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Riunione GdS Neuropatie Traumatiche e Iatrogene

Riunione GdS Neuropatie Traumatiche e Iatrogene. Proposte e aggiornamenti: Protocolli operativi “ interdisciplinari ” per lo studio dei nervi/plessi dopo lesione traumatica Aggiornamento studi collaborativi Prossima Riunione GdS (2012): candidati.

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Riunione GdS Neuropatie Traumatiche e Iatrogene

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  1. Riunione GdS Neuropatie Traumatiche e Iatrogene • Proposte e aggiornamenti: • Protocolli operativi “interdisciplinari” per lo studio dei nervi/plessi dopo lesione traumatica • Aggiornamento studi collaborativi • Prossima Riunione GdS (2012): candidati.

  2. 1) Protocolli operativi “interdisciplinari” Accuratezza diagnostica e prognostica EMG • Gold standard: EMG EMG +US/MR imaging: aumenta l’accuratezza diagnostica • TIMING: n. radiale-peroneale, PB: T0: 1 mese T1: 4-6 mesi (PB prognosi migliore se chirurgia < 12 mesi)

  3. ENG-EMG protocol • Muscles Needle Electrode Examination • Supraspinatus • Infraspinatus • Deltoid • Biceps brachii • Triceps • Brachioradialis • Extensor carpi radialis • Extensor digitorum communis • Extensor indicis proprius • Flexor carpi radialis • Pronator teres • Flexor pollicis longus • Flexor carpi ulnaris • Flexor digitorum profundus IV-V • First dorsal interosseous • Abductor digiti minimi • Abductor pollicis brevis. Sensory NCS • Med-D1,Med-D2,Med-D3 • Uln-D5, (Uln-UC) • Radial (base of thumb) • LABC • MABC Motor NCS • Axillary • Musculocutaneous • Radial • Ulnar • Median • (Sovrascapular) • (Long thoracic)

  4. Controversies in Brachial Plexus Surgery • WHEN? • WHETHER? • HOW? Conservative management of 3-4 months prior to operative exploration. No spontaneous recovery operative planning Kim et al. J Neurosurg, 2003; 98:1005-1016

  5. BP SURGERY: UP-TO-DATE ASAP PRIMARY or EARLY REPAIR (>72 hours-2/3 weeks) Neurotmesis (nerve sharply divided) Physical Therapy Nerve contused, epineurium ragged → end-to-end suture, auto/allografts, tubulizations SECUNDARY or DELAYED REPAIR (late<8-12 months, very late> 12 months) Closed injuries, partial nerve defects, after time (≥ 4 months) for spontaneous recovery and full clinical /neurophysiological evaluation of nerve functions. → surgical exploration (to determine the anatomic extent of the lesion): neurolisys, end-to-end/endo-to-side repair, neurotizations, tubulizations, auto/allografts, resection of neuroma in continuity, direct muscle neurotization Kim et al. J Neurosurg. 2003; 98:1005-1016

  6. Brachial Plexus: SURGICAL OUTCOMES • 1019 operative BPIs were managed at Lousiana State Universisty Health Sciende Center in 30 years • Infraclavicular stretch injury (less frequent-28%, than supraclavicular-72%) are technically more difficult to treat and are associated with a higher incidence of vascular and dislocation/fraction injuries. Better PROGNOSIS: lateral/posterior Poor PROGNOSIS: medial cord. Neurosurg Focus. 2004 May 15;16(5). Kim et al.

  7. Increased incidence and indications for surgery (>graft repair and neurotization) during recent years. • Open injuries have better outcomes (78%) than strech injuries (58%). • Only 22% patients become totally and permanently disabled. • Conclusion: an aggressive surgical approach in a specialized center remains appropriate.

  8. Problemi aperti • Mancanza di omogeneità di timing chirurgico in PB (3-6 mesi; < 12 mesi, > 12 mesi). • Follow up brevi per la valutazione del recupero (outcome finale valutabile solo dopo 2-3 anni dall’intervento/trauma). • Imprecisa valutazione dei risultati (definiti spesso “positivi” o “negativi” senza scelta di outcome standardizzati e omogenei).

  9. 1) Protocolli operativi “interdisciplinari” Chirurgia • PRIMARIA (0-20 gg): es. lesioni aperte. • SECONDARIA (lesioni chiuse): in assenza di segni clinici e elettrofisiologici di recupero dopo 6 - 8 mesi di osservazione → esplorazione chirurgica NB: importanti dati su follow up lunghi (> 1 anno).

  10. 2) Aggiornamento studi collaborativi:STUDIOMARKERS ELETTROFISIOLOGICI PROGNOSTICI DI RECUPERO NELLE NEUROPATIE TRAUMATICHE • Stardardized AAN EMG protocol (Ferrante, Wilbourn, 2002) • TIMING : A and B groups A) All suspected traumatic neuropathies (closed injuries) B) Primarysurgery (open injuries).

  11. 2) Aggiornamento studi collaborativi:STUDIOMARKERS ELETTROFISIOLOGICI PROGNOSTICI DI RECUPERO NELLE NEUROPATIE TRAUMATICHE 14 centri

  12. 3) Riunione GdS 2012: Candidati Sono aperte le candidature

  13. GRUPPO DI STUDIO “NEUROPATIE TRAUMATICHE E IATROGENE” Coordinatori: Palma Ciaramitaro palma.ciaramitaro@gmail.com Marcello Romano marcello.marceroma@gmail.co; ddegrandis@iol.it; montifa@units.it; <wtroni@yahoo.com>; <gianninif@unisi.it>;fabio.giannini@unisi.it; a.truini@libero.it; rravenni.md@libero.it; m.mondelli@usl7.toscana.it; fralogullo@yahoo.it; daniela.cassano@tiscalinet.it; eugenia_rota@yahoo.it; ila.paolasso@gmail.com; gianlucaisoardo@yahoo.it; fabiopoglio@libero.it; m.osio@tiscalinet.it; fabrizio.pisano@fsm.it; sergio.fumero@libero.it; scarzi@alice.it; <descisciolog@aou-careggi.toscana.it>; giuseppe.galardi@hsrgiglio.it; antonio.curra@uniroma1.it; lpadua@rm.unicatt.it; marinellatom@yahoo.co.uk; delcarro.ubaldo@hsr.it; gabriella.zara@sanita.padova.it; avillac@tin.it; mau_cle@libero.it; novellone@tin.it; verriello.lorenzo@aoud.sanita.fug.it, dariococito@yahoo.it>; pacst@fastwebnet.it

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