Recovery of nerve function after intraneural hematoma :
experimental comparative study in rats
Authors: Gean Paulo Scopel, MD, Marcus Castro Ferreira, MD, PhD, José Carlos
Marques Faria, MD, Simone Cristina Orpheu, MD, Helio R N Alves, MD, Julia
Peres, MD, and Izumi Hayashi, MD.
Purpose: An intraneural hematoma can result after trauma or
in relation to clotting disturbances. The decision for
clinical observation or descompressive surgical thecniques is
still controversial
The aim of this study is to compare the evolution of nervous
function in three situations: intraneural hematoma;
intraneural hematoma droned through epineural neurolysis and
surgical exploration of the sciatic nerve without hematoma
(CONTROL).
Methodology: Thirty Wistar rats, divided in three groups were
used in this study. In group A (n=10), an intraneural
hematoma was produced through injection of 0.2ml of blood in
the right sciatic nerve. In group B, after the production of
intraneural hematoma as in group A, epineural neurolysis with
consequent blood drainage was accomplished. The last group
(CONTROL) was used for evaluation of the isolated effects of
surgical manipulation under the nervous function. In this
group it was made exposition of the nerve without
compression.
The evaluation of nervous function was made by “walking
track” analysis and use of the sciatic functional index
(SFI) of Bain-Mackinnon-Hunter. SFI varies from 0 to -100,
representing 0+10 the normal nerve function and -100 total
absence of function.
Results: The group with isolated hematoma (A) presented
initial deficit of 28% (SFI = -28,43) of sciatic function,
with total recovery of the damaged nerve function in five
days. The group with hematoma in which epineurolysis was
accomplished (B) presented initial SFI of
-14.42, reaching
a normal index since the first postoperative day (Graphic 1).
There was a significant difference (p<0,05) between the
functional indexes among the group A and B until the fifth
postoperative day.
The functional evaluation of the control group (C) showed an
initial SFI similar to preoperative “status”.
Conclusion: The isolated presence of intraneural hematoma
provokes functional deficit, with recovery of the function in
5 days. The drainage of the hematoma by epineurolysis
generates faster recovery, with a normal sciatic function
index since the first postoperative day.
Days
0
SCIATIC FUNCTION
INDEX
1
3
5
7
11
15
19
23
27
31
46
61
-5
-10
-15
-20
-25
-30
-35
Group A
Group B
Group C
Graphic 1. Evolution of Sciatic Function Index (SFI) through the postoperative time.
References
1.
Blodgett,RC; Lipscomb,PR; Hill,RW. Incidence of haematologic
disease in patients with carpal tunnel syndrome. The Journal of the
American Medical Asssociation, 182:514-515.
2.
Brown,
CJ.;
Mackinnon,
SE.;Evans,
PJ.;Bain,
JR.;
Makino,
AP.;Hunter,DA.;
and
Hare,
GMT.
Self-evaluation
of
walking-track
measurement using a sciatic function index. Microsurgery 10:226-235,
1989.
3.
Brown, CJ.; Evans, PJ.; Mackinnon, SE.; Bain, JR.; Makino, AP.;
Hunter, DA.; and Hare, GMT. Inter- and intraobserver reliability of
walking-track analysis used to assess sciatic nerve function in rats.
Microsurgery 12:76-79, 1991.
4.
Crawford,GP.; Cordingley,FT. Ulnar nerve palsy in a haemophiliac
due to intraneural haemorhage. British Medical Journal 289:18-19.
5.
Dash, H.; Kononov, A.; Prayson, RA.; Petras, S.; Browne, EZ.
Evaluation of nerve
recovery from minimal duration crush injury. Ann
Plast Surg. 37(5): 526-531, 1996.
6.
Eversmann Jr,WW. Entrapment and Compression Neuropathies. In
Green, DP.Operative Hand Surgery.Third Edition. New York.
ChurchillLivingstone ,1993 p.1341-1354, Volume 2.
7.
Faithfull,DK; Wallace,RF. Traumatic rupture of median artery an
unusual cause for acute median nerve compression. The Journal of Hand
Surgery 12-B(2):233-235, 1987.
8.
Gentili, F.; Hudson, AR.; Hunter, D. Clinical and experimental
aspects of injection injuries of peripheral nerves. J Canadien Sciences
Neurol 7(2):143-150, 1980.
9.
Hare, GMT.; Evans, PJ.; Mackinnon, SE.; Best, TJ.; Bain, JR.;
Szalai, JP.; Hunter, DA. Walking track anlysis: a long-term assesment of
peripheral nerve recovery. Plast Reconst Surg 89(2):251-258, 1992.
10.
Hare, GMT.; Evans, PJ.; Mackinnon, SE.;Best, TJ.; Midha, R.;
Szalai, JP.; Hunter, DA. Walking track analysis: utilization of
individual footprint parameters. Ann Plast Surg 30(2):147-153, 1993.
11.
Hayden,JW; Median neuropathy in the carpal tunnel compression
caused by intraneural haemorrhage. The Journal of Bone and Joint Surgery
46A:6:1242-1244, 1964.
12.
Lundborg, G. The intrinsic vascularization of human peripheral
nerves: structural and functional aspects. J Hand Surg 4(1):34-41, 1979.
13.
Lundborg, G.; Meyers, R.; Powell, H. Nerve Compression Injury and
Increased Endoneurial Fluid Pressure: “a miniture compartment syndrome.”
J Neurol Neurosurg Psych 46: 1119-1124, 1983.
14.
Lundborg, G. Ischemic nerve injury.Experimental studies on
intraneural microvascular pathophysiology and nerve function in a limb ,
subjected to temporary circulatory arrest. Scand J Plast Reconstr Surg
Suppl :6, 1970.
15.
Lundborg,
G.
Structure
and
function
of
the
intraneural
microvessels as related to trauma, edema formation and nerve function. J
Bone Joint Surg (Am) 57:938, 1975.
16.
McCormack,LJ; Cauldwell, EW; Anson, BJ. Brachial and antibrachial
arterial patterns. Surgery, Gynecology and Obstetrics, 95:43-54, 1953.
17.
Richardson,RR; Hahn,YS; Siqueira,EB. Intraneural hematoma of the
sciatic nerve. . Neurosurg. 49:298-300, 1978.
18.
Rydevik, B.; McLean, WG.; Sjöstrand J.; Lunborg, G. Blockage of
axoplasmic transport induced by acute , graded compression of the rabbit
vagus
nerve
Apud in Lundborg, G. The intrinsic vascularization of
human peripheral nerves. Structural and functional aspects. J Hand Surg
4:34-41, 1979.
19.
Scopel,GP;
Orpheu,SC;
Ayari,NAM;
Bariani,RL;
Munhoz,AM;
Busnardo,FF. Recuperação da função nervosa após hematoma intraneural:
Estudo experimental comparativo em ratos submetidos à neurólise interna
imediata. Revista de Medicina DCCAOC. 78:346-352,1999.
20.
Seddon, HJ. Three types of nerve injury. Brain, 66:237-247, 1943.
21.
Seignon,B; Lombard, A; Elaerts,M et al. Paralysies crurales
compliquant les traitments anticoagulants. Sem. Hop Paris 52(3):159-163,
1976.
22.
Smith, JW. Factors influencing nerve repair. Arch Surg 93: 433436, 1966 .
23.
Suematsu, N. Tubulation for peripheral nerve gap: its history and
possibility. Microsurgery 10:71-74, 1989.
24.
Terris, DJ.; Fee, WE. Current issues in nerve repair. Arch
Otolaryngol Head Neck Surg 119:725-731, 1993.
25.
Wong, BJF.; Mattox, DE. Experimental nerve regeneration-a review.
Otolaryngol Clin
North Am 24(3):739-752, 1991