Can a neuroma be removed

Peripheral nerve surgery

Introduction - Neuropathy and Polyneuropathy

Peripheral nerves are the nerves in the body that are outside the central nervous system (the brain and spinal cord). There are sensory (feeling) and motor (movement triggering) and mixed nerves. The sensitive nerves give us the feeling in our hands and feet, for example, and are sensitive to pressure, temperature stimuli, movement and pain. They are therefore also responsible for the texture of the tissue, temperature control, perspiration and blood circulation "in the finer". If there is pressure on these nerves, there is a lack of oxygen at the corresponding points in the nerve. The nerves can be permanently damaged. This triggers abnormal sensations such as tingling, numbness or pain (neuropathy). You can surgically relieve these pressure-damaged nerves and thus improve or even eliminate the symptoms. These operations are called Nerve decompression procedure.

A common cause of a Neuropathy (Nerve lesion) is diabetes mellitus ("diabetes"). In addition, neuropathy can occur in the context of hormonal disorders, in particular of the thyroid gland, vitamin deficiency syndromes, alcoholism, heavy metal poisoning, leprosy or after chemotherapy or long-term ventilation. The diagnosis is often idiopathic neuropathy, i.e. a triggering cause could not be found.

If several nerves are affected, one speaks of one Polyneuropathy. It is often assumed that this cannot be treated surgically. What is correct, however, is that even after symptoms that have persisted for years, an improvement in the symptoms through surgical treatment is possible and realistic.

 

Nerve compression syndromes

Compression syndromes of the nerves usually occur at anatomically typical constrictions where the affected nerve has no alternative. This can be a bony area, for example, with a tight ligament / capsule apparatus over it. However, there are numerous other situations in which critical pressure on a nerve can occur. Possible causes include scars, swelling around the tendons or joints, a ganglion or even a nerve tumor. It is often a combination of several of these factors.

Explanations to Upper extremity nerve compression syndromes can be found in the hand surgery chapter:

 

Here you can find information about Nerve compression syndromes in the legs:

 

Partial knee denervation according to Dellon

We can offer patients suffering from chronic pain in the knee joint a treatment option that is little known in Germany. Prof. Dellon (Plastic Surgery and Neurosurgery, Baltimore, USA) developed an operation to treat knee pain, which he has been successfully performing clinically since 1992.

 

Nerve injuries from accident or surgery

Injuries to the terminal nerve branches can also occur as a result of injuries or operations, since not all nerve branches can always be spared in various foot and vascular operations.

 

Groin pain from injury or compression of nerves

Nerves in the lower abdomen or flank area can convey pain through chronic pressure, scarring, or injury.

 

Neuromas

Nerves that cannot regenerate completely after being severed, for example, tend to develop knots or scars at the end near the body. These nodes (neuromas) contain frustrated nerve endings that can cause considerable pain when touched, e.g. the phenomenon of phantom pain after amputations. Nerve injuries also occur again and again as a complication in routine operations, for example injuries to sensitive skin nerves (saphenous nerve on the thigh or sural nerve on the calf) during varicose vein operations.

Neuroma pain does not appear until a few weeks after the nerve injury. In most cases, however, the neuromas cannot simply be removed, as there is a high risk of their formation again. If a clean end-to-end seam of the injured nerve does not succeed, there is the option of nerve transplantation or sinking the painful nerve branch deep into the surrounding muscles (see also the section on nerve injuries). However, the sensory disturbance in the area supplied by this nerve then remains permanently, but the painful sensation of touch is then usually eliminated.

 

Nerve tumors

The procedure is similar for nerve tumors that can arise spontaneously in the peripheral nervous system, such as schwannomas (synonym: neurinomas) or neurofibromas. These usually benign tumors of the nerves also cause intense, knife-prick-like pain. Schwannoma occurs primarily on the flexors of the extremities and on the head and neck. At the beginning it characteristically only appears as a painless swelling. Neurofibromas, which are found primarily on the trunk of the body and also on the extremities, behave in a similar way. Malignant degeneration is rare. Nevertheless, all removed tumor components are examined histologically.

 

Surgery of the peripheral nerves and the treatment of chronic pain that could be triggered by these nerves is a focus of our practice.
We would be happy to advise and examine you if you discover that the above-mentioned aspects apply to your problem.

Our flyer on the subject: Peripheral Nerve Surgery (PDF)