Lindsay Lipinski, MD, FAANS, FACS, walks through three different types of surgeries offered at Roswell Park Comprehensive Cancer Center for patients experience nerve pain or loss of nerve function, whether from cancer treatment or other health complications.
“The goal is to improve function or to decrease pain or disability,” she says. “While at Roswell Park we treat tumors, including tumors of the peripheral nerves, we also have this expertise and experience to be able to apply that expertise to these other types of nerve surgeries. We’re really the only place in the region offering this type of procedure.”
My name is Lindsay Lipinski and I'm a neurosurgeon at Roswell Park Comprehensive Cancer Center. And today I'm gonna talk about peripheral nerve surgery and why it's important and what we can offer peripheral nerve surgery is a discipline where we uh treat nerves anywhere in the body. And the goal of that type of surgery is to improve function or to decrease pain and disability. The three main components of peripheral nerve surgery are tumor surgeries, surgeries for entrapment syndromes and then nerve repair or reconstruction. Tumors can arise on nerves anywhere in the body and they require a very specific approach to safely resect them to maintain the function of the nerve. For instance, we had a patient who was in his sixties who presented with a mass behind his leg and it was causing pain every time he sat because it aligned right with the edge of the chair. And so when his primary sent him for a biopsy, it showed a of tumor called a Schwannoma. It was arising from the sciatic nerve which controls most of the function of the leg and foot. And so he had a successful surgery to resect that Schwannoma with preservation of the nerve and the nerve function. Tumors like that can arise in any part of the body and do require sort of a specialized approach to be able to safely resect it and preserve the function of the nerve. Another area of peripheral nerve surgery are entrapment syndromes. And these are, if you imagine carpal tunnel syndrome, which is entrapment of the median nerve at the wrist, that can happen in other places in the body where the nerve is caught in an an atomic location that causes pressure on it and causes pain or dysfunction of that nerve. We can release the nerve anywhere in the body where it is entrapped to improve function of it. For instance, we had a patient who was referred to us after he had a number of back surgeries for pain into his leg. The spine surgeon thought that this was a radiculopathy. His EMG showed that it was actually a perineal neuropathy at the fibular head. And so we did a very small surgery where we released the nerve where it was entrapped in the, just below the knee. And he had improvement of his pain symptoms and actually improvement of his motor function as well. It's important to think about peripheral nerve injuries when patients present with pain and dysfunction and weakness outside of just the spine or the brain, even even as a neurosurgeon. And then I think the most exciting type of peripheral nerve surgery is the nerve repair and nerve reconstruction category. This is when we treat typically patients who have experienced trauma, but it can happen in other circumstances, like maybe a nerve was injured during the surgery for a different reason. And so the nerve is either disconnected or not functional. If the nerve is disconnected, sometimes we're able to reconnect the nerve using an number of different techniques to ultimately allow function to be restored for it. The other type of surgery that we do is uh what's called a nerve transfer. And that's basically when we borrow a piece of nerve from a healthy nerve somewhere in the neighborhood of the injured nerve. And we're able to actually use that nerve to re innervate the muscle that isn't working. For instance, we had a patient who was involved in a motor vehicle accident. She was actually a pedestrian that was struck by a car in her thirties and had significant trauma to her shoulder and arm and recovered really well from that. But what she didn't recover was axillary nerve function which really controls the deltoid and a lot of shoulder movement because of that, she was really disabled from this because she couldn't do things like steer her car because she couldn't move her shoulder. We were able to do a surgery where we borrowed a piece of the nerve from the radial nerve and then actually hooked it up into the axillary nerve so that, that muscle could regain function by sort of borrowing a nerve in a different part of the body. And then she ultimately, within just a few months, was able to regain function and is now about driving and, and living a much higher quality of life than she was before. This, even in the longer term, if patients aren't a candidate for nerve transfer, there are some other procedures that we can do reconstructive procedures where we bar muscles or tendons to be able to regain function in the part of the body that had lost function due to the nerve injury. While at Roswell Park, we treat tumors including tumors of the peripheral nerves. We also have this expertise and experience to be able to apply that to these other types of nerve surgeries. And we're really the only place regionally that is offering this type of procedure. We would encourage anyone in the community who is seeing a patient who has a nerve injury to send them to us for evaluation. There is some sensitivity in the amount of time since the nerve injury into what we can offer them. So the sooner we can see them, the better their outcomes are likely to be.
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