Center for Management and Surgery of Peripheral Nerve Disorders
The Department of Neurological Surgery leads the UCSF Center for Management and Surgery of Peripheral Nerve Disorders, a multi-disciplinary clinic that includes members of the Departments of Neurological Surgery, Neurology, Neuroradiology, Neuropathology, Rehabilitation Medicine, and Orthopedic Surgery. Comprehensive evaluation and treatment are provided, including non-invasive and surgical management. The surgical team includes experienced electrophysiologists who monitor nerve function during surgery to prevent damage to functional nerve fibers. State-of-the-art diagnostic tecniques include:
• Electromyogram and nerve conduction studies
• Nerve and muscle biopsies
• 3T MRI
• Tensor diffusion tractography and spectroscopy
The Center for Management and Surgery of Peripheral Nerve Disorders specializes in the treatment of all types of peripheral nerve tumors and associated conditions:
• Nerve sheath tumors: The most common nerve sheath tumors are schwannomas and neurofibromas. Neurofibromas often occur in patients with neurofibromatosis. Complete removal of the nerve sheath tumor is the mainstay of treatment.
• Malignant nerve sheath tumors: Rarely, nerve sheath tumors are malignant and require a comprehensive treatment plan that includes radiation and chemotherapy.
• Specialized neurofibromatosis clinic: NF1 and NF2 are common genetic syndromes. At UCSF, patients with neurofibromatosis are treated by a multidisciplinary group of specialists, including neurosurgeons, geneticists, neurologists, neuroradiologists, neuropathologists, physiatrists, and psychologists.
The Center for Management and Surgery of Peripheral Nerve Disorders provides fast, expert care for simple and complex traumatic nerve injuries, including injuries to the brachial plexus and sciatic nerve. These injuries require immediate evaluation, often followed with serial clinical exams and electrodiagnostic and imaging studies. Surgery for these injuries requires intraoperative expertise in electrophysiologically assessing specific nerves to determine the type and extent of nerve damage. Once identified, damaged nerves are repaired with a neurolysis, often using nerve grafts depending on the type and severity of nerve damage.
Pediatric Nerve Injury
Rarely, newborns can sustain injuries to the nerves that control the function of the arm and hand. Often, these injuries heal without treatment. Some patients, however, will require surgical treatment that can range from either removal of scar tissue from the damaged nerves or repair with nerve grafting. It is important that these patients be evaluated by the specialists in the Nerve Injury Clinic early as surgical repair should be performed by six months of age. This evaluation includes a direct examination, MR imaging, and electrical measurement of muscle and nerve function. In cases where the nerve injury is too extensive for direct repair of the nerves, specific procedures to help normal muscles take over some of the arm function can be done by our orthopedic surgeons, although these procedures are done after the first year of life.
Common Entrapment Syndromes
Entrapment syndromes (also called entrapment neuropathies) are characterized by numbing in the body caused by compression of the peripheral nerves. Patients may be candidates for surgical treatment of common entrapment syndromes if they are experiencing severe debiliting pain; progressive weakness or numbness; or if symptoms are not responsive to hand therapy.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is the most common nerve entrapment syndrome and involves the median nerve within the hand. Classic symptoms include numbness and tingling involving the thumb, index, and middle fingers that are usually worse at night. It is also characterized by reduced hand function, such as in opening jars. In advanced cases, there may be weakness of the thenar muscles. Surgical decompression of the median nerve is highly successful.
Ulnar Nerve Entrapment Across the Elbow
Ulnar nerve entrapment is the second most common entrapment syndrome and involves the ulnar nerve within the cubital tunnel at the elbow. Symptoms include numbness and tingling in the ring and little finger, elbow pain, and reduced hand dexterity and strength. Surgery involves decompression of the nerve across the elbow sometimes combined with a transposition.
Unsual Entrapment Syndromes
Thoracic Outlet Syndrome
This syndrome produces pain, numbness, and reduced function in the upper extremity often exacerbated with arm abduction above the shoulder. Botox injections into the scalene muscles can help this often difficult-to-diagnose condition. Surgery involves decompressing the brachial plexus, sometimes combined with resection of a rib. An extra cervical rib can cause thoracic outlet syndrome.
Piriformis syndrome involves compression of the sciatic nerve in the buttock by the overlying piriformis muscle. Surgical decompression under ultrasound guidance can minimize the size of the incision and postoperative pain.
This condition produces burning sensations along the anterolateral thigh from entrapment of the lateral femoral curtaneous nerve. It is treated by either surgically decompressing the nerve or proximally transecting it.