Miller/UHealth Team Defines New Surgical Technique for Removing Neuromas

A collaborative report encompassing three University of Miami Miller School of Medicine and UHealth departments highlights a new technique for surgically accessing sensory nerves and neuromas. Published online ahead of print in the journal Neurosurgery, the report is the first to illustrate the use of pre-operative ultrasound combined with specialized needle placement to localize the infrapatellar branches of the saphenous nerve (IPBSN).

Led by senior author Allan D. Levi, M.D., Ph.D., professor of neurological surgery, the publication “Ultrasound-guided Needle Localization of the Saphenous Nerve for Removal of Neuroma in the Infrapatellar Branches: Technical Report” describes two cases in which ultrasound guidance was effectively used to localize the saphenous nerve and its branches to facilitate operative treatment for patients with painful neuromas.

Neuroma formation in the IPBSN, a potential complication of arthroscopic knee surgery and trauma, can be improved with resection, Levi says, but navigating the nerve trunk and its tortuous branches can be challenging.

“Although ultrasound is a widely accepted and commonly used imaging modality, our report is the first to use this combined technique to aid the resection of neuromas within small painful sensory nerves,” Levi said. “The new technique shortened operative times, dissection and the size of the surgical incision.”

Anatomical dissections of cadavers were used to create a detailed neuroanatomical roadmap for the team, which also included Lee Kaplan, M.D., professor of orthopaedics and Chief of UHealth Sports Medicine, and first author Jean Jose, D.O., associate professor of clinical radiology.

Under the direction of Jose, ultrasound-guided needle localization was performed using a 12 MHz linear array transducer on a Philips iU22 scanner. Through sonographic visualization, the needle was strategically placed into the soft tissue surrounding the saphenous nerve, and patients were transported to the operating room for surgical resection with the needle in place.

By dissecting along the needle, the surgical team was able to avoid damage to neighboring structures, a common downfall of such an intricate procedure. Needle localization also eliminated the need to meticulously search through subcutaneous tissue, leading to shorter operative times.

“The size and distribution of human sensory nerves is incredibly variable,” Levi said. “With the advent of this ultrasound-assisted technique for localization developed at the Miller School of Medicine, surgical approaches for sensory nerve entrapments will be facilitated and provide patients with the best treatment options and outcomes.”

Other co-authors of the report include orthopaedic surgery resident Marvin Khalid Smith, M.D., and Bryson Lesniak, M.D., assistant professor of clinical orthopaedics.

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