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At least 19 recordsLinked to original sources
PubMed1989

Peripheral nerve pathological findings in familial amyloid polyneuropathy: a correlative study of proximal sciatic nerve and sural nerve lesions.

To analyze the peripheral nerve pathological abnormalities in familial amyloid polyneuropathy, a correlative pathological study was carried out on the spinal nerve roots, proximal sciatic nerves, sural nerves, and brachial plexuses from 3 patients with the disease in Japan. The spinal nerve roots appeared to be unaffected except for amyloid deposition on the epineurium. In sciatic nerves and brachial plexuses the nerve lesions had a multifocal distribution, showing prominent interstitial edema in the endoneurium frequently adjacent to deposits of amyloid; in these regions the nerve fibers were severely depleted. A teased-fiber study revealed that segmental demyelination was the predominant type of nerve fiber abnormality. However, these findings were not seen in the sural nerves; instead a diffuse fiber loss with axonal degeneration was observed. It is suggested that multifocal lesions in the proximal portions of the long extremity nerves could summate distally to produce a symmetrical polyneuropathy in the disease. In addition to a space-occupying effect of amyloid deposits in the endoneurium, severe endoneurial edema associated with amyloid deposition in blood vessels and the endoneurial interstitium may induce ischemia in nerve fibers, thus causing the progressive polyneuropathy in this disorder.

Adult↗
PubMed1978

Hypertrophic Charcot-Marie-Tooth disease. Light and electron microscope studies of the sural nerve.

Sural nerve biopsies from 15 patients with hypertrophic Charcot-Marie-Tooth disease have been studied by light and electron microscopy. There is a considerable variation in size of onion bulbs in patients from different kinships but the appearances were similar in patients from the same kinship. Comparison of sural nerve biopsies from patients within the same kinship suggests that with increasing age there is a progressive reduction in myelinated fibre density, an increased number of fibres undergoing demyelination and an increased frequency of onion bulb formations. Motor conduction velocities were reduced in all patients and were inversely proportional to the number of onion bulb lamellae, and to the proportion of demyelinated fibres found on sural nerve biopsy. Abnormalities of unmyelinated fibres were present in all the nerves studied. There was a relative increase in the density of denervated Schwann cell subunits and collagen pockets. The findings suggest that unmyelinated fibres undergo degeneration in the disease and lend some support to the hypothesis that the primary abnormality may be neuronal.

Adolescent↗
PubMed1989

Sural nerve grafts for delayed repair of divided posterior interosseos nerves.

Sural nerve grafts were used in three patients to bridge gaps measuring 2 1/2 to 4 1/2 cm in previously transected but not repaired posterior interosseous nerves. The grafts were done at 4, 5, and 7 months after injury. Extension was weaker in all three than on the uninjured side, but the range of motion was complete, with the exception of a slight lag of index finger extension and partial return of extension of the extensor carpi ulnaris in the same patient. All three patients recovered full function of the involved hand 1 year after grafting. The properties of the posterior interosseous nerve (pure motor and short distance to the muscle) contribute to good results with nerve grafts in delayed nerve repairs. We believe that these results are better than tendon transfers, at least in young patients.

Adolescent↗
PubMed2004

[Restoration of erectile function by reconstructing cavernous nerves with sural nerve grafts].

OBJECTIVE: To investigate the restoration of erectile function by reconstructing cavernous nerves with sural nerve grafts. METHODS: Forty-eight male Sprague-Dawley rats(3-4 m old and 300-400 g) were randomly divided into three groups: the sham-operated group (n = 16) underwent pelvic exploration without transection of the cavernous nerve; the nerve ablation group (n = 16) had a 5 mm segment of the cavernous nerve excised bilaterally; the graft group (n = 16) had a 5 mm segment of the cavernous nerve excised bilaterally, followed by immediate microsurgical reconstruction with an interposition graft of the sural nerve. The cavernous nerves of each group were electrostimulated to determine their potency after 2 and 4 months. And fluorescent retrograde-transported material Fluoro-Gold(FG) was injected into the penis. FG-labeled neuron cells in whole mounts of major pelvic ganglions were observed five days after injection. RESULTS: Electrical stimulation produced no erection in either the nerve ablation or the graft group, but 100% erection in the sham-operated group after 2 months. The numbers of FG-labeled neurons significantly differed between the nerve ablation group and the graft group. After 4 months erection examination showed statistical significance in the difference between the graft group and the nerve ablation group(P < 0.05). The FG-labeled neurons in the graft group significantly differed from those in the ablation (P < 0.05), and almost reached the level of the sham-operated(P < 0.05). CONCLUSION: Cavernous nerve grafting can successfully restore erectile dysfunction in rats after surgical injury.

Animals↗
PubMed1988

Sorbitol metabolism in the retina, optic nerve, and sural nerve of diabetic rats treated with an aldose reductase inhibitor.

Sorbitol concentration has been measured in retina, optic, and sural nerve of normal, diabetic, and aldose reductase inhibitor-treated diabetic rats. The sural nerve displayed significantly higher sorbitol content than the retina and the optic nerve both in control animals and in diabetic animals. In the sural nerve the response to treatment with an aldose reductase inhibitor was more marked than in the two other tissues. The activities of aldose reductase and sorbitol dehydrogenase were not influenced by diabetes. It is suggested that aldose reductase inhibition may be of greater use for alleviating peripheral nervous system accumulation of sorbitol than for hindering CNS accumulation of the polyol.

Aldehyde Reductase↗
PubMed1999

En bloc resection of an intracavernous oculomotor nerve schwannoma and grafting of the oculomotor nerve with sural nerve. Case report and review of the literature.

A case in which a left oculomotor nerve schwannoma treated by en bloc resection of the lesion and grafting of the oculomotor nerve with sural nerve is presented. Recovery of nerve function was partial, but useful and cosmetically good. The last follow-up examination performed 2 years after surgery revealed recovery of function in the elevator muscle of the upper eyelid, together with slight vertical movement of the eye.

Cavernous Sinus↗
PubMed1991

Intraoperative recordings of spinal somatosensory evoked potentials to tibial nerve and sural nerve stimulation.

Somatosensory evoked potentials (SSEPs) to stimulation of the tibial nerve at the knee (TN-K) and ankle (TN-A), and the sural nerve at the ankle (SN-A), were recorded from 3 or 4 spinal levels during surgery for scoliosis in 11 neurologically normal subjects. With stimulation of all 3 nerves, the propagation velocity along the spine was nonlinear: it was faster over cauda equina and midthoracic cord than over caudal spinal cord. Over the mid-thoracic cord, TN-K SSEP propagation was faster than that of TN-A and SN-A SSEPs, whereas over the caudal spinal cord these values were similar on stimulation of all 3 nerves. These data suggest that fast conducting second order afferent fiber systems contribute to spinal cord SSEPs evoked by stimulating both mixed and cutaneous peripheral nerves.

Adolescent↗
PubMedDate not supplied

[Recovery of facial nerve function using sural nerve transplantation after its injury in acoustic nerve surgery].

INTRODUCTION: Statoacoustic n. neurinoma is a benign, slow-growing and usually unilateral tumor. During its growth the tumor exerts pressure on the surrounding anatomic forms within the pontocerebellar angle: cranial nerves, pons, cerebellum. Therefore the first clinical symptoms are ear buzzing and deafness, vision disorders, occipital headache or walking difficulties. The diagnosis of such conditions must be precise, whereas CT (computerized tomography) and MRI (magnetic resonance imaging) are the methods of choice. Surgical tumor removal is the only therapy, but during surgery facial nerve injury occurs. The objective of this paper is a case report of a facial nerve injury and sural nerve transplantation during acoustic neurinoma surgery and recovery of facial nerve function. CASE REPORT: A 23-year-old male patient suffered from ear buzzing in the right ear for a year and a half with gradual development of deafness. Due to frequent headaches and after ophthalmologic examination, the patient was urgently hospitalized at the Neurology Clinic of the Faculty of Medicine in Novi Sad where MRI of the endocranium was performed revealing a tumor of the pontocerebellar right angle, 3 x 3.5 cm in size. The patient has undergone surgery at the Neurosurgery Clinic of the Faculty of Medicine in Pees in Hungary, with suboccipital craniotomy and tumor ablation. During surgery facial nerve injury occurred in the premeatal segment and intraoperative transplantation of sural nerve grafts from the left leg to the distal parts of the facial nerve was performed. The histopathologic finding revealed an acoustic neurinoma (Schwannoma). After surgery a control CT was performed revealing a complete tumor removal. The wound healed per primam intentionem and the patient was released from hospital two weeks later. During the postoperative period physical therapy was performed in the aim of rehabilitation of the facial nerve due to peripheral paralysis. After electrodiagnostic tests using GALVOMED 20 apparatus, massage was performed in the periorbital and perioral regions. Kinesitherapy was also done in front of a mirror several times a day. 6 months after surgery an EMG (electromyography) of m. frontalis dx., m. orbicularis oculi dx. and m. orbicularis oris dx. were performed. The EMG revealed evident reinnervation possibilities. A year after surgery the control MR finding of the endocranium was regular, as well as the control MR two years after surgery (postoperative cyst without signs of recurrence of the removed neurinoma). Control EMG of the m. frontalis dx., m. orbicularis oculi dx., m. orbicularis oris dx. showed signs of reinnervation. DISCUSSION: Tumors of the pontocerebellar angle are usually acoustic nerve neurinomas. 8% of intracranial tumors are Schwannomas. They originate from neurilemmal cells, by rule they grow slowly and are benign tumors. Therefore, for years the only signs pointing to them are ear buzzing and gradual development of deafness. That is why these anamnestic data are important for diagnosis. Headaches, walking difficulties, vision disorders are the usual difficulties due to which patients seek doctor's help. Computerized tomography and magnetic resonance imaging represent the diagnostic methods of choice in establishing the diagnosis. In this case MRI was performed on time. Surgery is the only therapy, but during tumor ablation the facial nerve was injured in the premeatal region. Intraoperative transplantation of grafts taken from sural nerve to proximal and distal parts of the facial nerve provides possibilities for injured nerve regeneration. The process of regeneration of such a nerve is long-term and often permanent 40% axon loss occurs. This is the reason to perform a control EMG two years after surgery. During peripheral paralysis rehabilitation is performed in the aim of preventing contractures. It is achieved by passive exercises in front of a mirror a few times a day. (ABSTRACT TRUNCATED)

Adult↗
PubMed2005

Peroneal nerve lesion after sural nerve graft harvest: an unusual complication--case report.

After harvesting of the sural nerve, the patient developed a partial palsy of the common peroneal nerve due to a lesion of the peroneal nerve and a neuroma of the sural nerve stump. Motor function recovered after performing neurolysis of the common peroneal nerve and mobilization of the neuroma. The sural nerve, in this case originating from the common peroneal nerve, was harvested using a nerve stripper and four small skin incisions. Direct lesion by the forced use of the nerve-stripping instrument followed by the formation of a neuroma close to the peroneal nerve are the suspected reasons for motor dysfunction. Although many authors report using a nerve stripper as a safe, less invasive method to gain nerve material for transplantation, we recommend lengthening the skin incision so as to be aware of anatomical variations and to refrain from pulling the nerve distally to avoid the described complications.

Adult↗
PubMed1989

[Syndrome of compression of the external saphenous nerve (or the sural nerve)].

The authors describe a new canal syndrome, which they call the "superficial sural aponeurosis canal syndrome" or "sural nerve tunnel syndrome". Mostly seen in sportsmen, it was observed in this case in the context of a myositis ossificans circumscripta of the tendo-muscular junction of the heel. The clinical signs are caused by compression of the sural nerve where it passes through a nonextensible tunnel formed by the fold of the posterior sural aponeurosis. This is distinguished from a loge syndrome; the most typical clinical sign is increased pain in the territory of the sural nerve during plantar flexion of the ankle; in this position reduced sensory conduction velocity is measured. The treatment consists in a section of the fibro-aponeurotic arch.

Female↗
PubMed2000

Peripheral nerve amyloidosis in sural nerve biopsies: a clinicopathologic analysis of 13 cases.

OBJECTIVE: Amyloidosis is a well-recognized but uncommon cause of peripheral neuropathy. Our objectives were to determine the overall prevalence of peripheral nerve amyloidosis in sural nerve biopsies and to evaluate the clinical and pathologic features of these lesions. METHODS: All available histologic and ultrastructural materials on biopsy tissue from 13 cases of peripheral nerve amyloidosis were examined. Muscle biopsies performed at the same time as the nerve biopsy were reviewed when available. Clinical data were collected on all patients. RESULTS: The prevalence of amyloidosis in sural nerve biopsies at our institution was 13 (1.2%) of 1098 cases over a 15.8-year period. These patients ranged in age from 41 to 82 years (median, 61 years) at initial presentation and included 10 men and 3 women. Presenting neuropathy symptoms were sensory in 6 of the 13 patients, motor in 2 cases, and mixed in 5 cases. Cardiac, renal, or gastrointestinal involvement was present in 7 of 13 cases. Two patients had myeloma and 7 had systemic autonomic symptoms. Two patients had probable familial amyloid polyneuropathy, and 1 patient demonstrated an alanine 60 point mutation. Amyloid, identified as amorphous eosinophilic extracellular deposits demonstrating apple green birefringence on Congo red stain or recognized by its characteristic fibrillar ultrastructure by electron microscopy, was identified in the endoneurium in 12 nerves, perineurium in 2 nerves, and epineurium in 9 nerves. Chronic inflammation was identified in 5 nerves. Axonal loss was recorded as mild (<25%) in 1 nerve, moderate (25% to 75%) in 8 nerves, and severe (>75%) in 4 nerves. Axonal degeneration predominated over demyelination in 8 of 10 cases that could be evaluated. Concomitant muscle biopsies contained amyloid deposits in 8 of 9 cases. CONCLUSIONS: Amyloidosis is a rare (1.2% in our series) cause of peripheral neuropathy with a distinct microscopic and ultrastructural appearance. Just over half the patients in our study had visceral organ involvement and systemic autonomic symptoms. The peripheral neuropathy was associated with axonal degeneration and a moderate to severe axonal loss in the majority of cases. Amyloid deposition was present in 8 out of 9 muscle biopsies performed at the same time.

Adult↗
PubMed2004

Near nerve potential of sural nerve in leprosy.

Leprosy neuropathy is characterized by initial involvement of the small nerve fibers, later followed by involvement of the large fibers, when routine nerve conduction studies become abnormal. To increase the diagnostic yield and precocity of these studies, we applied the near nerve technique to the sural nerve of 8 leprosy patients. Contrary to our expectations, the main component of the sural nerve sensory action potential was abnormal in all patients, but the minimum conduction velocity originating from small 3-6 mm fibers was normal or only mildly involved in three patients. Also, although Schwann cells are the first to be involved in leprosy, the results are suggestive of axonal degeneration instead of demyelination. To better understand the neurophysiology and physiology of leprosy and to increase the accuracy and precocity of the diagnosis, it will be necessary to investigate patients in the very early stages of the disease and to correlate these findings with the corresponding nerve pathology.

Action Potentials↗
PubMed1998

Unmyelinated nerve fibers in sural nerve in pure autonomic failure.

We examined sural nerve biopsy specimens from 7 patients with pure autonomic failure (PAF). The mean unmyelinated nerve fiber density in these patients was 40% less than in age-matched controls. Increased numbers of clusters of collagen pockets not containing unmyelinated axons were the most prominent finding in PAF. This appears to reflect recent dropout of a group of sympathetic efferents and suggests grouping of unmyelinated fibers by modality at the level of the sural nerve trunk.

Aged↗
PubMed1995

[Surgical anatomy of the sural nerve].

The sural nerve is generally used as a graft in nervous reconstructions due to its easy access and minimal sequelae after its withdrawal. Although this nerve presents a constancy in its topographical localization, anatomical variations are frequent. Thus, trying to determine the formation pattern of the sural nerve complex, 38 legs from 19 cadaveres were dissected. The data obtained differ from those of the literature as to the frequency of the occurrence of the two classically known patter (pattern I and II). Besides, it was possible to identify two other paterns (pattern III and IV) of the sural nerve formation not yet described The cutaneous nerve and the comunicating peroneal nerve were found in 21% of the cases. In the literature, the frequency is of 65.8% to 80%. Pattern II, where the sural nerve is originated from the medial sural cutaneous nerve, was identified in 52.6% of cases, while in the literature its frequency is of 20 to 34.2%. Pattern III, not yet described in the literature, had the sural nerve coming from the junction between the medial sural cutaneous nerve and the lateral sural cutaneous one, with a frequency of 21% of the cases. Pattern IV, also not yet described in the literature, had the sural nerve originated from the common fibular nerve in 5.2% of patients. It was also possible to identify in the sample the presence of the lateral sural cutaneous nerve (branch of the common fibular nerve) and of the peroneal communicating nerve (branch of the lateral sural cutaneous nerve) with anatomical characteristics indicating them as an alternative source of nerve grafts.

Cadaver↗
PubMed1999

Epidermal nerve fiber density and sural nerve morphometry in peripheral neuropathies.

OBJECTIVE: To study intraepidermal nerve fiber (IENF) density in distal leg skin biopsies, sural nerve morphometry, electrophysiology, and clinical features in patients with peripheral neuropathies. METHODS: We studied 26 patients with neuropathic complaints who had undergone clinical evaluation, nerve conduction studies, distal leg skin biopsy, and sural nerve biopsy. We quantified densities of IENF and of myelinated and unmyelinated fibers in the sural nerve. Associations among skin and sural nerve morphometric measures and sensory nerve action potential (SNAP) amplitudes were examined nonparametrically. Morphometric measures were examined with respect to diagnostic category of neuropathy. RESULTS: IENF density correlated with the densities of sural nerve total myelinated (r = 0.57, p = 0.0011), small myelinated (r = 0.53, p = 0.0029), and large myelinated fibers (r = 0.49, p = 0.0054). There was a trend toward an association between IENF and sural nerve unmyelinated fiber densities (r = 0.32, p = 0.054). Sural SNAP amplitude and large myelinated fiber densities were highly correlated (r = 0.87, p < 0.0001). IENF density and sural nerve small fiber measures were concordant in 73% of patients. Reduced IENF density was the only indicator of small fiber depletion in 23% of cases. It was usually normal in acquired demyelinating neuropathies and where clinical suspicion for neuropathy was low. CONCLUSIONS: Distal leg Intraepidermal nerve (IENF) density may be more sensitive than sural nerve biopsy in identifying small fiber sensory neuropathies. Assessments of IENF density and large fiber measures on biopsy and electrophysiology are both useful for characterizing sensory and sensorimotor neuropathies.

Action Potentials↗
PubMed1981

Bilateral microneurosurgical reconstruction of inferior alveolar nerves via autogenous sural nerve transplantation.

Microneurosurgical operative techniques permit satisfactory restoration of sensation in many lesions of the inferior alveolar nerve. Therefore, restoration of the sensory deficit is becoming increasingly more important in the total functional rehabilitation of individuals with mandibular continuity defects involving transection of or permanent damage to the inferior alveolar nerve. This article reviews the case history of a young man who underwent bilateral osseous mandibular reconstruction and microneurosurgical reconstruction of his inferior alveolar nerves following severe maxillofacial trauma. A new technique for isolating the sural nerve is introduced to facilitate harvesting of the graft. Scanning electron microscopic examination of the resected proximal inferior alveolar nerve is recommended to determine the prognosis for regeneration across the proximal anastomosis and to decide whether secondary resection and reanastomosis of the distal anastomosis is indicated when anesthesia persists 9 to 12 months after initial transplantation of a long donor nerve.

Adult↗
PubMed1996

Changes of unmyelinated nerve fibers in sural nerve in amyotrophic lateral sclerosis, Parkinson's disease and multiple system atrophy.

Quantitative changes in unmyelinated nerve fibers (UMNFs) of sural nerves in patients of amyotrophic lateral sclerosis (ALS), Parkinson's disease (PD) and multiple system atrophy (MSA) were evaluated using autopsy materials whose pathological diagnosis had been confirmed by careful postmortem examinations. Ordinary ALS cases demonstrated no involvement in cutaneous UMNFs; however, the patients with long survival due to the application of ventilatory support showed bimodality in UMNF diameter histograms, and a patient with involvement of systems other than motor pathways showed an abnormal value in two indices: a low percentage of subunits containing axon(s) and a high mean number of Schwann cell profiles per axon. A significant reduction of the mean value of UMNF density (21%) was found in PD patients. Because the density of myelinated nerve fibers did not show any significant decrease as compared with age-matched controls, the change of nerve fibers in peripheral nervous system was considered to be confined to UMNFs in PD. Elderly PD cases showed enhanced changes in the ageing process, as expressed by the two indices described above. In MSA, the mean value of UMNF density was significantly decreased (23%), and this decrease almost paralleled that of myelinated nerve fiber density. Abnormal values for the two indices described above were found and two out of four cases demonstrated bimodality in the diameter histogram of UMNFs. Unlike MSA, ALS and PD have not been included in the disorders with cutaneous UMNF involvement. Our results supply the first evidence of morphological changes in cutaneous UMNFs in PD cases. In ordinary ALS cases, the emergence of such morphological changes is suggested in cases with long survival.

Age Distribution↗