Neurovascular Bundle Decompression without Excessive Dissection for Tarsal Tunnel Syndrome
Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the posterior tibial nerve and its branches in the tarsal tunnel. We present our less invasive surgical treatment of TTS in 69 patients (116 feet) and their clinical outcomes. The mean follow-up period was 64.6 months. With the patient unde...
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Veröffentlicht in: | Neurologia medico-chirurgica 2014, Vol.54(11), pp.901-906 |
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creator | KIM, Kyongsong ISU, Toyohiko MORIMOTO, Daijiro SASAMORI, Toru SUGAWARA, Atsushi CHIBA, Yasuhiro ISOBE, Masahiro KOBAYASHI, Shiro MORITA, Akio |
description | Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the posterior tibial nerve and its branches in the tarsal tunnel. We present our less invasive surgical treatment of TTS in 69 patients (116 feet) and their clinical outcomes. The mean follow-up period was 64.6 months. With the patient under local anesthesia we use a microscope to perform sharp dissection of the flexor retinaculum and remove the connective tissues surrounding the posterior tibial nerve and vessels. To prevent postoperative adhesion and delayed neuropathy, decompression is performed to achieve symptom improvement without excessive dissection. Decompression is considered complete when the patient reports intraoperative symptom abatement and arterial pulsation is sufficient. The sensation of numbness and/or pain and of foreign substance adhesion was reduced in 92% and 95% of our patients, respectively. In self-assessments, 47 patients (68%) reported the treatment outcome as satisfactory, 15 (22%) as acceptable, and 7 (10%) were dissatisfied. Of 116 feet, 4 (3%) required re-operation, initial decompression was insufficient in 2 feet and further decompression was performed; in the other 2 feet improvement was achieved by decompression of the distal tarsal tunnel. Our surgical method involves neurovascular bundle decompression to obtain sufficient arterial pulsation. As we use local anesthesia, we can confirm symptom improvement intraoperatively, thereby avoiding unnecessary excessive dissection. Our method is simple, safe, and without detailed nerve dissection and it prevents postoperative adhesion. |
doi_str_mv | 10.2176/nmc.oa.2014-0090 |
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We present our less invasive surgical treatment of TTS in 69 patients (116 feet) and their clinical outcomes. The mean follow-up period was 64.6 months. With the patient under local anesthesia we use a microscope to perform sharp dissection of the flexor retinaculum and remove the connective tissues surrounding the posterior tibial nerve and vessels. To prevent postoperative adhesion and delayed neuropathy, decompression is performed to achieve symptom improvement without excessive dissection. Decompression is considered complete when the patient reports intraoperative symptom abatement and arterial pulsation is sufficient. The sensation of numbness and/or pain and of foreign substance adhesion was reduced in 92% and 95% of our patients, respectively. In self-assessments, 47 patients (68%) reported the treatment outcome as satisfactory, 15 (22%) as acceptable, and 7 (10%) were dissatisfied. Of 116 feet, 4 (3%) required re-operation, initial decompression was insufficient in 2 feet and further decompression was performed; in the other 2 feet improvement was achieved by decompression of the distal tarsal tunnel. Our surgical method involves neurovascular bundle decompression to obtain sufficient arterial pulsation. As we use local anesthesia, we can confirm symptom improvement intraoperatively, thereby avoiding unnecessary excessive dissection. Our method is simple, safe, and without detailed nerve dissection and it prevents postoperative adhesion.</description><identifier>ISSN: 0470-8105</identifier><identifier>EISSN: 1349-8029</identifier><identifier>DOI: 10.2176/nmc.oa.2014-0090</identifier><identifier>PMID: 25367582</identifier><language>eng</language><publisher>Japan: The Japan Neurosurgical Society</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anesthesia, Local ; decompression ; Dissection - methods ; entrapment neuropathy ; Female ; Follow-Up Studies ; Humans ; Male ; Microvascular Decompression Surgery - methods ; Middle Aged ; Original ; tarsal tunnel syndrome ; Tarsal Tunnel Syndrome - diagnosis ; Tarsal Tunnel Syndrome - surgery</subject><ispartof>Neurologia medico-chirurgica, 2014, Vol.54(11), pp.901-906</ispartof><rights>2014 by The Japan Neurosurgical Society</rights><rights>2014 The Japan Neurosurgical Society 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c651t-d984b78dbea0d743b238a5628513f91e720c7186bd1fb4811358b6bd14e13f053</citedby><cites>FETCH-LOGICAL-c651t-d984b78dbea0d743b238a5628513f91e720c7186bd1fb4811358b6bd14e13f053</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4533351/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4533351/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,728,781,785,865,886,1884,4025,27928,27929,27930,53796,53798</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25367582$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>KIM, Kyongsong</creatorcontrib><creatorcontrib>ISU, Toyohiko</creatorcontrib><creatorcontrib>MORIMOTO, Daijiro</creatorcontrib><creatorcontrib>SASAMORI, Toru</creatorcontrib><creatorcontrib>SUGAWARA, Atsushi</creatorcontrib><creatorcontrib>CHIBA, Yasuhiro</creatorcontrib><creatorcontrib>ISOBE, Masahiro</creatorcontrib><creatorcontrib>KOBAYASHI, Shiro</creatorcontrib><creatorcontrib>MORITA, Akio</creatorcontrib><title>Neurovascular Bundle Decompression without Excessive Dissection for Tarsal Tunnel Syndrome</title><title>Neurologia medico-chirurgica</title><addtitle>Neurol. Med. Chir.(Tokyo)</addtitle><description>Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the posterior tibial nerve and its branches in the tarsal tunnel. We present our less invasive surgical treatment of TTS in 69 patients (116 feet) and their clinical outcomes. The mean follow-up period was 64.6 months. With the patient under local anesthesia we use a microscope to perform sharp dissection of the flexor retinaculum and remove the connective tissues surrounding the posterior tibial nerve and vessels. To prevent postoperative adhesion and delayed neuropathy, decompression is performed to achieve symptom improvement without excessive dissection. Decompression is considered complete when the patient reports intraoperative symptom abatement and arterial pulsation is sufficient. The sensation of numbness and/or pain and of foreign substance adhesion was reduced in 92% and 95% of our patients, respectively. In self-assessments, 47 patients (68%) reported the treatment outcome as satisfactory, 15 (22%) as acceptable, and 7 (10%) were dissatisfied. Of 116 feet, 4 (3%) required re-operation, initial decompression was insufficient in 2 feet and further decompression was performed; in the other 2 feet improvement was achieved by decompression of the distal tarsal tunnel. Our surgical method involves neurovascular bundle decompression to obtain sufficient arterial pulsation. As we use local anesthesia, we can confirm symptom improvement intraoperatively, thereby avoiding unnecessary excessive dissection. Our method is simple, safe, and without detailed nerve dissection and it prevents postoperative adhesion.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthesia, Local</subject><subject>decompression</subject><subject>Dissection - methods</subject><subject>entrapment neuropathy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Male</subject><subject>Microvascular Decompression Surgery - methods</subject><subject>Middle Aged</subject><subject>Original</subject><subject>tarsal tunnel syndrome</subject><subject>Tarsal Tunnel Syndrome - diagnosis</subject><subject>Tarsal Tunnel Syndrome - surgery</subject><issn>0470-8105</issn><issn>1349-8029</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkM1OwzAQhC0Egqpw54TyAin-TZwLEpRSkBAcKBculuNsaFBiV3ZS6NuTUKjKZa31zHwrDULnBE8oSZNL25iJ0xOKCY8xzvABGhHGs1himh2iEeYpjiXB4gSdhVDlGFMuOZPpMTqhgiWpkHSE3p6g826tg-lq7aObzhY1RLdgXLPy0OecjT6rdum6Npp9meFn3etVCGDaQSydjxbaB11Hi85aqKOXjS28a-AUHZW6DnD2-47R691sMb2PH5_nD9Prx9gkgrRxkUmep7LIQeMi5SynTGqRUCkIKzMCKcUmJTLJC1LmXBLChMyHjUNvwIKN0dWWu-ryBgoDtvW6VitfNdpvlNOV-q_Yaqne3VpxwRjrr4wR3gKMdyF4KHdZgtVQteqr7jlqqFoNVfeRi_2bu8Bfsb1hvjV8hFa_w86gfVuZGn6IgitChrmP3jnMUnsFln0Dbh6W7Q</recordid><startdate>2014</startdate><enddate>2014</enddate><creator>KIM, Kyongsong</creator><creator>ISU, Toyohiko</creator><creator>MORIMOTO, Daijiro</creator><creator>SASAMORI, Toru</creator><creator>SUGAWARA, Atsushi</creator><creator>CHIBA, Yasuhiro</creator><creator>ISOBE, Masahiro</creator><creator>KOBAYASHI, Shiro</creator><creator>MORITA, Akio</creator><general>The Japan Neurosurgical Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>2014</creationdate><title>Neurovascular Bundle Decompression without Excessive Dissection for Tarsal Tunnel Syndrome</title><author>KIM, Kyongsong ; ISU, Toyohiko ; MORIMOTO, Daijiro ; SASAMORI, Toru ; SUGAWARA, Atsushi ; CHIBA, Yasuhiro ; ISOBE, Masahiro ; KOBAYASHI, Shiro ; MORITA, Akio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c651t-d984b78dbea0d743b238a5628513f91e720c7186bd1fb4811358b6bd14e13f053</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthesia, Local</topic><topic>decompression</topic><topic>Dissection - methods</topic><topic>entrapment neuropathy</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Male</topic><topic>Microvascular Decompression Surgery - methods</topic><topic>Middle Aged</topic><topic>Original</topic><topic>tarsal tunnel syndrome</topic><topic>Tarsal Tunnel Syndrome - diagnosis</topic><topic>Tarsal Tunnel Syndrome - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>KIM, Kyongsong</creatorcontrib><creatorcontrib>ISU, Toyohiko</creatorcontrib><creatorcontrib>MORIMOTO, Daijiro</creatorcontrib><creatorcontrib>SASAMORI, Toru</creatorcontrib><creatorcontrib>SUGAWARA, Atsushi</creatorcontrib><creatorcontrib>CHIBA, Yasuhiro</creatorcontrib><creatorcontrib>ISOBE, Masahiro</creatorcontrib><creatorcontrib>KOBAYASHI, Shiro</creatorcontrib><creatorcontrib>MORITA, Akio</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Neurologia medico-chirurgica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>KIM, Kyongsong</au><au>ISU, Toyohiko</au><au>MORIMOTO, Daijiro</au><au>SASAMORI, Toru</au><au>SUGAWARA, Atsushi</au><au>CHIBA, Yasuhiro</au><au>ISOBE, Masahiro</au><au>KOBAYASHI, Shiro</au><au>MORITA, Akio</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Neurovascular Bundle Decompression without Excessive Dissection for Tarsal Tunnel Syndrome</atitle><jtitle>Neurologia medico-chirurgica</jtitle><addtitle>Neurol. Med. Chir.(Tokyo)</addtitle><date>2014</date><risdate>2014</risdate><volume>54</volume><issue>11</issue><spage>901</spage><epage>906</epage><pages>901-906</pages><issn>0470-8105</issn><eissn>1349-8029</eissn><abstract>Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the posterior tibial nerve and its branches in the tarsal tunnel. We present our less invasive surgical treatment of TTS in 69 patients (116 feet) and their clinical outcomes. The mean follow-up period was 64.6 months. With the patient under local anesthesia we use a microscope to perform sharp dissection of the flexor retinaculum and remove the connective tissues surrounding the posterior tibial nerve and vessels. To prevent postoperative adhesion and delayed neuropathy, decompression is performed to achieve symptom improvement without excessive dissection. Decompression is considered complete when the patient reports intraoperative symptom abatement and arterial pulsation is sufficient. The sensation of numbness and/or pain and of foreign substance adhesion was reduced in 92% and 95% of our patients, respectively. In self-assessments, 47 patients (68%) reported the treatment outcome as satisfactory, 15 (22%) as acceptable, and 7 (10%) were dissatisfied. Of 116 feet, 4 (3%) required re-operation, initial decompression was insufficient in 2 feet and further decompression was performed; in the other 2 feet improvement was achieved by decompression of the distal tarsal tunnel. Our surgical method involves neurovascular bundle decompression to obtain sufficient arterial pulsation. As we use local anesthesia, we can confirm symptom improvement intraoperatively, thereby avoiding unnecessary excessive dissection. Our method is simple, safe, and without detailed nerve dissection and it prevents postoperative adhesion.</abstract><cop>Japan</cop><pub>The Japan Neurosurgical Society</pub><pmid>25367582</pmid><doi>10.2176/nmc.oa.2014-0090</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Adult Aged Aged, 80 and over Anesthesia, Local decompression Dissection - methods entrapment neuropathy Female Follow-Up Studies Humans Male Microvascular Decompression Surgery - methods Middle Aged Original tarsal tunnel syndrome Tarsal Tunnel Syndrome - diagnosis Tarsal Tunnel Syndrome - surgery |
title | Neurovascular Bundle Decompression without Excessive Dissection for Tarsal Tunnel Syndrome |
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