Peripheral nerve surgery covers all surgery on nerves outside the central nervous system (brain and spine). This includes trauma with reconstruction including brachial plexus; entrapment syndromes (Carpal tunnel, ulnar nerve, common peroneal nerve etc); and tumours (schwannomas, neurofibromas). Dr Biggs trained with Prof David Kline (peripheral nerve surgeon at Louisiana State University)
Peripheral Nerve Surgery
The brain and spinal cord make up the Central Nervous System (CNS). Surgery involving nerves outside the CNS is referred to as Peripheral nerve surgery. Nerves originating in the spinal cord in the neck leave the spinal cord and form a network of nerves called the Brachial plexus before dividing into specific nerves of the arm. Similarly, nerves originating in the lumbar spine form the Lumbosacral plexus before dividing into specific nerves of the leg.
The commonest indications for peripheral nerve surgery include trauma to nerves, tumours in nerves and entrapment syndromes involving nerves. Carpal tunnel syndrome (CTS) is the commonest entrapment syndrome and Carpal tunnel release (CTR) is the most common procedure performed worldwide. Symptoms of CTS include pain and numbness in the hands and sometimes up the arm, typically occurring at night or when driving the car.
Other common entrapment syndromes involve the ulnar nerve at the elbow, lateral femoral cutaneous nerve at the hip (meralgia paraesthetica), common peroneal nerve at the knee, and posterior tibial nerve at the ankle (tarsal tunnel syndrome), to name just a few.
Many types of Tumours occur within nerves, but the most common are benign tumours called Schwannomas or Neurofibromas. Mostly these are one off sporadic cases, but rarely are part of an inherited syndrome such as Familial Schwannomatosis or Hereditary Neurofibromatosis type 1 (NF1) or type 2 (NF2).
Trauma to nerves may take the form of sharp or blunt (stretch) injuries. Generally sharp injuries are surgically repaired early, while blunt injuries are observed for a short time to see if spontaneous recovery occurs.