Dual-portal endoscopic release of the transverse ligament in carpal tunnel syndrome: results of 411 procedures with special reference to technique, efficacy, and complications.
OBJECTIVE
Endoscopic release of carpal tunnel syndrome is still under debate. The main advantages of the technique are considered to be minor postoperative pain and a more rapid postoperative recovery. Disadvantages are thought to be the impossibility of a direct median nerve neurolysis and a higher surgical complication rate, including injury to the median nerve.


METHODS
The results of 411 consecutive endoscopic carpal tunnel procedures performed between March 1995 and September 2004 are presented. All patients were prospectively followed.


RESULTS
In the present series, a success rate of 98.05% was observed. There was no permanent morbidity and, in particular, there was no injury of the median nerve. In four (0.97%) patients, the preoperative symptoms did not improve. In two (0.49%) of these patients, an incomplete release of the carpal ligament occurred. In another four patients (0.97%), a switch to open surgery was required.


CONCLUSIONS
The present data prove that the endoscopic technique is a safe and reliable technique for carpal tunnel surgery. The data do not support the current discussion of a higher risk of median nerve injury with endoscopic carpal tunnel surgery. Thus, for our group, the endoscopic technique represents the therapy of choice for the primary idiopathic carpal tunnel syndrome.
Oertel
Joachim
J
Department of Neurosurgery, Hannover Nordstadt Hospital, Hannover Medical School, Hannover, Germany. oertelj@freenet.de
Schroeder
Henry W S
HW
Gaab
Michael R
MR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002348:Carpal Bones / Q000033:anatomy & histology / Q000503:physiopathology; D050824:Carpal Joints / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002349:Carpal Tunnel Syndrome / Q000503:physiopathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000295:instrumentation* / Q000379:methods; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D008022:Ligaments / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008029:Lighting / Q000295:instrumentation / Q000379:methods; D008297:Male; D008475:Median Nerve / Q000293:injuries / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000295:instrumentation* / Q000379:methods; D010149:Postoperative Pain / Q000503:physiopathology / Q000517:prevention & control; D010292:Paresthesia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D020127:Recovery of Function / Q000502:physiology; D016896:Treatment Outcome