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This study aimed to assess the time to cure of hypoesthesia caused by inferior alveolar nerve (IAN) injury after horizontally impacted mandibular third molar (M3) extraction under continuous administration of mecobalamin, a vitamin B12 preparation, and factors that influence the time to cure. This was a single-center retrospective study including 33 patients who experienced hypoesthesia after horizontally impacted M3 extraction and were treated with continuous oral administration of mecobalamin alone. The patients were divided into cured (n = 28) and uncured groups (n = 5). Demographic and clinical data were collected and analyzed. Of the 33 patients, 5 (15 %) reported uncured hypoesthesia. The median time to cure of hypoesthesia with mecobalamin administration was 33 (range, 6–202) days, and no cure beyond 7 months was reported. Age (≥30 years), Pell and Gregory classification (Position), and presence of Rood and Shehab signs ("interruption of white line of canal" and "diversion of canal") were significantly associated with prolonged time to cure. It may be necessary to evaluate the efficacy of mecobalamin for IAN injury after horizontally impacted M3 extraction approximately 30 days after the initiation of administration and consider treatment modification or additional treatment within approximately 7 months. [ABSTRACT FROM AUTHOR]

Cryoablation during minimally invasive repair for pectus excavatum (MIRPE) reduces opioid use and hospital length of stay. Skin hypoesthesia of the chest wall also occurs. This study sought to determine the frequency, onset, duration, and location of sensory changes and neuropathic pain after cryoablation. A prospective study was conducted on patients aged ≤21 years undergoing MIRPE with cryoablation of T3 to T7 dermatomes bilaterally for 120 s at a single institution between March 2021 to December 2022. Patients underwent sensory testing of the chest wall and neuropathic pain surveys (S-LANSS) preoperatively and then postoperatively for 6 months. Incidence and duration of hypoesthesia and neuropathic pain were evaluated. Of 61 patients enrolled in the study, 45 completed evaluations at six months postoperatively. All patients had skin hypoesthesia on postoperative day (POD)1. The mean percentage of the treated anterior chest wall surface area (TACWSA) with hypoesthesia to cold stimulus was 52% (±29.3) on POD 0 and 55% (±19.7) on POD 1. Sensation returned over time, with hypoesthesia affecting 11.1% (±15.5) TACWSA at 6 months. At study completion 58% of patients (26/45) had complete return of sensation; hypoesthesia was found at: 1 dermatome 13% (2/45), 2 dermatomes 22% (11/45), and 3 dermatomes 4% (2/45). Neuropathic pain (S-LANSS ≥12) was documented in 16% (9/55) of patients at hospital discharge but decreased to 6.7% of patients at 6 months. Onset of skin hypoesthesia after cryoablation occurred on POD0 and affected 52% of the TACWSA. All patients experienced return of sensation to varying degrees, with 58% experiencing normal sensation in all dermatomes by 6 months. The etiology of persistent hypoesthesia to select dermatomes is unknown but may be related to operative technique or cryoablation. Chronic neuropathic pain is uncommon. II. Prognosis Study. [ABSTRACT FROM AUTHOR]

Lower lip hypoesthesia is the most common complication following osseous genioplasty. Concentrated growth factor (CGF) has recently been shown to improve neural regeneration. The aim of this study was to evaluate the effect of concentrated growth factor on neurosensory recovery after osseous genioplasty. Patients who underwent osseous genioplasty between June 2017 and February 2020 were enrolled. CGF was applied to the mental nerve on one side. The treatment side was randomized, and the other side was considered as the control. Lower lip hypoesthesia was assessed preoperatively and postoperatively (1 week, 1, 3, 6, and 9 months) using the two-point discrimination test and a 10-point visual analogue scale (self-reported paresthesia). The assessor was blinded. Twenty-six female patients completed the study. At 1 and 3 months, both the mean two-point discrimination value and mean visual analogue scale score were significantly lower in the CGF group than in the control group (P < 0.001). At 3 months, the percentage of patients with lower lip hypoesthesia in the CGF group was significantly lower than that in the control group (P < 0.001). Both groups showed resolution of lower lip hypoesthesia at 6 months. Concentrated growth factor may accelerate the recovery of long-standing sensory nerve impairment following mental osteotomy. [ABSTRACT FROM AUTHOR]

Patients with instability because of congenital craniovertebral anomalies often have complex C1-C2 osseovascular anomalies. C2 nerve root sacrifice has been described to address such difficult anatomy during posterior C1-C2 fixation and has its own downsides. Its preservation as a recent alternative poses greater surgical challenge, and the considerations differ from other causes of craniovertebral junctional instability; the pertaining outcomes have been scarcely studied. The objective of this study was to prospectively determine the feasibility and outcomes related to C2 nerve root preservation in patients with congenital atlantoaxial dislocation (CAAD) after posterior C1-C2 fixation. In this observational study, 63 patients (126 nerve roots) with CAAD after posterior fixation were prospectively assessed. Underlying osseovascular anomalies affecting the feasibility of C2 nerve root preservation, and C2 nerve–related dysfunction at 12 months follow-up were analyzed. The overall C2 nerve root preservation rate was 89.7%. Even in the presence of extreme joint obliquity/spondyloptosis and anomalous vertebral artery, it was feasible in about three fourths. After preservation, 28.3% patients developed new-onset C2 nerve root dysfunction: neuralgia in 2, dysesthesia in 6, and hypoesthesia/paresthesia in 9. The symptoms were not disabling in most patients. In most patients with CAAD, C2 nerve root preservation is feasible despite an aberrant bony and vascular anatomy. A few patients after nerve root preservation develop related symptoms that are conservatively manageable, with no significant adverse consequences. Given the controversy in the literature on C2 nerve sacrifice–related outcomes, we favor an attempt at C2 nerve root preservation. [ABSTRACT FROM AUTHOR]

This systematic review and exploratory meta-analysis of the available evidence was performed to examine whether early nerve repair of lingual nerve (LN) and inferior alveolar nerve (IAN) injuries has an effect on neurosensory recovery. A literature search was conducted to identify relevant studies meeting the inclusion criteria. Two reviewers independently evaluated the methodological quality of the included studies and the risk of bias using the ROBINS-I quality assessment tool. For the quantitative analysis, data were pooled using the Mantel–Haenszel random-effects method due to the clinical heterogeneity across the studies. Sensitivity and subgroup analyses were performed based upon the group definition of timing from injury to nerve repair, with breakpoints of 2, 3, and 6 months. A total 1236 citations were identified, with a final 13 studies included in the systematic review. A clear definition of 'early' versus 'late' repair was not reported in six studies, allowing only seven to be included in the meta-analysis. The effect of early repair on functional sensory recovery was found not to be significant in nine studies, while four studies found a significant effect of early intervention. The meta-analysis showed a combined success rate of 93.0% for the early group and 78.5% for the late group. The odds of improvement were 5.49 (95% confidence interval 1.40–21.45) in the 3-month breakpoint studies and 2.28 (95% confidence interval 1.05–4.98) in the 6-month studies. A trend towards early repair achieving better functional sensory recovery outcomes was observed, but the specific time period is unknown. [ABSTRACT FROM AUTHOR]

Objective Deliberate C2 nerve root sectioning and its preservation have been described during posterior fusion for atlantoaxial dislocation (AAD). However, the associated outcomes have been less studied, especially in congenital AAD. Our objective was to study the clinical outcomes after C2 nerve root sectioning and the feasibility of C2 preservation in these patients. Methods The data from 190 patients were retrospectively studied. The decision to cut or preserve the C2 nerve root was determined by the preoperative radiologic findings and intraoperative suitability of its preservation. During follow-up, the patients were questioned about C2 nerve-related dysfunction. The pros and cons of sectioning or preservation of the C2 nerve root and the related feasibility factors are also described. Results Complex C1-C2 anatomy that required extensive dissection and drilling was seen in 139 patients. After C2 nerve root sectioning in 178 patients, none reported bothersome hypoesthesia, paresthesia, or dysesthesia that required medication. However, 9 patients (5.1%) developed nonhealing occipital ulcers and most required flap coverage or a skin graft. C2 nerve root preservation is feasible with an adequate inferior C1 lateral mass and normal-size ganglion. In patients with C1–occipital condyle hypoplasia, extremely oblique joints, spondyloptosis, incurved occiput, pseudofacets, and anomalous vertebral artery, preservation of the C2 nerve root is difficult. Conclusions The advantages of sectioning the C2 nerve root are many. However, a subset of patients is prone to morbid occipital neuropathic ulcers. After C2 nerve sectioning, one should be cautious of such complications. C2 nerve root preservation should be strongly considered for patients with favorable anatomy. Highlights • Sectioning or preservation of the C2 ganglion in posterior C1-C2 fusion is controversial. • We studied the clinical outcome after C2 nerve root sectioning in congenital AAD. • A few patients developed nonhealing occipital ulcers that were challenging to treat. • We also discussed the feasibility of C2 nerve root preservation in these patients. [ABSTRACT FROM AUTHOR]

Little research has been conducted into hypoesthesia, and no studies have elucidated the risk factors for refractory hypoesthesia and compared treatment modalities. The purpose of this multicentre retrospective cohort study was to investigate the relationships between various risk factors, treatment modalities, and refractory hypoesthesia. Risk factors for refractory hypoesthesia after oral surgery were evaluated using univariate and multivariate analysis. To minimize the selection bias associated with a retrospective data analysis, a propensity score analysis was performed between the medication and non-medication groups (65 sites in each group). Moderate or severe hypoesthesia (odds ratio 13.42) and no or late administration of ATP/vitamin B12 (odds ratio 2.28) were significantly associated with refractory hypoesthesia. In the propensity score analysis, the incidence rate of refractory hypoesthesia in the medication group was lower than that in the non-medication group ( P < 0.001). This study demonstrated the multivariate relationships between various risk factors, treatment modalities, and refractory hypoesthesia. Moderate or severe hypoesthesia and no or late administration of ATP/vitamin B12 were significantly associated with refractory hypoesthesia. Therefore, clinicians should consider these risk factors and initiate early oral administration of ATP/vitamin B12 in cases of hypoesthesia. [ABSTRACT FROM AUTHOR]

Purpose Mandibular fractures are amongst the most common facial fractures and are usually treated by open reduction and internal fixation (ORIF). Inferior alveolar nerve (IAN) injuries are seen frequently in mandibular fractures as well as after ORIF of these fractures due to the exposition and the close proximity of the nerve during fracture reduction. Therefore the continuity of the IAN can be disrupted. Permanent injury to the IAN can result in diminished quality of life. This retrospective study was designed to objectively analyse the incidence and the outcome of pre- and postoperative mental nerve hypoesthesia after ORIF of mandibular fractures. Material and methods Patients who were consecutively treated at the Department of Cranio-Maxillofacial and Oral Surgery of the University Hospital Zurich between 2004 and 2010 with mandibular fractures who underwent ORIF were included. Follow-up period was 12 months. Demographic, pre-, peri- and postsurgical data were tabulated and statistically evaluated using the χ 2 test and the Kruskall-Wallis-Test. Results 340 patients met the inclusion criteria. 27% of the study population presented with postinjury (preoperative) mental nerve hypoesthesia, 46% suffered from purely postoperative hypoesthesia and 27% showed no nerve damage. Complete recovery was seen in 70% of all cases, partial recovery in 20% of the cases and less than 10% suffered from a permanent (>12 months) IAN damage. Mandibular angle fractures were accompanied with significantly higher rates of hypoesthesia (79% vs. 68%). Recovery rate was significantly worse in older patients, when preoperative hypoesthesia was present (66% vs. 73%) and in patients with multiple fractures in proximity to the IAN (36% vs. 52%). Mandibular body fractures showed worse recovery rates than fractures that did not affect the body (44% vs. 52%). Conclusion The present study shows that IAN injury is seen frequently in mandibular fractures. Mental nerve hypoesthesia may influence quality of life. Nerve continuity may not be preserved due to the initial trauma or may result as a postoperative complication. Nevertheless the results of this study show a high potential for full recovery. [ABSTRACT FROM AUTHOR]

A randomized, prospective, controlled trial was conducted to determine the efficacy of single and repeated betamethasone doses on facial oedema, pain, and neurosensory disturbances after bilateral sagittal split osteotomy. Thirty-seven patients (mean age 23.62 years, range 17–62 years) with either mandibular prognathism or retrognathism were enrolled consecutively into the study and divided into three groups: control ( n = 12), repeated dose 4 + 8 + 4 mg betamethasone ( n = 14), single dose 16 mg betamethasone ( n = 11). The intake of diclofenac and paracetamol was assessed individually. Measurements of facial oedema, pain, and sensitivity in the lower lip/chin were obtained 1 day, 7 days, 2 months, and 6 months postoperatively. Furthermore, we investigated the possible influences of gender, age, total operating time, amount of bleeding, postoperative hospitalization, and advancement versus setback of the mandible. A significant difference ( P = 0.017) was observed in percentage change between the two test groups and the control group regarding facial oedema (1 day postoperatively). Less bleeding was associated with improved pain recovery over time ( P = 0.043). Patients who required higher postoperative dosages of analgesics due to pain had significantly delayed recovery of the inferior alveolar nerve at 6 months postoperatively ( P < 0.001). Betamethasone did not reduce neurosensory disturbances over time. [ABSTRACT FROM AUTHOR]

Background Physical signs often are present in many psychiatric conditions, making up a fundamental part of them and accompanying the psychiatric manifestations themselves. Identifying minor neurological signs is especially of interest due to they are easily accessible through simple neurological examination and could be a useful if underused tool for the diagnostic process and patient therapy. Method A group of depressed patients ( n =85) and group of healthy individuals ( n =101) that served as control were examined using the Wartenberg wheel, a medical device for neurological use, in order to determine the presence of hypoesthesia on both sides of their ankles. Results The data revealed: i) patients with depression are generally more likely to present malleolar hypoesthesia than healthy participants; and ii) participants who presented malleolar hypoesthesia presented greater depressive symptomatology as well as greater anxiety symptomatology at the time of assessment. Limitations Although all patients in this study were taking psychotropic medication, anxiolytics and antidepressants are not associated with skin sensitivity. As is usual, the categorization of hypoesthesia is based on participant subjectivity. However, this subjectivity cannot explain the differences between depressed patients and healthy individuals. Conclusions The present findings corroborate that localized tactile sensitivity is altered in depression and correlates with anxiety-depressive symptomatology, even on a subclinical level. The observation of neurological soft signs such as the detection of malleolar hypoesthesia in patients with depressive symptomatology is easily accessible using a simple neurological examination, and it could became a powerful tool that could provide objective information on affective disorders. [ABSTRACT FROM AUTHOR]

Abstract: Background: Deficit of tactile sensation in patients with MS is frequent and can be associated with interference with daily life activities. Transcranial direct current stimulation (tDCS) showed to increase tactile discrimination in healthy subjects. Objective: In the present study, we investigated whether tDCS may be effective in ameliorating tactile sensory deficit in MS patients. Methods: Patients received sham or real anodal tDCS of the somatosensory cortex for 5 consecutive days in a randomized, double blind, sham-controlled study. Discrimination thresholds of spatial tactile sensation were measured using the grating orientation task (GOT). As secondary outcomes we also measured subjective perception of tactile sensory deficit through a visual analog scale (VAS), quality of life and overall disability to evaluate the impact of the treatment on patients daily life. Evaluations were performed at baseline and during a 4-week follow-up period. Results: Following anodal but not sham tDCS over the somatosensory cortex, there was a significant improvement of discriminatory thresholds at the GOT and increased VAS for sensation scores. Quality of life, and disability changes were not observed. Conclusion: Our results indicate that a five day course of anodal tDCS is able to ameliorate tactile sensory loss with long-lasting beneficial effects and could thus represent a therapeutic tool for the treatment of tactile sensory deficit in MS patients. [Copyright &y& Elsevier]

Abstract: In this study we investigated the relationships among the risk factors for inferior alveolar nerve injury (IANI), and the difference between preoperative imaging findings on panoramic radiographs and computed tomography (CT), by univariate and multivariate analyses. We determined the following to be significant variables by multivariate analysis: panoramic radiographic signs, such as the loss of the white line of the inferior alveolar canal or the diversion of the canal; excessive haemorrhage during extraction; and a close relationship of the roots to the IAN (type 1 cases) on CT examination. CT findings of type 1 were associated with a significantly higher risk (odds ratio 43.77) of IANI. In addition, many panoramic findings were not consistent with CT findings (275 of 440 teeth; 62.5%). These results suggest that CT findings may be able to predict the development of IANI more accurately than panoramic findings. Panoramic radiography alone did not provide sufficiently reliable images required for predicting IANI. Therefore, when the panoramic image is suggestive of a close relationship between the impacted tooth and the IAN, CT should be recommended as a means of conducting further investigations. [Copyright &y& Elsevier]

Abstract: Sagittal split osteotomy may result in sensory impairment of the inferior alveolar nerve; altered sensation in the lower lip varies from patient to patient. We evaluated individual and intraoperative risk factors of sagittal split osteotomy and correlated these findings with self-reported postoperative changes in lower-lip sensation. Follow-up data for 163 consecutive patients who underwent a bilateral sagittal split osteotomy were assessed for self-reported sensibility disturbances in the lower lip at the last follow-up visit. These self-reports were categorized as normal, hypoesthesia, hyperesthesia, or slightly diminished sensation in the central area of the chin. The overall rate of self-reported changed sensibility was 15.1% (49/324; 13.0% on the right side and 17.3% on the left side). Of 16 patients (9.9%) who experienced hypoesthesia on the right side and 25 patients (15.4%) who experienced hypoesthesia on the left side, 10 experienced bilateral hypoesthesia (31 patients total, 19.1%). Genioplasty and age at surgery were significant predictors of hypoesthesia; a 1-year increase in age at surgery increased the odds of hyposensitivity by 5%, and the odds of hypoesthesia in patients with concurrent genioplasty were 4.5 times higher than in patients without genioplasty. Detachment of the nerve at the left side, but not at the right side, was significantly correlated with hypoesthesia. [Copyright &y& Elsevier]

Abstract: Burkitt''s lymphoma is a malignant lymphoma of high malignancy grade and accounts for less than 1% of all cases of malignant lymphoma. Patients with malignant lymphoma in the oral and maxillofacial region including Burkitt''s lymphoma, frequently present with gingival swelling, or a tumor mass/ulcers as the initial symptoms. We present an extremely rare case with bilateral mental nerve paralysis as the initial symptom without not only regional tumor but also brain and nose-pharyngeal area. This report indicates that the unexplained oral abnormalities such as inferior alveolar nerve hypoesthesia must be considered, potentially prodromal symptoms of Burkitt''s lymphoma. [Copyright &y& Elsevier]

Abstract: The authors evaluated changes in position and angle of the proximal segment, including the condyle, after intraoral vertical ramus osteotomy (IVRO) with and without a Le Fort I osteotomy to verify whether displacement of the proximal segment could induce postoperative complications. Changes in condylar angle, ramus angle, and displacement of proximal segment were measured pre- and postoperatively. The position of the temporomandibular joint (TMJ) disc was examined pre- and postoperatively. Trigeminal nerve hypoesthesia in the lower lip was assessed bilaterally. The postoperative horizontal condylar angle was significantly smaller than the preoperative one on the deviated and non-deviated sides (P<0.0001). The postoperative coronal condylar angle was significantly larger than the preoperative one on the deviated side (P=0.0483). The postoperative sagittal ramus angle was larger than the preoperative one on the deviated (P<0.0001) and non-deviated (P=0.00005) side. Most joints with an anteriorly-displaced disc with and without reduction improved on the non-deviated side; 5 of 16 joints improved on the deviated side. Results suggest the position and angle of the proximal segment, including the condyle, could change after IVRO. This could be associated with symptomatic improvement in TMJ, and extreme medial displacement of the proximal segment could delay recovery from lower lip hypoesthesia. [Copyright &y& Elsevier]

Abstract: This study is a randomized control split-mouth non-blinded prospective trial, the aim of which was to evaluate clinically the frequency and type of injury to the inferior alveolar nerve (IAN) following mandibular third molar surgery using or not using the tooth section technique. The sample consisted of 50 lower third molars in 25 patients, in the control group the tooth section technique was not used, and it was used in the experimental group. The outcomes have shown a frequency of 8% of IAN injury for both groups (in both genders), and there were no statistically significant associations between the use of the tooth section technique and a diminished incidence of IAN injury or the presence of radiographic signs of a direct relationship between the tooth/nerve/mandibular canal and IAN injury. There was no association between deformities of the tip of dental needles and nerve injury. Temporary hypoesthesia and paresthesia were the commonest nerve injuries. All patients recovered from these injuries within six months. [Copyright &y& Elsevier]

Abstract: The purpose of this study was to evaluate hypoesthesia of the lower lip using trigeminal somatosensory-evoked potential following 2 types of sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO). There were 30 patients with mandibular prognathism, with and without asymmetry, who were divided into three groups: the Obwegeser method (Ob) group, the Obwegeser–Dal Pont method (ODP) group and the intraoral vertical ramus osteotomy (IVRO) group. The trigeminal somatosensory-evoked potential was recorded in the region of the lower lip and evaluated preoperatively and postoperatively. The average recovery periods from lower lip hypoesthesia in the IVRO and the Ob group were significantly shorter than in the ODP group (P <0.05). In conclusion, IVRO showed the earliest recovery from hypoesthesia or an absence of hypoesthesia, and lower lip hypoesthesia was less with the Ob method than the ODP method. [Copyright &y& Elsevier]

Quantitative sensory testing revealed that pain induced by intracutaneous capsaicin injection elicited secondary hyperalgesia coexisting with secondary tactile hypoesthesia. Mapping the areas of altered mechanical sensations adjacent to the capsaicin injection disclosed that the area of secondary hyperalgesia was always nested in a larger area of secondary hypoesthesia easily detected as numbness by most subjects. Psychometric functions revealed a twofold rightward shift of tactile detection (hypoesthesia), which coexisted with a more than fourfold leftward shift of pricking pain detection (hyperalgesia) in the same skin area. As a mechanism we propose a functional switch at the spinal level based on C-fibre-induced primary afferent depolarisation resulting in presynaptic inhibition of low threshold mechanoreceptor input and an ensuing loss of tactile sensitivity. [Copyright &y& Elsevier]

• Chronic sensory loss is often associated with nerve injury. • VNS paired with tactile rehabilitation drives recovery of somatosensory function. • The tactile experience paired with VNS affects the degree of sensory recovery. • VNS-dependent recovery of sensory function generalizes to other forelimb functions. Loss of sensory function is a common consequence of neurological injury. Recent clinical and preclinical evidence indicates vagus nerve stimulation (VNS) paired with tactile rehabilitation, consisting of delivery of a variety of mechanical stimuli to the hyposensitive skin surface, yields substantial and long-lasting recovery of somatosensory function after median and ulnar nerve transection and repair. Here, we tested the hypothesis that a specific component of the tactile rehabilitation paired with VNS is necessary for recovery of somatosensory function. In a second experiment in a separate cohort, we investigated whether VNS paired with tactile rehabilitation could improve skilled forelimb motor function. Elements of the study design, including planned sample size, assessments, and statistical comparisons, were preregistered prior to beginning data collection (https://osf.io/3tm8u/). Animals received a peripheral nerve injury (PNI) causing chronic sensory loss. Eight weeks after injury, animals were given a VNS implant followed by six weeks of tactile rehabilitation sessions consisting of repeated application of one of two distinct mechanical stimuli, a filament or a paintbrush, to the previously denervated forepaw. VNS paired with either filament indentation or brushing of the paw significantly improved recovery of forelimb withdrawal thresholds after PNI compared to tactile rehabilitation without VNS. The effect size was twice as large when VNS was paired with brushing compared to VNS paired with point indentation. An independent replication in a second cohort confirmed that VNS paired with brush restored forelimb withdrawal thresholds to normal. These rats displayed significant improvements in performance on a skilled forelimb task compared to rats that did not receive VNS. These findings support the utility of pairing VNS with tactile rehabilitation to improve recovery of somatosensory and motor function after neurological injury. Additionally, this study demonstrates that the sensory characteristics of the rehabilitation paired with VNS determine the degree of recovery. [ABSTRACT FROM AUTHOR]

Trochlear schwannoma in the absence of neurofibromatosis is a rare entity. 1 These schwannomas originate usually from the intradural cisternal part of the nerve and expand in the ambient and interpeduncular cisterns as well as inferiorly in the upper part of the cerebellopontine cistern. 2 This case involves a rare pontomesencephalic lesion removed successfully via the simple retrosigmoid suboccipital route (Video 1). A 49-year-old woman presented to our institute with decreased sensation on the left side of her body for 2 months. Neurologic examination revealed left hemihypoesthesia. Cranial magnetic resonance imaging revealed a lobulated, heterogeneously enhanced cystic tumor within the right ambient cistern compressing the adjacent midbrain and extending to the cerebellopontine angle. After obtaining consent for surgery, the patient underwent a right suboccipital retrosigmoid approach for exploration and resection of the lesion. During the operation, it was determined that the tumor originated from the trochlear nerve. Nerve-sparing surgery was performed with intraoperative neuromonitoring including cranial nerve V, VII, X, XI, and XII electromyography and muscle motor evoked potentials. Gross total resection of the tumor was achieved. In the early postoperative period, the patient's eye movements were normal in all directions. The patient did not have any visual problems and experienced improvement in hemihypoesthesia. She was discharged on the third postoperative day. Pathologic examination confirmed diagnosis of schwannoma. At 2 months after surgery, the patient's eye movements were intact, and trochlear nerve palsy did not occur. The patient gave written informed consent for surgery and publication of this case report. [ABSTRACT FROM AUTHOR]

A patient suffering from a brachial plexus injury after axillary arteriography is discussed. In the pertinent literature, local complications such as hematomas or pseudoaneurysms have been reported. Herein, rendering this patient, we introduce a new type of a delayed complication after the angiography—compressive injury of the brachial plexus. [Copyright &y& Elsevier]

Objective After knee surgery, sensitive disorders due to cutaneous nerve lesions are common and often described as benign. However, some patients may experience abnormally high levels of neuropathic pain. Therefore, we explored the link between the type and intensity of sensitive disorders and neuropathic pain intensity. Material/patients and methods In a prospective comparative study, we included every patient admitted for functional rehabilitation after knee surgery in our PRM center, irrespective of the time elapsed since surgery. They were screened for the intensity and the type of pain (nociceptive or neuropathic) using a numerical pain scale, a DN4 questionnaire and a McGill questionnaire (MGQ). The patients were evaluated by a quantitative sensitivity test. First, the main sensitive disorder was qualified and mapped. Second, hypoesthesia was quantified through the pressure and vibration perception thresholds (PPT, respectively VPT), and allodynia through a color code using the monofilaments of Semmes-Weinstein. Sixty patients were evaluated and classified in two groups: 41 in a neuropathic painful group and 19 in a non-painful group. Results Our first finding was that every painful patient had an underlying sensitive disorder. For them, we found mostly hypoesthesia ( n = 31) and in some cases allodynia ( n = 9) or hyperesthesia ( n = 1). These disorders were not systematically found in the non-painful group: Three patients did not have any trouble and 16 had hypoesthesia. When comparing the painful with the non-painful group, but with the restriction of elapsed time since surgery (inferior to 6 months), we found a significant difference for PPT ( P = 0.0053) with a higher level of hypoesthesia for the painful group. Discussion – conclusion Our results suggest that hypoesthesia intensity is linked to neuropathic pain after knee surgery. Systematic quantitative sensitivity testing of neuropathic painful patients after knee surgery could be proposed to track sensitive disorders. This assessment could lead to an appropriate sensitive rehabilitation that may possibly prevent an evolution to chronic pain. [ABSTRACT FROM AUTHOR]