
Anterior Branch ◽  
The Mean

Abstract BACKGROUND: Lower-limb function is severely impaired after sacral plexus nerve injury. Nerve transfer is a useful reconstructive technique for proximal nerve injuries. OBJECTIVE: To investigate the clinical effectiveness and safety of transferring the ipsilateral obturator nerve to the branch of the tibial nerve innervating the medial head of the gastrocnemius muscle to recover knee and ankle flexion. METHODS: From 2007 to 2011, 5 patients with sacral plexus nerve injury underwent ipsilateral obturator nerve transfer as part of a strategy for surgical reconstruction of their plexuses. The mean patient age was 31.4 years (range, 19-45 years), and the mean interval from injury to surgery was 5.8 months (range, 3-8 months). The anterior branch of the obturator nerve was coapted to the branch of the tibial nerve innervating the medial head of the gastrocnemius muscle by autogenous nerve grafting. RESULTS: Patient follow-up ranged from 24 to 38 months. There were no complications related to the surgery. Three patients recovered to Medical Research Council grade 3 or better in the medial head of the gastrocnemius muscle. Thigh adduction function was not affected in any patient. CONCLUSION: Knee and ankle flexion can be achieved by transferring the anterior branch of the obturator nerve to the branch of the tibial nerve innervating the medial head of the gastrocnemius muscle, which is useful for balance. This procedure can be used as a new method for treating sacral plexus nerve injury.

scholarly journals An Uncommon Case of Bilateral Peroneal Nerve Palsy following Delivery: A Case Report and Review of the Literature

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Kristen Bunch ◽  
Erica Hope
Keyword(s):  
Peroneal Nerve ◽  
Nerve Palsy ◽  
Preventive Measures ◽  
Foot Drop ◽  
Peroneal Nerve Palsy ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Peroneal Neuropathy ◽  
Peroneal Palsy ◽  
Uncommon Case

Peroneal nerve palsy is an infrequent but potential complication of childbirth. Bilateral peroneal palsy is particularly rare following delivery with few reported cases. A 38-year-old gravida 1, para 0 underwent a prolonged second stage of labor, was diagnosed with an arrest of descent, and subsequently underwent an uncomplicated primary cesarean section. The patient was diagnosed with bilateral peroneal neuropathy four days after delivery. By two months postpartum, her foot drop had improved by 85% and the remainder of her symptoms resolved. Awareness of the risks of a peroneal neuropathy as well as implementation of preventive measures is important for members of the delivery team. Regional anesthesia during labor is a risk factor for the development of a peroneal neuropathy.

scholarly journals The anatomic location and importance of the tibialis posterior fascicular bundle at the sciatic nerve bifurcation: report of 3 cases

2019 ◽  
Vol 131 (6) ◽  
pp. 1869-1875 ◽  
Author(s):  
Thomas J. Wilson ◽  
Andres A. Maldonado ◽  
Kimberly K. Amrami ◽  
Katrina N. Glazebrook ◽  
Michael R. Moynagh ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Common Peroneal Nerve ◽  
Foot Drop ◽  
Preoperative Imaging ◽  
Tibialis Posterior ◽  
Severe Injuries ◽  
Nerve Action ◽  
Internal Neurolysis

The authors present the cases of 3 patients with severe injuries affecting the peroneal nerve combined with loss of tibialis posterior function (inversion) despite preservation of other tibial nerve function. Loss of tibialis posterior function is problematic, since transfer of the tibialis posterior tendon is arguably the best reconstructive option for foot drop, when available. Analysis of preoperative imaging studies correlated with operative findings and showed that the injuries, while predominantly to the common peroneal nerve, also affected the lateral portion of the tibial nerve/division near the sciatic nerve bifurcation. Sunderland’s fascicular topographic maps demonstrate the localization of the fascicular bundle subserving the tibialis posterior to the area that corresponds to the injury. This has clinical significance in predicting injury patterns and potentially for treatment of these injuries. The lateral fibers of the tibial division/nerve may be vulnerable with long stretch injuries. Due to the importance of tibialis posterior function, it may be important to perform internal neurolysis of the tibial division/nerve in order to facilitate nerve action potential testing of these fascicles, ultimately performing split nerve graft repair when nerve action potentials are absent in this important portion of the tibial nerve.

scholarly journals Obturator to tibial nerve transfer via saphenous nerve graft for treatment of sacral plexus root avulsions: A cadaveric study

2020 ◽  
Vol 106 (2) ◽  
pp. 291-295 ◽  
Author(s):  
Hamid Namazi ◽  
Masood Kiani ◽  
Saeed Gholamzadeh ◽  
Amirreza Dehghanian ◽  
Dehghani Nazhvani Fatemeh
Keyword(s):  
Tibial Nerve ◽  
Nerve Transfer ◽  
Nerve Graft ◽  
Saphenous Nerve ◽  
Cadaveric Study ◽  
Sacral Plexus

scholarly journals Clinical Results of Transferring a Motor Branch of the Tibial Nerve to the Deep Peroneal Nerve for Treatment of Foot Drop

Neurosurgery ◽  
2013 ◽  
Vol 73 (4) ◽  
pp. 609-616 ◽  
Author(s):  
Leandro Pretto Flores ◽  
Roberto Sérgio Martins ◽  
Mario Gilberto Siqueira
Keyword(s):  
Medical Research ◽  
Soleus Muscle ◽  
Peroneal Nerve ◽  
Research Council ◽  
Medical Research Council ◽  
Tibial Nerve ◽  
Foot Drop ◽  
Deep Peroneal Nerve ◽  
Motor Branch ◽  
Patient Reported

Abstract BACKGROUND: Foot drop is a very debilitating condition affecting patients' daily activities, and its treatment has been a challenge for neurosurgeons. Grafting the peroneal or sciatic nerve usually results in poor outcomes. Our previous anatomic study demonstrated the feasibility of transferring a motor branch of the tibial nerve to the deep peroneal nerve at the level of the popliteal fossa. OBJECTIVE: To demonstrate the outcomes obtained after the transfer of a branch of the tibial nerve to the peroneal nerve for recovery of foot drop. METHODS: A retrospective review of 13 patients with foot drop caused by injuries to a lumbar root or the sciatic or peroneal nerve, who underwent a transfer of the nerve of the soleus muscle to the deep peroneal nerve. The results were evaluated using the British Medical Research Council grading system. RESULTS: Three patients were lost to follow-up. Of the remaining 10 patients, the outcomes were considered good (Medical Research Council grade M3 or M4) in 2 patients (20%) concerning ankle dorsiflexion and in 2 patients concerning toe extension (20%). One patient reported a reduced calf circumference. CONCLUSION: The transfer of the nerve of the soleus muscle to the deep peroneal nerve demonstrated poor results in most of the patients, although favorable outcomes were observed in a few subjects. Due to the inconsistency of the results, we do not favor the routine use of this technique for the treatment of foot drop.

scholarly journals Acute Complete Foot Drop Caused by Intraneural Ganglion Cyst without a Prior Traumatic Event

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Stavros Stamiris ◽  
Dimitrios Stamiris ◽  
Athanasios Sarridimitriou ◽  
Elissavet Anestiadou ◽  
Christos Karampalis ◽  
...  
Keyword(s):  
Traumatic Event ◽  
Ganglion Cyst ◽  
Clinical Manifestations ◽  
Common Peroneal Nerve ◽  
Foot Drop ◽  
Intraneural Ganglion ◽  
Intraneural Ganglion Cyst ◽  
First Case ◽  
Peroneal Palsy ◽  
The Common

Intraneural ganglion cysts are benign soft-tissue masses located in the epineurium of peripheral nerves. They originate from nearby joint connections via articular branches. Traumatic events seem to play a role in their pathogenesis as well. Clinical manifestations include pain over the area of the cyst, palpable tender mass, hypoesthesia, and muscle weakness depending on the affected nerve. Our case highlights an uncommon clinical manifestation of this entity with acute foot drop, as the primary symptom, without any previous traumatic event, enriching by this way the current diagnostic thinking process of clinical physicians. We report a case of a 42-year-old military officer who presented to our emergency department with acute foot drop that appeared during a march. Initially, the common peroneal palsy was misdiagnosed as L5-S1 disc herniation, but investigation with lumbar MRI scan led to rejection of our primary diagnosis. After performing EMG of the lower extremity and knee MRI, an intraneural ganglion cyst of the common peroneal nerve was diagnosed. Patient was treated with surgical decompression of the cyst, followed by ligation and complete resection of the articular branch, as well as disarticulation of the superior tibiofibular joint. At a twelve-month follow-up, the patient showed significant functional recovery. This is, to the best of our knowledge, the first case of intraneural ganglion cyst manifested with an acute complete foot drop without a clear prior traumatic event. We underline the need for a high index of suspicion when dealing with cases of acute peroneal palsy without any accompanying symptoms.

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