Artikel
Interosseous anterior syndrome – no space left for surgery?
Interosseus anterior Syndrom – ein nervenchirurgisches Problem?
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Autoren
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Christian Heinen
- Evangelisches Krankenhaus Campus Carl-von-Ossietzky-Universität Oldenburg, Universitätsklinik für Neurochirurgie, Oldenburg, Deutschland
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Thomas Schmidt
- Evangelisches Krankenhaus Campus Carl-von-Ossietzky-Universität Oldenburg, Universitätsklinik für Neurochirurgie, Oldenburg, Deutschland
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Patrick Dömer
- Evangelisches Krankenhaus Campus Carl-von-Ossietzky-Universität Oldenburg, Universitätsklinik für Neurochirurgie, Oldenburg, Deutschland
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Johannes Woitzik
- Evangelisches Krankenhaus Campus Carl-von-Ossietzky-Universität Oldenburg, Universitätsklinik für Neurochirurgie, Oldenburg, Deutschland
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Henrich Kele
- Neurologie Neuer Wall, Neurologie, Hamburg, Deutschland
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Thomas Kretschmer
- Klinikum Klagenfurt am Wörthersee, Department of Neurosurgery & Neurorestauration, Klagenfurt, Österreich
| Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: Since the first description by Nevin and Kiloh the compression syndrome of anterior interosseous nerve has been the subject of controversial discussion. Recently, the use of MR-neurography (MRN) and high-resolution neurosonography (HRNS) spawned the idea of neuritis as only agent causing a fascicular motor lesion.The co-existence of a “real” mechanic compression neuropathy is severely called into question, and consequently surgical treatment is losing importance.
Methods: Retrospectively, we analyzed medical charts of n= 9 treated surgically for interosseus anterior syndromepatients. Demographics, clinical and imaging features, intraoperative findings and outcome were assessed.
Results: Overall n= 9 patients were assessed, of these n= 4 were female and n= 5 male. Mean age was 38 years (range 7- 67 years). Clinical symptoms consisted of pain in n= 4, typical pinch grip weakness in n= 10 and sensory deficits in n= 8 patients. N= 3 suffered from prior traumatic arm fractures. N=1 was treated unsuccessfully with immunoglobulins before. N= 10 patients were assessed by HRNS and n= 8 with MRN. The preoperative imaging correlated in all cases with intraoperative findings. Specifically, in n= 6 patients' compressive fascia, in n= 2 additional nerve crossing vessels and in n= 3 a massive scar was found and released. Open surgery was performed in n= 7 and endoscopic assisted surgery in n=2 patients. No complications occurred. Mean follow-up 6.75 months in the surgical group with n=1 lost to follow-up. All other patients reported on pain relief and in n= 6 motoric function improved significantly.
Conclusion: In our experience mechanical compressive interosseous anterior syndrome exists besides the recently described causal neuritic proximal fascicular lesion. Imaging techniques such as MRN and HRNS facilitate the correct identification of the causal lesion, unraveling the presence of either compressive neuropathy or neuritis. Therefore, meticulous preoperative work-up is mandatory to decide on the appropriate therapy.
