-
Surgical Neurology International 2020Perineural invasion (PNI) and spread are one of the grimmest prognostic factors associated with primary skin and head-and-neck cancers, yet remain an often confused, and... (Review)
Review
BACKGROUND
Perineural invasion (PNI) and spread are one of the grimmest prognostic factors associated with primary skin and head-and-neck cancers, yet remain an often confused, and underreported, phenomenon. Adding complexity to reaching a diagnosis and treating perineural spread (PNS) is the finding that patients may have no known primary tumor, history of skin cancer, and/or incidental PNI in the primary tumor. These delays in diagnosis and treatment are further compounded by an already slow disease process and often require multidisciplinary care with combinations of stereotactic radiosurgery, surgical resection, and novel treatments such as checkpoint inhibitors.
METHODS
Six patients with metastatic cancer to the cranial nerves who underwent Gamma Knife radiosurgery (GKRS) treatment were chosen for retrospective analysis. This information included age, gender, any past surgeries (both stereotactic and regular surgery), dose of radiation and volume of the tumor treated in the GKRS, date of PNS, comorbidities, the patient follow-up, and pre- and post-GKRS imaging. The goal of the follow-up with radiographing imaging was to assess the efficacy of GKSS.
RESULTS
The clinical course of six patients with PNS is presented. Patients followed variable courses with mixed outcomes: two patients remain living, one was lost to follow-up, and three expired with a median survival of 12 months from date of diagnosis. Patients at our institution are ideally followed for life.
CONCLUSION
Given the morbidity and mortality of PNS of cancer, time is limited, and further understanding is required to improve outcomes. Here, we provide a case series of patients with PNS treated with stereotactic radiosurgery, discuss their clinical courses, and review the known literature.
PubMed: 32874709
DOI: 10.25259/SNI_146_2020 -
Skeletal Radiology Oct 2023The T12 to S4 spinal nerves form the lumbosacral plexus in the retroperitoneum, providing sensory and motor innervation to the pelvis and lower extremities. The... (Review)
Review
The T12 to S4 spinal nerves form the lumbosacral plexus in the retroperitoneum, providing sensory and motor innervation to the pelvis and lower extremities. The lumbosacral plexus has a wide range of anatomic variations and interchange of fibers between nerve anastomoses. Neuropathies of the lumbosacral plexus cause a broad spectrum of complex pelvic and lower extremity pain syndromes, which can be challenging to diagnose and treat successfully. In their workup, selective nerve blocks are employed to test the hypothesis that a lumbosacral plexus nerve contributes to a suspected pelvic and extremity pain syndrome, whereas therapeutic perineural injections aim to alleviate pain and paresthesia symptoms. While the sciatic and femoral nerves are large in caliber, the iliohypogastric and ilioinguinal, genitofemoral, lateral femoral cutaneous, anterior femoral cutaneous, posterior femoral cutaneous, obturator, and pudendal nerves are small, measuring a few millimeters in diameter and have a wide range of anatomic variants. Due to their minuteness, direct visualization of the smaller lumbosacral plexus branches can be difficult during selective nerve blocks, particularly in deeper pelvic locations or larger patients. In this setting, the high spatial and contrast resolution of interventional MR neurography guidance benefits nerve visualization and targeting, needle placement, and visualization of perineural injectant distribution, providing a highly accurate alternative to more commonly used ultrasonography, fluoroscopy, and computed tomography guidance for perineural injections. This article offers a practical guide for MR neurography-guided lumbosacral plexus perineural injections, including interventional setup, pulse sequence protocols, lumbosacral plexus MR neurography anatomy, anatomic variations, and injection targets.
Topics: Humans; Magnetic Resonance Imaging; Lumbosacral Plexus; Nerve Block; Lower Extremity; Pain
PubMed: 37495713
DOI: 10.1007/s00256-023-04384-7 -
American Journal of Cancer Research 2019Perineural invasion (PNI) can be found in a variety of malignant tumors. It is a sign of tumor metastasis and invasion and portends the poor prognosis of patients. The... (Review)
Review
Perineural invasion (PNI) can be found in a variety of malignant tumors. It is a sign of tumor metastasis and invasion and portends the poor prognosis of patients. The pathological description and clinical significance of PNI are clearly understood, but exploration of the underlying molecular mechanism is ongoing. It was previously thought that the low-resistance channel in the anatomic region led to the occurrence of PNI. However, with rapid development of precision medicine and molecular biology, we have gradually realized that the occurrence of PNI is not the result of a single factor. The latest study suggests that PNI of cancer is a continuous and multistep process. A specific peripheral microenvironment, also called the perineural niche, is formed by neural cells, supporting cells, recruited inflammatory cells, altered extracellular matrix, blood vessels, and immune components in the background of carcinoma. Various soluble signaling molecules and their receptors comprise a complex signal network, which achieves the interaction between nerve and tumor. Nerve cells and tumor cells can interact directly or through the opening and closing of the signal transduction pathways and/or the recognition and response of the ligands and receptors. The information is transferred to the targets accurately and effectively, leading to the specific interactions between the nerve cells and the malignant tumor cells. PNI occurs through changes in nerve cells and supporting cells in the background of cancer; change and migration of the perineural matrix; enhancement of the viability, mobility, and invasiveness of the tumor cells; injury and regeneration of nerve cells; interaction, chemotactic movement, contact, and adherence of the nerve cells and the tumor cells; escape from autophagy, apoptosis, and immunological surveillance of tumor cells; and so on. Certainly, exploring the mechanism of PNI clearly has great significance for blocking tumor progression and improving patient survival. The current review aims to elucidate the cellular and molecular mechanisms of PNI, which may help us find a strategy for improving the prognosis of malignant tumors.
PubMed: 30755808
DOI: No ID Found -
Canadian Journal of Anaesthesia =... Jun 2015Perineural steroids are often used to treat chronic peripheral neuropathic pain (NP) secondary to trauma or compression. Nevertheless, when compared with local... (Comparative Study)
Comparative Study Meta-Analysis Review
PURPOSE
Perineural steroids are often used to treat chronic peripheral neuropathic pain (NP) secondary to trauma or compression. Nevertheless, when compared with local anesthetics (LA) or conventional medical management (CMM), their efficacy and safety in patients with trauma or compression-related neuropathic pain syndromes is unclear. The purpose of this systematic review and meta-analysis was to determine the efficacy and safety of perineural steroids in compression or trauma-related NP after one to three months of injection.
SOURCE
We reviewed randomized controlled trials from MEDLINE(®), EMBASE™, Cochrane central register of controlled trials, Cochrane database of systematic reviews, and Google Scholar (first 200 hits) up to April 2014 that compared perineural injections of steroids with LA or CMM in adult patients with trauma or compression-related chronic peripheral NP. A meta-analysis was performed on the data on pain scores measured at one to three months after the interventions. Quality of evidence was classified using the GRADE system. Two authors independently reviewed all identified titles and abstracts for eligibility.
PRINCIPAL FINDINGS
Five trials comprising 353 patients (177 in the steroid group and 176 in the comparator groups) were included. At one to three months after the interventions, patients who received perineural steroids reported lower pain scores than those who received LA or CMM (mean difference: -1.31 points on a 0-10 numerical rating scale for pain; 95% confidence interval: -2.50 to -0.13; quality of evidence: low; I(2) = 89%). None of the studies reported any significant adverse effects.
CONCLUSIONS
Perineural steroids may provide analgesic efficacy for one to three months in patients with chronic peripheral NP of traumatic or compressive origin; however, the strength of this recommendation is weak. Well-designed large randomized studies are required.
Topics: Adult; Anesthetics, Local; Glucocorticoids; Humans; Injections; Neuralgia; Randomized Controlled Trials as Topic; Time Factors
PubMed: 25744141
DOI: 10.1007/s12630-015-0356-5 -
American Journal of Stem Cells 2021Most epithelium tissues continuously undergo self-renewal through proliferation and differentiation of epithelial stem cells (known as homeostasis), within a specialized... (Review)
Review
Most epithelium tissues continuously undergo self-renewal through proliferation and differentiation of epithelial stem cells (known as homeostasis), within a specialized stem cell niche. In highly innervated epithelium, peripheral nerves compose perineural niche and support stem cell homeostasis by releasing a variety of neurotransmitters, hormones, and growth factors and supplying trophic factors to the stem cells. Emerging evidence has shown that both sensory and motor nerves can regulate the fate of epithelial stem cells, thus influencing epithelium homeostasis. Understanding the mechanism of crosstalk between epithelial stem cells and neurons will reveal the important role of the perineural niche in physiological and pathological conditions. Herein, we review recent discoveries of the perineural niche in epithelium mainly in tissue homeostasis, with a limited touch in wound repair and pathogenesis.
PubMed: 34849302
DOI: No ID Found -
Journal of Korean Medical Science Jun 2023Interscalene brachial plexus block (ISB) is a common regional technique to manage acute postoperative pain for arthroscopic rotator cuff tear repair. However, rebound... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Interscalene brachial plexus block (ISB) is a common regional technique to manage acute postoperative pain for arthroscopic rotator cuff tear repair. However, rebound pain may compromise its overall benefit. Our aim was to investigate the primary hypothesis that perineural and intravenous dexamethasone have different effects on rebound pain after resolution of ISB for arthroscopic rotator cuff tear repair.
METHODS
Patients aged ≥ 20 years scheduled for elective arthroscopic rotator cuff tear repair under general anesthesia with preoperative ISB were included. The participants were randomized to receive dexamethasone either perineurally (perineural group) or intravenously (intravenous group). In the perineural group, patients received ISB with 12 mL of 0.5% ropivacaine containing 5 mg of dexamethasone; simultaneously, 1 mL of 0.9% normal saline was administered intravenously. In the intravenous group, patients received ISB with 12 mL of 0.5% ropivacaine; simultaneously, 1 mL of dexamethasone 5 mg was administered intravenously. The primary outcome was the difference in the pain score (0-10 on numeric rating scale) between before and after ISB resolution. The secondary outcomes were the incidence of rebound pain; onset, duration, and intensity of rebound pain; time to the first analgesic request; and pain-related sleep disturbance.
RESULTS
A total of 71 patients were randomized to either perineural group (n = 36) or intravenous group (n = 35). After block resolution, pain scores increased significantly more in the perineural group (mean ± standard deviation, 4.9 ± 2.1) compared to the intravenous group (4.0 ± 1.7, = 0.043). The duration of ISB was more prolonged in the perineural group (median [interquartile range], 19.9 [17.2-23.1] hours) than the intravenous group (15.1 [13.7-15.9] hours, < 0.001). The incidence of rebound pain and pain-related sleep disturbance during the first postoperative week was significantly higher in the perineural group than in the intravenous group (rebound pain: 44.4% vs. 20.0%, = 0.028; sleep disturbance: 55.6% vs. 25.7%, = 0.011). The duration and intensity of rebound pain were similar between the two groups.
CONCLUSION
Although perineural dexamethasone provided longer postoperative analgesia, intravenous dexamethasone was more beneficial in reducing pain increase after ISB resolution, incidence of rebound pain, and pain-related sleep disturbance.
TRIAL REGISTRATION
Clinical Research Information Service Identifier: KCT0006795.
Topics: Humans; Brachial Plexus Block; Ropivacaine; Anesthetics, Local; Rotator Cuff Injuries; Pain, Postoperative; Arthroscopy; Dexamethasone
PubMed: 37337808
DOI: 10.3346/jkms.2023.38.e183 -
Neuroimaging Clinics of North America Nov 2021Perineural extension is an increasingly recognized pathway of extension of cutaneous, mucosal, and salivary gland neoplasms associated with a severe adverse prognosis.... (Review)
Review
Perineural extension is an increasingly recognized pathway of extension of cutaneous, mucosal, and salivary gland neoplasms associated with a severe adverse prognosis. Imaging identification is feasible by MR imaging 3-dimensional contrast-enhanced submillimetric sequences. The trigeminal nerve branches and facial nerve are the most commonly involved. PET with computed tomography may aid in the identification of the primary tumor location or recognition of recurrence, but only in conjunction with MR imaging does it achieve similar detection rates for perineural extension. Computed tomography scanning is an adjunct to MR imaging to increase specificity and for surgical treatment planning.
Topics: Cranial Nerve Neoplasms; Head and Neck Neoplasms; Humans; Magnetic Resonance Imaging; Neoplasm Recurrence, Local; Skull Base Neoplasms
PubMed: 34689928
DOI: 10.1016/j.nic.2021.05.007 -
Journal of Neurological Surgery. Part... Apr 2016Head and neck malignancies with orbital involvement present difficult decisions to the treating physician. When the spread is perineural, the challenges are greater due... (Review)
Review
Head and neck malignancies with orbital involvement present difficult decisions to the treating physician. When the spread is perineural, the challenges are greater due to the incipient nature of the spread and the fact that the orbit can also be involved by centrifugal spread from the non-ophthalmic branches of the trigeminal nerve. The disease is often misdiagnosed and the subsequent delay in treatment results in worse outcomes. This article discusses the evaluation of the eye and the many facets of orbital involvement by perineural spread of malignancy including the treatment of complications.
PubMed: 27123389
DOI: 10.1055/s-0036-1582239 -
Survey of Ophthalmology 2021A 69-year-old woman presented with chronic, painful, progressive binocular diplopia. Examination showed deficits in multiple sequential cranial nerves (II, III, IV, V,...
A 69-year-old woman presented with chronic, painful, progressive binocular diplopia. Examination showed deficits in multiple sequential cranial nerves (II, III, IV, V, and VI). She was initially diagnosed with Tolosa-Hunt syndrome and had a partial response to systemic corticosteroids. Skull base biopsy eventually showed poorly differentiated carcinoma consistent with perineural spread of squamous cell carcinoma.
Topics: Aged; Biopsy; Diagnosis, Differential; Diplopia; Female; Humans; Magnetic Resonance Imaging; Ophthalmoplegia; Tolosa-Hunt Syndrome
PubMed: 33129799
DOI: 10.1016/j.survophthal.2020.10.005 -
Life (Basel, Switzerland) Jun 2023Basal cell carcinoma (BCC) is a malignant tumor with a rising incidence and is the beneficiary of several innovative evaluation techniques. Histopathology remains the...
Basal cell carcinoma (BCC) is a malignant tumor with a rising incidence and is the beneficiary of several innovative evaluation techniques. Histopathology remains the gold standard for assessment, having the possibility of addressing multiple high-risk factors such as perineural invasion (PNI). The current study included a number of 244 BCC patients and targeted the identification of positive PNI and its suggestive signs, and whether they correlated or not with other high-risk tumor signs. PNI was found in 20.1% of patients, with 30.7% of patients having perineural chronic inflammation (PCI), which is a suggestive sign of PNI. PNI was also found in larger tumors, with deeper Clark levels, in high-risk BCCs and high-grade tumors. PNI and PCI are both important for pathology reporting, aiding in treatment choice and further patient management, with possibly positive outcomes concerning morbidity and mortality.
PubMed: 37374188
DOI: 10.3390/life13061406