RESUMEN
OBJECTIVE: Biopsies of peripheral nerve tumors (PNTs) are often used to plan an efficient treatment strategy. However, performing a biopsy is controversial when the mass is likely to be a benign PNT (BPNT). The aim of this study was to evaluate the side effects of biopsies in patients with potential PNTs. METHODS: A retrospective and cross-sectional study was conducted on 24 patients who underwent biopsy of a mass of unknown origin potentially originating from a peripheral nerve (MUOPON), performed in nonspecialty services, and who were later referred to the authors' service for resection of their lesion between January 2005 and December 2022. The patients were evaluated for pain score, presence of a motor or sensory deficit, biopsy diagnosis, and definitive histopathological postsurgical diagnosis. RESULTS: The location of the tumor was supraclavicular in 7 (29.2%) patients, in the axillary region in 3 (12.5%), in the upper limb in 7 (29.2%), and in the lower limb in 7 (29.2%). Twenty-one (87.5%) patients were evaluated by MRI before biopsy, and 3 (12.5%) underwent ultrasound. One patient did not have an examination before the procedure. Based on the biopsy findings, 12 (50%) analyses had an inconclusive histopathological result. The preexisting pain worsened, as measured 1 week after biopsy, in all patients and had remained unchanged at the first evaluation by the authors (median 3 months, range 2-4 months). In 1 case, the open biopsy had to be interrupted because the patient experienced excruciating pain. Four (16.7%) patients developed motor deficits. Subsequent surgery was hampered by scar formation and intratumoral hemorrhage in 5 (20.8%) patients. The initial diagnosis obtained by biopsy differed from the final histopathological diagnosis in all patients, of whom 21 (87.5%) had BPNTs, 2 (8.3%) malignant peripheral nerve sheath tumors, and 1 (4.2%) an ancient schwannoma. CONCLUSIONS: Biopsies of PNTs are controversial and may result in misdiagnosis, neuropathic pain, or neurological deficit due to axonal damage, and they may also hinder microsurgical resection when if performed when not indicated. Indications for biopsy of an MUOPON must be carefully considered, especially if BPNT is a possible diagnosis.
Asunto(s)
Neoplasias de la Vaina del Nervio , Neoplasias del Sistema Nervioso Periférico , Humanos , Neoplasias de la Vaina del Nervio/cirugía , Estudios Retrospectivos , Estudios Transversales , Biopsia/efectos adversos , Neoplasias del Sistema Nervioso Periférico/diagnóstico por imagen , Neoplasias del Sistema Nervioso Periférico/cirugía , Nervios Periféricos/patología , Errores Diagnósticos , DolorRESUMEN
Objective Intraoperative ultrasound (IOUS) is an imaging method that can be used in various neurosurgical procedures. It assists in the removal of brain tumors, hematomas, in the insertion of ventricular catheters, and in spinal and peripheral nerve surgeries. The original studies using IOUS were performed with devices that produced lower-quality images, generating little interest in their use. The introduction of ultrasound devices that yielded higher-quality images associated with a relative low cost and ease of use rendered IOUS attractive. Thus, we started using it in multiple neurosurgical procedures, studying its practicality, efficacy and limitations. Materials and methods A retrospective case study on the use of IOUS in neurosurgery from August 2014 to December 2020 at a single institution, evaluating its practicality, efficacy and limitations. Results A total of 127 IOUS scans were performed in 112 patients aged 19 to 83 (mean: 53.8) years: 106 scans of the brain, 4 of the spinal cord, and 2 of the peripheral nerves. Brain tumors were the majority, with 86 cases (67.8%). The IOUS was unsatisfactory in 9 cases (7.1%), and there were no cases of infection related to the IOUS. Conclusion The IOUS is a dynamic, safe, and practical exam. It can be performed in a few minutes and repeated several times during the surgical procedure. It enables surgeons to observe the pulsation of tissues and vessels, the displacement of lumps in liquid collections, and to monitor the drainage of cysts and collections, in vivid, interactive and real-time images.
Objetivo A ultrassonografia intraoperatória (USIO) é um método de imagem que pode ser utilizado em vários procedimentos neurocirúrgicos. Auxilia na remoção de tumores cerebrais, hematomas, no implante de cateteres ventriculares, e em cirurgias espinhais e de nervos periféricos. Os estudos iniciais com a USIO eram realizados com aparelhos que disponibilizavam imagens de baixa qualidade, o que gerava pouco interesse no seu uso. Com o desenvolvimento de aparelhos de ultrassom que produziam imagens de melhor qualidade, eram de fácil manuseio e tinham relativo baixo custo, reacendeu-se o interesse na USIO. Por este motivo, iniciamos a utilização da USIO em múltiplos procedimentos neurocirúrgicos, e estudamos sua praticidade, eficácia e limitações. Materiais e métodos Estudo retrospectivo dos casos em que a USIO foi utilizada em neurocirurgia de agosto de 2014 a dezembro de 2020 em uma só instituição, com a avaliação de sua praticidade, eficácia e limitações. Resultados Foram realizadas 127 USIOs em 112 pacientes com idades entre 19 e 83 (média: 53,8) anos, 106 no encéfalo, 4 em medula espinhal, e 2 em nervo periférico. Os tumores cerebrais foram a maioria, com 86 casos (67,8%). A USIO foi insatisfatória em 9 casos (7,1%), e não houve casos de infecção relacionada à USIO. Conclusões A USIO é um exame dinâmico, seguro e prático. Pode ser feito em poucos minutos e repetido várias vezes durante o procedimento cirúrgico. É possível observar a pulsação dos tecidos e vasos, o deslocamento de grumos em coleções líquidas, e acompanhar a drenagem de cistos e coleções, em imagens vivas, interativas e em tempo real.