Literally speaking, neurolysis means liberation of a nerve from compression. Before the microscope was incorporated into surgical procedures, surgeons were only able to grossly release the major nerve trunks from possible surrounding compressive factors or tissues. The general belief was that if the nerve was in continuity, the function would be restored. From the experimental work and clinical experiences of Seddon and Sunderland, we deepened our understanding regarding different possible lesions of nerves in continuity. The Grade I and II injuries of Sunderland, equivalent to Neurapraxia and Axonotmesis as described by Seddon, represent the lesions. Nevertheless, the most important aspect of Sunderland’s classification was the introduction of a third degree of lesion, which is a combination of neural and connective tissue lesion. This type of lesions demonstrated that even after external decompression of a nerve lesion in continuity, the functional outcome was not predictable. With the introduction of the operating microscope, we have become able to virtually dissect the major nerve trunk into its smaller anatomical units, namely the fascicular groups by removing the fibrotically altered epineural tissues surrounding the fascicles. I have already designated this technique “fascicular perineural neurolysis” (Samii 1970). This technique allowed us to go a step further eliminating the extrafascicular compression. However, as Sunderland mentioned regarding the grade III type of injuries, one cannot be sure of what is happening within the fascicles, which means that even a fascicular neurolysis may not be sufficient.
KeywordsNerve Injury Nerve Lesion Nerve Trunk Operating Microscope Peripheral Nerve Lesion
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