Ultrasound-guided percutaneous injection of methylene blue to identify nerve pathology and guide surgery.
OBJECT The objective of this study was to provide a technique that could be used in the preoperative period to facilitate the surgical exploration of peripheral nerve pathology. METHODS The authors describe a technique in which 1) ultrasonography is used in the immediate preoperative period to identify target peripheral nerves, 2) an ultrasound-guided needle electrode is used to stimulate peripheral nerves to confirm their position, and then 3) a methylene blue (MB) injection is performed to mark the peripheral nerve pathology to facilitate surgical exploration. RESULTS A cohort of 13 patients with varying indications for peripheral nerve surgery is presented in which ultrasound guidance, stimulation, and MB were used to localize and create a road map for surgeries. CONCLUSIONS Preoperative ultrasound-guided MB administration is a promising technique that peripheral nerve surgeons could use to plan and execute surgery.
Department of Neurological Surgery, University of California, San Francisco, California;
Joseph A
JA
Osorio
Department of Neurological Surgery, University of California, San Francisco, California;
Jonathan D
JD
Breshears
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois;
Omar
O
Arnaout
Prince of Wales Clinical School, University of New South Wales, Randwick, and Department of Neurology, St. Vincent's Hospital, Darlinghurst, New South Wales, Australia; and.
Neil G
NG
Simon
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois;
Ashley M
AM
Hastings-Robinson
Department of Anesthesia & Perioperative Care, University of California, San Francisco, California.
Pedram
P
Aleshi
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois;
Michel
M
Kliot
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007271:Injections, Intradermal; D008279:Magnetic Resonance Imaging; D008297:Male; D008751:Methylene Blue / Q000008:administration & dosage / Q000378:metabolism*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods* / Q000592:standards; D010523:Peripheral Nervous System Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000378:metabolism / Q000601:surgery*; D018084:Ultrasonography, Interventional / Q000379:methods*
D008751:Methylene Blue
MB = methylene blue; methylene blue; peripheral nerve; ultrasonography