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Acta Neurochirurgica

, Volume 161, Issue 10, pp 2133–2139 | Cite as

A cadaveric study using the ultra-minimally invasive thread transection technique to decompress the superficial peroneal nerve in the lower leg

  • Danzhu Guo
  • Danqing GuoEmail author
  • Richard Harrison
  • Logan McCool
  • Hao Wang
  • Brionn Tonkin
  • Michel Kliot
Original Article - Neurosurgical technique evaluation
Part of the following topical collections:
  1. Neurosurgical technique evaluation

Abstract

Background

After successful applications of the ultra-minimally invasive thread transecting technique (Guo Technique) for both thread carpal tunnel release and thread trigger finger release, we hypothesized that this technique could be used for superficial peroneal nerve release in the lower leg by selective crural fasciectomy. This study is aimed at testing the operative feasibility of performing the thread superficial peroneal nerve release (TSPNR) procedure in cadavers.

Methods

The TSPNR procedure was performed on 15 fresh frozen cadaveric lower-extremity specimens under ultrasound guidance. All cadaveric specimens were dissected and visually assessed immediately after the procedures.

Results

All 15 legs demonstrated a complete transection of the crural fasciae along the course of the superficial peroneal nerve (SPN) including where it penetrated and traversed the crural fascia. There was no evidence of any iatrogenic damage to the neurovascular bundle or adjacent tendons. The average operating time was less than 20 min.

Conclusion

This cadaveric study demonstrated that the technique of TSPNR was accurate, reliable, and feasible while causing no injury to adjacent neurovascular structures and avoiding having to make a skin incision. Further studies are warranted to verify the results of this study before implementing this new technique in the clinical setting.

Keywords

Superficial peroneal nerve entrapment release Leg pain Thread transecting procedure Ultrasound-guidance Ultra-minimally invasive procedure Guo technique 

Abbreviations

TSPNR

Thread superficial peroneal nerve release

SPN

Superficial peroneal nerve

TCTR

Thread carpal tunnel release

TTFR

Thread trigger finger release

D

Distal point

DM

Distal margin

P

Proximal point

PM

Proximal margin

Notes

Acknowledgements

The authors would like to thank Dennis Dykstra, M.D., Ph.D. for his ongoing support.

Compliance with ethical standards

Conflict of interest

Two of the authors, Danzhu Guo and Danqing Guo, are brothers to Joseph Guo who is the inventor of the Loop & Sheer thread. All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

Video 1

The arrow indicates the superficial peroneal nerve as it courses distally piercing through the crural fascia, and the moving white dots above the superficial peroneal nerve are the thread looping the crural fascia (MP4 7976 kb)

References

  1. 1.
    Balius R, Bong DA, Ardèvol J, Pedret C, Codina D, Dalmau A (2016) Ultrasound-guided fasciotomy for anterior chronic exertional compartment syndrome of the leg. J Ultrasound Med Off J Am Inst Ultrasound Med 35(4):823–829Google Scholar
  2. 2.
    Ducic I, Dellon AL, Graw KS (2006) The clinical importance of variations in the surgical anatomy of the superficial peroneal nerve in the mid-third of the lateral leg. Ann Plast Surg 56(6):635–638CrossRefGoogle Scholar
  3. 3.
    de Fijter WM, Scheltinga MR, Luiting MG (2006) Minimally invasive fasciotomy in chronic exertional compartment syndrome and fascial hernias of the anterior lower leg: short- and long-term results. Mil Med 171(5):399–403CrossRefGoogle Scholar
  4. 4.
    Franco MJ, Phillips BZ, Lalchandani GR, Mackinnon SE (2017) Decompression of the superficial peroneal nerve: clinical outcomes and anatomical study. J Neurosurg 126(1):330–335CrossRefGoogle Scholar
  5. 5.
    Garfin S, Mubarak SJ, Owen CA (1977) Exertional anterolateral-compartment syndrome. Case report with fascial defect, muscle herniation, and superficial peroneal-nerve entrapment. J Bone Joint Surg Am 59(3):404–405CrossRefGoogle Scholar
  6. 6.
    Grant TH, Omar IM, Dumanian GA, Pomeranz CB, Lewis VA (2015) Sonographic evaluation of common peroneal neuropathy in patients with foot drop. J Ultrasound Med Off J Am Inst Ultrasound Med 34(4):705–711Google Scholar
  7. 7.
    Guo D, Guo D, Guo J, Malone DG, Wei N, McCool LC (2016) A cadaveric study for the improvement of thread carpal tunnel release. J Hand Surg 41(10):e351–e357CrossRefGoogle Scholar
  8. 8.
    Guo D, Guo D, Guo J, McCool LC, Tonkin B (2018) A cadaveric study of the thread trigger finger release: the first annular pulley transection through thread transecting technique. Hand 13(2):170–175CrossRefGoogle Scholar
  9. 9.
    Guo D, Guo D, Guo J, Schmidt SC, Lytie RM (2017) A clinical study of the modified thread carpal tunnel release. Hand 12(5):453–460CrossRefGoogle Scholar
  10. 10.
    Guo D, McCool L, Senk A, Tonkin B, Guo J, Lytie RM, Guo D (2018) Minimally invasive thread trigger digit release: a preliminary report on 34 digits of the adult hands. J Hand Surg Eur 43(9):942–947CrossRefGoogle Scholar
  11. 11.
    Guo D, Tang Y, Ji Y, Sun T, Guo J, Guo D (2015) A non-scalpel technique for minimally invasive surgery: percutaneously looped thread transection of the transverse carpal ligament. Hand (New York, NY) 10(1):40–48CrossRefGoogle Scholar
  12. 12.
    Henry AK (1973) Extensile exposure, Second edn. Churchill LivingstoneGoogle Scholar
  13. 13.
    Kopell H, Thompson W (1963) Entrapment neuropathies. Williams & Wilkins, Baltimore, MarylandGoogle Scholar
  14. 14.
    KOPELL HP, THOMPSON WA (1960) Peripheral entrapment neuropathies of the lower extremity. N Engl J Med 262:56–60CrossRefGoogle Scholar
  15. 15.
    Macaré van Maurik JFM, ter Horst B, van Hal M, Kon M, Peters EJG (2015) Effect of surgical decompression of nerves in the lower extremity in patients with painful diabetic polyneuropathy on stability: a randomized controlled trial. Clin Rehabil 29(10):994–1001CrossRefGoogle Scholar
  16. 16.
    Mackey D, Colbert DS, Chater EH (1977) Musculo-cutaneous nerve entrapment. Ir J Med Sci 146(4):100–102CrossRefGoogle Scholar
  17. 17.
    Mackinnon SE (2018) Superficial peroneal nerve release in the lower leg - extended. In: WUSTL learn surg. https://www.youtube.com/watch?v=OGBWww538oY
  18. 18.
    Malavolta M, Malavolta L (2007) Surgery for superficial peroneal nerve entrapment syndrome. Oper Orthop Traumatol 19(5–6):502–510CrossRefGoogle Scholar
  19. 19.
    Marques Mansano A, Trescot A (2016) The role of peripheral nerve injections in the diagnosis and treatment of CRPS. Phys Med Rehabil Res.  https://doi.org/10.15761/PMRR.1000121
  20. 20.
    Peer S, Kovacs P, Harpf C, Bodner G (2002) High-resolution sonography of lower extremity peripheral nerves: anatomic correlation and spectrum of disease. J ultrasound Med Off J Am Inst Ultrasound Med 21(3):315–322Google Scholar
  21. 21.
    Ray WZ, Mahan MA, Guo D, Guo D, Kliot M (2017) An update on addressing important peripheral nerve problems: challenges and potential solutions. Acta Neurochir 159(9):1765–1773CrossRefGoogle Scholar
  22. 22.
    Rosson GD, Dellon AL (2005) Superficial peroneal nerve anatomic variability changes surgical technique. Clin Orthop (438):248–252Google Scholar
  23. 23.
    Saragaglia D, Farizon F, Drevet JG, Butel J (1986) Peroneal nerve entrapment syndrome of the front of the foot. Treatment by neurolysis. Apropos of a bilateral case. Rev Chir Orthop Reparatrice Appar Mot 72(8):579–581Google Scholar
  24. 24.
    Styf JR, Körner LM (1986) Chronic anterior-compartment syndrome of the leg. Results of treatment by fasciotomy. J Bone Joint Surg Am 68(9):1338–1347CrossRefGoogle Scholar
  25. 25.
    Styf J, Morberg P (1997) The superficial peroneal tunnel syndrome: results of treatment by Descompression. J Bone Jt Surg 79-B(5):801–803CrossRefGoogle Scholar
  26. 26.
    Yang LJS, Gala VC, McGillicuddy JE (2006) Superficial peroneal nerve syndrome: an unusual nerve entrapment. J Neurosurg 104(5):820–823CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Danzhu Guo
    • 1
  • Danqing Guo
    • 1
    Email author
  • Richard Harrison
    • 1
  • Logan McCool
    • 2
  • Hao Wang
    • 3
  • Brionn Tonkin
    • 2
  • Michel Kliot
    • 4
  1. 1.BayCare Clinic Pain & Rehab MedicineAurora/BayCare HealthGreen BayUSA
  2. 2.Department of Rehabilitation Medicine Division of PM&RUniversity of MinnesotaMinneapolisUSA
  3. 3.Guilford Orthopedics and Sports Medicine CenterGreensboroUSA
  4. 4.Department of NeurosurgeryStanford UniversityPalo AltoUSA

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