Ultrasound-guided percutaneous injection of methylene blue to identify nerve pathology and guide surgery

Author:

Osorio Joseph A.1,Breshears Jonathan D.1,Arnaout Omar2,Simon Neil G.3,Hastings-Robinson Ashley M.2,Aleshi Pedram4,Kliot Michel2

Affiliation:

1. Department of Neurological Surgery, University of California, San Francisco, California;

2. Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois;

3. 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

4. Department of Anesthesia & Perioperative Care, University of California, San Francisco, California

Abstract

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.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

Neurology (clinical),General Medicine,Surgery

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