Name of the Procedure:

Excision of neuroma; major peripheral nerve, except sciatic

Summary

An excision of a neuroma is a surgical procedure to remove a benign growth on a major peripheral nerve, excluding the sciatic nerve. This growth, known as a neuroma, often arises from nerve tissue as a result of injury or compression and can cause significant pain or sensory disturbance.

Purpose

The procedure aims to alleviate pain, numbness, or tingling caused by the neuroma. Removing the neuroma can restore normal nerve function and improve the patient's quality of life.

Indications

• Chronic pain that is not alleviated by conservative treatments (e.g., physical therapy, medications).
• Numbness, tingling, or burning sensations in the affected area.
• Functional impairment in the limb or area served by the affected nerve.
• Enlargement or palpable mass along the path of a peripheral nerve (excluding the sciatic nerve).

Preparation

• Patients may be advised to fast for several hours before the procedure.
• Preoperative assessments may include imaging studies (like MRI or CT scans) and nerve conduction studies.
• Medication adjustments, particularly blood thinners, may be necessary.

Procedure Description

1. Anesthesia: The procedure is typically performed under general or regional anesthesia.
2. Incision: An incision is made over the site of the neuroma.
3. Exposure and Identification: The affected nerve is carefully exposed and the neuroma is identified.
4. Excision: The neuroma is meticulously dissected and removed while preserving as much of the healthy nerve tissue as possible.
5. Closure: The incision is closed with sutures, and a sterile dressing is applied.

Duration

The procedure typically takes between 1 to 2 hours, depending on the complexity and location of the neuroma.

Setting

This procedure is usually performed in a hospital or a surgical center equipped with the necessary surgical and anesthetic facilities.

Personnel

• Surgeon (usually a neurosurgeon or an orthopedic surgeon specialized in nerve surgery)
• Anesthesiologist
• Surgical nurse
• Operating room technician

Risks and Complications

• Infection
• Bleeding or hematoma
• Nerve damage leading to worsening symptoms or new neurological deficits
• Scar tissue formation
• Incomplete relief of symptoms or recurrence of the neuroma

Benefits

• Relief from chronic pain or sensory disturbances
• Improved functional capacity of the affected limb or area
• Enhanced overall quality of life Benefits are often realized within a few weeks post-surgery as the nerve heals.

Recovery

• Post-surgical pain may require medications for relief.
• Instructions on wound care to prevent infection.
• Physical therapy may be recommended to restore full function.
• Most patients can resume normal activities within 4-6 weeks, but complete nerve recovery may take several months.
• Follow-up appointments to monitor healing and nerve function.

Alternatives

• Non-surgical treatments such as physical therapy, splinting, pain medications, or steroid injections.
• Neurolysis, a procedure to release nerve entrapments without removing the neuroma.

Pros and Cons of Alternatives:

• Non-surgical treatments are less invasive but may provide only temporary relief.
• Neurolysis is effective but may not be sufficient for large or complex neuromas.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel any pain. Postoperative discomfort can be managed with pain medications. Patients may experience some soreness and swelling at the surgical site, and they will be encouraged to gradually increase activity as tolerated. Regular follow-ups will ensure proper recovery and address any concerns.