Year 2020 Vol. 28 No 1

NEUROSURGERY

A.I. TRETIAKOVA 1, I.V. KOVALENKO 2, R.A. TRETIAKOV 3, YU.V. TSYMBALIUK 1, L.L. CHEBOTARIOVA 1, A.A. GATSKIY 1, IA.V. TSYMBALIUK 1, I.B. TRETYAK 1

DIAGNOSTICS AND TREATMENT OF PROXIMAL TUNNEL NEUROPATHIES OF THE UPPER LIMBS

A.P. Romodanov Neurosurgery Institute 1, Kiev, Ukraine,
Zhytomyr Regional Hospital named after A.F. Gerbachevsky 2, Zhytomyr,
Institute of Traumatology and Orthopedics 3,
Kiev, Ukraine

Objective. To determine diagnostic criteria for objectifying the localization, nature and severity of pathological changes, improving treatment tactics for tunnel neuropathies of the upper limb at the proximal level.
Methods. The treatment results of 77 patients with the tunnel neuropathies of the upper limb at the proximal level from 2009 to 2018 were analyzed. The average age is 39.12.1 years (Mσ), among them 46 patients (59.7%) were women, 31 patients (40.3%) were men. Among the additional methods of examination, the ultrasound of the vessels of the upper limb and peripheral nerve trunks was used as well as magnetic resonance imaging (MRI) of the brachial plexus, cervical spine, multidetector computed tomography (MDCT). Neurophysiological parameters were evaluated according to needle and stimulation electromyography (EMG). Of the methods of surgical treatment, we used both decompression of nerves/plexuses and resection of a problem area of a nerve with its subsequent nerve grafting, or distal neurotization was used. The combination of nerve decompression with the implantation of the system for long-term epineural electrical stimulation was used in 25 cases (32.5%). Evaluation of the early results of surgical treatment was carried out in the first days after surgery, distant in the period from four months to six years.
Results. In determining the area and nature of the compression, the MRI data were essential. EMG allowed us to determine the functional state of nerves and muscles, to exclude other pathological processes and the level of damage. Positive results of surgical treatment in patients with thoracic outlet syndrome (TOS) were observed in 42 (76.4%) cases, with tunnel mononeuropathies in 20 (90.9%) patients.
Conclusions. Using the capabilities of modern diagnostic methods for compression neuropathies of the upper limb at the proximal level allows significantly correcting treatment tactics. An individual approach to the choice of treatment methods allows achieving a favorable restoration of the function of structures that have undergone compression.

Keywords: compression neuropathy, thoracic outlet syndrome, electroneuromyography, diagnostics, electrostimulation
p. 62-73 of the original issue
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Address for correspondence:
04050, Ukraine,
Kiev, Platon Mayboroda Str., 32,
A.P. Romodanov Neurosurgery Institute,
Department of Reconstructive Neurosurgery.
Tel.: +38(044) 483-12-53,
e-mail: ihor.tretyak@gmail.com,
Ihor B. Tretyak
Information about the authors:
Tretiakova Albina I., MD, Head of the Department of Functional Diagnostics, A.P. Romodanov Neurosurgery Institute, Kiev, Ukraine.
https://orcid.org/0000-0002-3638-4339
Kovalenko Ihor V., Neurosurgeon, Zhytomyr Regional Hospital named after A.F. Gerbachevsky, Zhytomyr, Ukraine.
https://orcid.org/0000-0003-2678-466X
Tretiakov Roman A., Radiologist, Institute of Traumatology and Orthopedics, Kiev, Ukraine.
https://orcid.org/0000-0003-0419-6373
Tsymbaliuk Yuliya V., MD, Neurosurgeon, Department of Reconstructive Neurosurgery, A.P. Romodanov Neurosurgery Institute, Kiev, Ukraine.
https://orcid.org/0000-0002-0025-3505
Chebotariova Lidia L., MD, Professor, Honored Worker of Science and Technology of Ukraine, Head of the Department of Neurophysiology, A.P. Romodanov Neurosurgery Institute, Kiev, Ukraine.
https://orcid.org/0000-0001-7881-8564
Gatskiy Alexander A., PhD, Neurosurgeon, Department of Reconstructive Neurosurgery, A.P. Romodanov Neurosurgery Institute, Kiev, Ukraine.
https://orcid.org/0000-0002-2212-2143
Tsymbaliuk Iaroslav V., Neurosurgeon, Department of Reconstructive Neurosurgery, A.P. Romodanov Neurosurgery Institute, Kiev, Ukraine.
https://orcid.org/0000-0002-8746-0944
Tretyak Ihor B., MD, Head of the Department of Reconstructive Neurosurgery, A.P. Romodanov Neurosurgery Institute, Kiev, Ukraine.
https://orcid.org/0000-0003-0977-7062
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