AAHS ASPN ASRM - 2013 Annual Meeting - American Association ...

Treatment of Painful Neuroma by End-to-End Neurorraphy and a Nerve Conduit
Institution where the work was prepared: Georgetown University Hospital, Washington, DC, USA
Ivica Ducic, MD, PhD; Ali Al-Attar, MD; Georgetown University Hospital
There are number of reported treatments for painful neuroma. Most commonly, following the neuroma excision they include implantation of the proximal nerve
stump into muscle or bone. About sixty year ago, attempts were made with the end-to-end neurorraphy as an alternative solution for neuroma treatment but
failed to prove the efficacy. Over the past few years, five patients with forehead or dorsum of the foot neuroma, allowed us to re-visit the effectiveness of the endto-end
neurorraphy. Five consecutive patients presented with forehead (3 patients) and dorsum of the foot (2 patients) pain. The first three patients had traumatic
(2) or post-operative (1) supraorbital/supratrochelar nerve neuroma, while the remaining two patients had post-operative superficial and/or deep peroneal nerve
neuroma. The conservative managements provided no pain relief. Patients had pain for 2.3 years (1.9-4 y) in average. Patients with forehead headaches refused
trigeminal ablative procedures, while patients with dorsum of foot neuroma desired no proximal nerve excision in order to maximally preserve the sensation.
Therefore, following neuroma excision, the terminal end of supraorbital nerve was sutured into the terminal end of supratrochelar nerve via a nerve conduit.
Similarly, neuroma of the superficial peroneal nerve (1 patient) and superficial/deep peroneal nerve (1 patient) were addressed in patients with foot pain. Patient's
follow up was 2.1 year (range 1.5-2.9 years). Pre-operative pain level was 6-7 without direct stimulation of the neuroma, while with the pressure over the painful
site was 10. Post-operatively, after the resolution of the incisional pain, the resting pain was 0-1, while when the direct pressure was applied over the neurorraphy
site, it was 3-4 for few weeks and 1 at 1 year (p