Dorsal root ganglionectomy for the diagnosis of sensory neuropathies. Surgical technique and results.
BACKGROUND
Inflammatory diseases stand out among sensory neuronopathies because, in their active phase, they can be treated with immunosuppressive agents. Immunosuppressive therapy may present severe adverse effects and requires previous inflammatory activity confirmation. Sensory neuronopathies are diagnosed based on clinical and EMG findings. Diagnostic confirmation and identification of inflammatory activity are based on sensory ganglion histopathological examination. We describe the surgical technique used for dorsal root ganglionectomy in patients with clinical/EMG diagnosis of sensory neuronopathies.


METHODS
The sensory ganglion was obtained from 15 patients through a small T7-T8 hemilaminectomy and foraminotomy to expose the C7 root from its origin to the spinal nerve bifurcation. In 6 patients, the dural cuff supposed to contain the ganglion was resected en bloc; and in 9 patients, the ganglion was obtained through a longitudinal incision of the dural cuff and microsurgical dissection from the ventral and dorsal roots and radicular arteries. All ganglia were histopathologically examined.


RESULTS
No ganglion was found in the dural cuff in 2 patients submitted to en bloc removal, and the ganglion was removed in all patients who underwent microsurgical dissection. All but 2 patients that had ganglion examination presented a neuronopathy of nerve cell loss, 3 with mononuclear inflammatory infiltrate. These patients underwent immunosuppressive therapy, and 2 of them presented clinical improvement. No surgical complications were observed.


CONCLUSIONS
Microsurgical dorsal root ganglionectomy for diagnosing inflammatory sensory ganglionopathies was effective and safe. Although safe, en bloc resection of the proximal dural cuff was not effective for this purpose.
Colli
Benedicto Oscar
BO
Division of Neurosurgery, Department of Surgery, Ribeirão Preto Medical School, University of São Paolo, Brazil. bocolli@fmrp.usp.br
Carlotti
Carlos Gilberto
CG
Assirati
João Alberto
JA
Lopes
Luiza da Silva
Lda S
Marques
Wilson
W
Chimelli
Leila
L
Neder
Luciano
L
Barreira
Amilton Antunes
AA
D000293:Adolescent; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D005727:Ganglia, Spinal / Q000473:pathology* / Q000601:surgery*; D015171:Ganglionectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009475:Neurons, Afferent / Q000473:pathology*; D012678:Sensation Disorders / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome