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How I do it: selective tibial neurotomy

  • How I Do it - Functional Neurosurgery - Other
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Abstract

Background

Selective neurotomy is known as an effective method to reduce focal spasticity when medical treatment including botulinum toxin is not sufficient. The tibial nerve can be targeted to treat spastic equinovarus foot with (or without) claw toes.

Method

Tibial nerve trunk is dissected in the popliteal fossa. Sensitive and motor branches are identified using electrical stimulation to monitor motor responses. The muscular nerves corresponding to the targeted muscles are partially sectioned according to a preoperative chart. A postoperative rehabilitation program is mandatory.

Conclusion

Precise and rigorous selective neurotomy provided a definitive and safe treatment for spastic equinovarus foot.

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Author information

Authors and Affiliations

  1. Service de Neurochirurgie Fonctionnelle, Hospices Civils de Lyon, Hôpital neurologique et neurochirurgical Pierre Wertheimer, 59 Bd Pinel, 69003, Lyon, France

    Corentin Dauleac & Patrick Mertens

  2. Université de Lyon, Université Claude Bernard Lyon I, Lyon, France

    Corentin Dauleac & Patrick Mertens

  3. Centre de la douleur, Clinique Bretéché, Nantes, France

    Marc Sindou

  4. Laboratoire d’Anatomie, Université de Lyon, Université Claude Bernard Lyon I, Lyon, France

    Patrick Mertens

Authors
  1. Corentin Dauleac
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  2. Marc Sindou
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  3. Patrick Mertens
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Corresponding author

Correspondence to Corentin Dauleac.

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Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Key Points

• Detailed multidisciplinary clinical assessment with nerve block-test and/or toxin injection must be performed preoperatively in order to decide surgical indication but also to establish a preoperative chart determining muscles to be targeted and the proportion of sectioning for each nerve.

• Installation of the patient on the operating table must allow the surgeon to check the motor responses to stimulations.

• Precise electrical nerve stimulation is mandatory during surgery for nerve mapping. This allows the differentiation of sensitive from motor branches, and, after fascicles section, it allows to check the amount of residual motor response.

• Inside the tibial nerve trunk, it is necessary to be very careful and do not handle or cut sensitive fascicles with the risk of secondary neuropathic pain.

• Necessity of postoperative rehabilitation program to take in profit the new neurological status.

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This article is part of the Topical Collection on Functional Neurosurgery - Other

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Dauleac, C., Sindou, M. & Mertens, P. How I do it: selective tibial neurotomy. Acta Neurochir 162, 1921–1923 (2020). https://doi.org/10.1007/s00701-020-04314-9

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  • DOI: https://doi.org/10.1007/s00701-020-04314-9

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