Selective fasciculotomy of tibial nerve at treatment of spasticity of lower limbs in infants with cerebral palsy

Authors

DOI:

https://doi.org/10.25305/unj.50268

Keywords:

infantile cererbral palsy, spasticity, tibial nerve fasciculotomy

Abstract

Objective. To assess efficacy of selective fasciculotomy and tibial nerve suture in patients with infantile cererbral palsy (ICP) in incurable spasticity of lower limbs.

Materials and methods. In 9 cases with ICP with equine-varus foot deformity 14 selective fasciculotomies and suture of transected movement fascicules of tibial nerve in upper third of shin were performed. Selective criteria was an positive bupivacaine blockage probe. EMG and functional test were used for objectification of intervention results.

Results. In 12 cases significant improvement, increase of movement rate in joints in remote period, were achieved. Transposition of tendon of m.tibialis posterior to dorsal surface of foot were performed in 2 cases. Best results determined by staging and physiotherapy.

Conclusions. Selective fasciculotomy and fascicular suture of tibial nerve in patients with ICP with incurable spasticity leads to permanent improvement of function of lower limb extremities.

References

1. Ekusheva EV, Shavlovskaya OA. [A role of the level of the nervous system lesion in the development of spasticity]. Zh Nevrol Psikhiatr Im S S Korsakova. 2013;113(4):54-6. Russian. [PubMed]

2. Pichkur LD. [Surgical tactics for spasticity of upper extremities in patients with infantile cerebral palsy]. Ukrainian Neurosurgical Journal. 2009;(1):52–58. Ukrainian. [eLIBRARY]

3. Vlasenko SV, Kushnir GM. [Catamnesis Results of Botulinum Toxin Type A Application in Patients with Cerebral Palsy with Spastic Diplegia Form within 10-year Observation Period]. Mezhdunar Nevrol Zhurn. 2011;2(40):129–136. Russian.[Publisher Full Text] [eLIBRARY]

4. Zinovyeva OE, Katushkina EA, Yakhno NN, Shenkman BS. [The alteration of skeletal muscles in post-stroke spasticity]. Nevrologichesky Zhurnal. 2011;16(4):19-26. Russian.[Publisher Full Text] [eLIBRARY]

5. Matviyenko YuO. Spastychnist: ohlyad problemy [Spasticity: Overview of the problem]. Sudynni zakhvoryuvannya holovnoho mozku. 2014;(2-3):29-34. Ukrainian.

6. Kushnir GN, SV Vlasenko SV. [Diagnostics peculiarities, approaches to therapy of patients with infantile cerebral paralysis with heavy forms of motive disorders]. Ukr Nevrolog Zhurn. 2008;(2):51-56. Russian. [eLIBRARY]

7. Wissel J, Ward A, Erztgaard P, Bensmail D, Hecht MJ, Lejeune TM, Schnider P. European consensus table on the use of botulinum toxin type A in adult spasticity. Journal of Rehabilitation Medicine. 2009;41(1):13-25. [CrossRef]

8. Stoffel A. The treatment of spastic contractures. Am J Orthop Surg. 1913;210(4):611-644.[Publisher Full Text]

9. Silfverskiold N. Reduction of the uncrossed two muscles of the leg to one joint muscle in spastic condition. Acta Chir Scand. 1924;(56):315-322.t/s2-10/4/611.

10. Ouaknine GE. [Surgical treatment of spasticity-role of selective posterior rhyzotomy]. Union Med Can. 1980 Oct;109(10):1424-44. French. [PubMed]

11. Maarrawi J, Mertens P, Luaute J, Vial C, Chardonnet N, Cosson M, Sindou M. Long-term functional results of selective peripheral neurotomy for the treatment of spastic upper limb: prospective study in 31 patients. Journal of Neurosurgery. 2006;104(2):215-225. [CrossRef]

12. Sindou M, Abdennebi B, Boisson D, Eyssette M, Goutelle A. [Treatment of spastic foot by selective neurotomy of the tibial nerve. Results of a series of 31 cases]. Neurochirurgie. 1985;31(3):189-97. French. [PubMed]

13. Pіchkur LD. [Neurosurgical treatment of cerebral palsy] [dissertation]. Kiev (Ukraine): Romodanov Neurosurgery Institute; 2007. 276 p. Ukrainian.

14. Belova AN. [Scale, tests and questionnaires in neurology and neurosurgery]. Moscow; 2004. 432 p. Russian.

15. Dekopov AV, Shabalov VA, Tomsky AA, Salova EM, Khit MA. [The neurosurgical treatment of movement disorders because of infantile cerebral paralysis] The Russian Journal of Neurosurgery. 2013;(3):30-40. Russian. http://therjn.com/ru-ru/Files/Pdf/2013/3/30.pdf. [eLIBRARY]

16. Khat’kova SE. [Current trends in the use of botulinum treatment(dysport)in post-stroke spasticity]. Russian Zh Nevrol Psikhiatr Im S S Korsakova. 2012;112(8):92-9. Russian. [PubMed]

17. Sindou M, Mertens P. Selective neurotomy of the tibial nerve for treatment of the spastic foot. Neurosurgery. 1988;23(6):738-44. [CrossRef]

Published

2015-09-16

How to Cite

Pichkur, L., & Lontkovsky, Y. (2015). Selective fasciculotomy of tibial nerve at treatment of spasticity of lower limbs in infants with cerebral palsy. Ukrainian Neurosurgical Journal, (3), 70–75. https://doi.org/10.25305/unj.50268

Issue

Section

Original articles