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Objective To outline the epidemiological profile of surgical patients treated at the peripheral-nerve outpatient clinic of a public hospital in the state of Pernambuco, Brazil, from 2008 (the year this service was implemented in the hospital ) to 2016. Material and Methods A cross-sectional study with data collection from the medical records. A descriptive analysis was performed with the qualitative variables presented as relative and absolute frequencies, and the quantitative variables, as means and standard deviations. The studied variables were gender, age, diagnosis, and surgical techniques. Results In total, 506 medical records were analyzed. Of these, 269 were of male patients (53%), and 238 were of female patients (46%). The age of the sample ranged from 5 to 84 years (41 14 years). The most prevalent diagnoses were: carpal tunnel syndrome (38.9%) followed by traumatic brachial plexus injury (33.2%). The first diagnosis was more frequent among women, while the second, among men. This collaborates with the predominant findings of upper-limb lesions (91%), in which men accounted for 52,75% (244) and women, for 47,25% (217). Conclusion The present study provided relevant information regarding the reality of peripheral-nerve surgeries performed at a public hospital in the state of Pernambuco, Brazil. Public health issues increasingly require the continuity of public policies and government incentive.

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INTRODUCCIÓN: La endometriosis afecta hasta un 10-15% de las mujeres jóvenes. Se define como tejido endometrial funcional fuera de la cavidad uterina y su presentación clásica es la dismenorrea. La variedad profunda afecta a un 1-2% y las localizaciones más frecuentes son el peritoneo pélvico, ovarios, ligamentos útero-sacros y septum recto-vaginal; sin embargo, puede presentarse de forma muy infrecuente como implantes aislados localizados en relación al nervio ciático. El diagnóstico habitualmente es complejo y tardío, dado que los síntomas son inespecíficos y el examen físico puede ser indistinguible de otras etiologías. El estudio imagenológico de elección para la endometriosis profunda es la resonancia magnética (RM) de pelvis ya que una adecuada localización pre-quirúrgica de las lesiones es fundamental. CASO CLÍNICO: Paciente de sexo femenino de 46 años, con tres años de dolor pélvico, dismenorrea y dispareunia. El síntoma cardinal fue dolor ciático progresivo, con déficit motor y alteraciones sensitivas, los cuales se exacerbaban durante la menstruación y no presentaban respuesta al tratamiento farmacológico. En la RM se identifica nódulo sólido sospechoso de endometriosis en relación al nervio ciático derecho. El caso es evaluado por un comité multidisciplinario y se realiza cirugía laparoscópica. El diagnóstico de sospecha es confirmado histológicamente. La paciente presenta buena recuperación post-quirúrgica y cese completo de los síntomas descritos. DISCUSIÓN: La endometriosis profunda presenta un reto diagnóstico y habitualmente es tardío. Este caso presenta el resultado exitoso de una buena sospecha clínica, un estudio imagenológico completo y la resolución con una técnica quirúrgica compleja.

INTRODUCTION: Endometriosis is a disease that affects 10-15% of young women. It is characterized as functional endometrial tissue outside the uterine cavity. The most common form of presentation is dysmenorrhea. Deep endometriosis affects 1-2% of the patients, and is frequently located in the pelvic peritoneum, ovaries, utero-sacral ligaments and recto-vaginal septum. The isolated endometriosis of the sciatic nerve is a very uncommon presentation of this disease. Late diagnosis is frequent, mainly because the symptoms are non-specific, and the physical examination may be indistinguishable from other etiologies. The imaging study of choice is the pelvic magnetic resonance imaging (MRI) and an accurate pre-surgical location of the lesions is critical for a successful surgical outcome. CLINICAL CASE: 46-year-old female patient with 3 years of pelvic pain, dysmenorrhea and dyspareunia. The cardinal symptom was progressive sciatic pain, with motor deficit and sensory alterations. The pain was persistent despite pharmacological treatment and exacerbated during menstruation. MRI identifies a nodule located in the pelvic portion of the right sciatic nerve, suggestive of an endometriosis implant. The case was discussed by a multidisciplinary committee and laparoscopic surgery was performed. The diagnosis was confirmed with histology. The patient recovered well from surgery with significant improvement of the previously described symptoms. DISCUSSION: The diagnosis of deep endometriosis is challenging and usually delayed. This rare disease had a successful outcome, due to an early clinical suspicion, a thorough imaging study and an effective resolution with a complex surgical technique.

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The purpose of this paper is to provide a comprehensive review encompassing the syndromes associated with the lower cranial nerves (LCNs). We will discuss the anatomy of some of these syndromes and the historical contributors after whom they were named. The LCNs can be affected individually or in combination, since the cranial nerves at this level share their courses through the jugular foramen and hypoglossal canal and the extracranial spaces. Numerous alterations affecting them have been described in the literature, but much remains to be discovered on this topic. This paper will highlight some of the subtle differences among these syndromes. Symptoms and signs that have localization value for LCN lesions include impaired speech, deglutition, sensory functions, alterations in taste, autonomic dysfunction, neuralgic pain, dysphagia, head or neck pain, cardiac or gastrointestinal compromise, and weakness of the tongue, trapezius, or sternocleidomastoid muscles. To assess the manifestations of LCN lesions correctly, precise knowledge of the anatomy and physiology of the area is required. Treatments currently used for these conditions will also be addressed here. Effective treatments are available in several such cases, but a precondition for complete recovery is a correct and swift diagnosis.

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Anterior interosseous nerve syndrome (Nevin-Kiloh syndrome) is a rare entity caused by compression of the purely motor anterior interosseous nerve in the forearm. Historically, conventional surgical treatment has consisted of open decompression of the nerve. Unfortunately, open decompression is often complicated by scarring and significant morbidity. Endoscopic decompression is an alternative means of surgical intervention in the hands of well-trained surgeons comfortable with soft tissue endoscopy. In this report, we review relevant anatomy, offer technical hints, and present our personal experience with 4 illustrative cases, all with greater than 1.5 years of follow-up. Our patients showed considerable improvement of their symptoms with minimal scarring. No significant complications occurred.

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Endometriosis infiltrating the sacral nerve roots is a rarely reported manifestation of the disease. The objectives of this article are to report such a case and to describe the surgical technique for laparoscopic decompression of sacral nerve roots and treatment of endometriosis at this site. The patient as a 38-year-old woman who had undergone 2 previous laparoscopic procedures for electrocoagulation of peritoneal endometriosis and self-reported perimenstrual right-sided sciatica and urinary retention. Clinical examination revealed allodynia (pain from a stimulus that does not normally cause pain) on the S2 to S4 dermatomes and hypoesthesia on part of the S3 dermatome. Magnetic resonance imaging showed an endometriotic nodule infiltrating the anterior rectal wall. Laparoscopic exploration of the sacral nerve roots demonstrated vascular compression of the lumbosacral trunk and endometriosis entrapping the S2 to S4 sacral nerve roots, with an endometrioma inside S3. The endometriosis was removed from the sacral nerve roots and detached from the sacral bone, and a nodulectomy of the anterior rectal wall was performed. Normal urinary function was restored on postoperative day 2, and pain resolved after a period of post-decompression. Intrapelvic causes of entrapment of sacral nerve roots are rarely described in the current literature, either because of misdiagnosis or actual rareness of the condition. Recognition of the clinical markers for these lesions may lead to an increase in diagnosis and specific treatment.

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Adult peripheral nerve pathology is quite extensive, it comprises traumatic injuries (closed and open), compressive neuropathies and lesions secondary to other medical procedures. It is important to have a well established protocol for diagnosis, as in some lesions time is a key factor for recovery. This is important for the primary care physician that makes the diagnosis, regardless of who will treat the patient. When proposing a management plan it is important to set goals, as some lesions may be completely resolved, but in other cases all we can offer is palliative treatment due to the evolution and severity of the case.

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PURPOSE: To evaluate the applicability of the use of autogenous muscle treated in various ways, as a substitute of the nerve grafts. METHODS: Rats were divided into seven groups that received, as a treatment for a standard nerve injury, the following types of grafts: fresh muscle, muscle fixed with 10% formaldehyde, muscle frozen in a freezer, muscle frozen in refrigerator, nerveless muscle, peripheral nerve and a group was without any treatment. It assessed the histological appearance of the nerve fibers in the segment repaired. RESULTS: The evaluation of the segment nervous repaired showed nerve fibers through the graft in almost all groups, but the methodology employed has not adequately characterized the differences between the groups. CONCLUSION: This study showed the migration of nerves fibers through all grafts used.

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PURPOSE: To evaluate the applicability of the use of autogenous muscle treated in various ways, as a substitute of the nerve grafts. METHODS: Rats were divided into seven groups that received, as a treatment for a standard nerve injury, the following types of grafts: fresh muscle, muscle fixed with 10 percent formaldehyde, muscle frozen in a freezer, muscle frozen in refrigerator, nerveless muscle, peripheral nerve and a group was without any treatment. It assessed the histological appearance of the nerve fibers in the segment repaired. RESULTS: The evaluation of the segment nervous repaired showed nerve fibers through the graft in almost all groups, but the methodology employed has not adequately characterized the differences between the groups. CONCLUSION: This study showed the migration of nerves fibers through all grafts used.

OBJETIVO: Avaliar a aplicabilidade do uso de músculo autógeno, tratado de diversas maneiras, em substituição aos enxertos de nervo. MÉTODOS: Os ratos foram separados em sete grupos que receberam, como tratamento a uma lesão nervosa padronizada, os seguintes tipos de enxertos: músculo fresco, músculo fixado com formol 10 por cento, músculo congelado em freezer, músculo congelado em refrigerador, músculo denervado, nervo periférico e um grupo ficou sem qualquer tratamento. Foi avaliado o aspecto histológico das fibras nervosas no segmento reparado. RESULTADOS: A avaliação do segmento nervoso reparado mostrou que existiam axônios em quase todos os grupos, mas a metodologia empregada não possibilitou caracterizar adequadamente as diferenças entre os grupos. CONCLUSÃO: Este estudo mostrou a migração de axônios por meio de todos os enxertos utilizados.

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Cervical spondylotic myelopathy is a common disease caused by chronic segmental compression of the spinal cord. Despite the fact that the columns of the nuclei of the phrenic nerve are located between the 3rd and 5th cervical nerve segments, phrenic nerve paresis is not usually clinically significant. We present one case of cervical spondylotic myelopathy with bilateral phrenic paresis in whom magnetic resonance imaging and surgical findings confirmed intrinsic cord disease as being the cause of this syndrome. This case report suggests that one pathophysiology of clinical phrenic nerve paresis may be segmental damage to the anterior horns caused by cervical spondylosis.

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