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Anterior interosseous nerve compression syndrome: Is there a role for endoscopy?

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Abstract

Background

Anterior interosseous nerve syndrome is characterized by paralysis of the flexor digitorum profundus, the flexor pollicis longus and the pronator quadratus muscles without sensory loss. Extended exploration of the anterior interosseous nerve is the surgical treatment of choice. The present study evaluates the feasibility of an endoscopic approach for nerve decompression.

Methods

Preparation of the anterior interosseous nerve was performed in ten human cadaver arms. Subsequently, one female patient suffering from anterior interosseous nerve syndrome was endoscopically operated on.

Findings

A skin incision of 3–4 cm in the proximal direction was made at the forearm, and the median nerve was visualized between the pronator teres muscle and the flexor digitorum superficialis. Subsequently, the anterior interosseus nerve branch was identified, followed distally and decompressed under endoscopic view. The procedure could be accomplished in all cases under endoscopic view. Due to the very steep surgical angle, a branch of the anterior interosseus nerve was injured in one cadaver case. In all other cases, no adverse effects were observed. In the clinical case, the anterior interosseus nerve was endoscopically identified and decompressed, but a skin incision of 5 cm was required.

Conclusions

The results demonstrate that an endoscopic decompression of the anterior interosseus nerve is possible. Several difficulties occurred: Due to the depth of the surgical approach, especially in case of bulky muscles and very small skin incisions, the view is limited, harboring a higher risk of nerve injury. With more experience and specially designed endoscopes, application of this technique in anterior interosseus nerve compression syndrome might become more feasible.

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Acknowledgement

The authors gratefully acknowledge expert support of Mr. S. Kindel and Dr. A. Stadie in the illustration of the surgical approach.

Conflicts of interest

None.

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Authors and Affiliations

  1. Neurochirurgische Klinik, Universitaetsklinikum des Saarlandes, 66421 Homburg-Saar, Homburg Saar, Germany

    Doerthe Keiner & Joachim Oertel

  2. Institut für Anatomie, Zentrum für Anatomie und Zellbiologie, Medizinische Universitaet, Wien, Austria

    Manfred Tschabitscher

  3. Neurochirurgische Klinik, Universitaetsmedizin, Johannes Gutenberg-Universitaet, Mainz, Germany

    Stefan Welschehold

Authors
  1. Doerthe Keiner
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  2. Manfred Tschabitscher
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  3. Stefan Welschehold
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  4. Joachim Oertel
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Corresponding author

Correspondence to Joachim Oertel.

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Keiner, D., Tschabitscher, M., Welschehold, S. et al. Anterior interosseous nerve compression syndrome: Is there a role for endoscopy?. Acta Neurochir 153, 2225–2229 (2011). https://doi.org/10.1007/s00701-011-1091-5

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  • DOI: https://doi.org/10.1007/s00701-011-1091-5

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