Areas of Expertise

Peripheral Nerve Surgery

Treats nerve lesions surgically: compressive neuropathies, nerve injuries & nerve tumors. A highly specialized field is the surgery of brachial & lumbar plexus lesions (brachial plexus & lumbosacralis plexus lesions).

I cover the complete spectrum and also use self- developed diagnostic- & surgical techniques.

Nerve Injuries- traumatic nerve lesions

Injuries to the peripheral nerves, are not infrequent, irrespective if acquired during daily live activities or surgical procedures (iatrogenic injuries). They can have deep impact on quality of life and working force. Besides the loss of functionality they are often painful (pain of nerve origin, neuropathic pain). Regarding the appropriate treatment of such lesions, also if substantial, frequently insecurity prevails, especially amongst physicians: if there is no functional improvement during an observational course, the microsurgical treatment options are very often neglected or downrated. We use the whole microsurgical armamentarium of modern peripheral nerve reconstruction: microsurgical neurolysis (using a surgical microscope), graft & split graft repair, nerve transfer and selected tendon transfers (motor replacement surgery). Prior to surgery it is essential to recognize the type of injury, and judge if there is a real chance for spontaneous recovery or not. This also depends on nerve affected and injury mechanism. In order to decide if surgery could be helpful to improve function it is essential for me to ascertain case history and have the opportunity for a thorough physical examination.  The decision is very much helped by high frequency nerve ultrasound, magnetic resonance imaging (MRI) and electrophysiology.

Nerve tumors & Neurofibromatosis

Often nerve tumors are not recognized as such and therefore are not treated appropriately. So called benign peripheral nerve sheath tumors (PNST) like schwannomas and neurofibromas, can mostly be removed with no or minimal loss of function, if the proper microneurosurgical techniques and intraoperative stimulation techniques (intraoperative monitoring) are used.

Patients with neurofibromatosis are suffering from a genetic disorder that manifests itself with multiple tumors and other changes to the body that can be inherited in 50% of the cases. There are several types of neurofibromatosis, which completely differ in their appearance (e.g. NF type I or type II, or type III/schwannomatosis). An important aspect of the consultation is monitoring of the course, and evaluation of new or changing growths. So it will be decided, which of the tumors need to be surgically removed, and what time interval is chosen for next follow-up and imaging. Many of  the patients with neurofibromatosis are counseled to undergo genetic evaluation, especially if there is a wish to have children. For patients with neurofibromatosis we offer to connect to colleagues of the other necessary disciplines (“neurofibromatosis network”). Due to the lavish assessment of images and previous, we kindly ask to supply these in advance.

Compressive neuropathies & Thoracic-outlet Syndrome

The most frequent compressive neuropathy is carpal tunnel syndrome. The complaints are due to compression of the median nerve at the level of the proximal palm of the hand underneath the retinaculum flexorum (transverse carpal tunnel ligament). Surgery transects this ligament, and thus the nerve gains its space again and can recover. Such an operation is called ”nerve decompression”. There are many other compressive neuropathies at other locations. The principle of surgical treatment is similar - “gain space by decompression“. Very special is the diagnosis and treatment of the neurogenic Thoracic-outlet Syndrome (TOS), a compression neuropathy of the lower elements of the brachial plexus. A sophisticated diagnostic regime is decisive to include or exclude this diagnosis in cases of therapy resistant shoulder-arm pain with or without neurological deficits (e.g. atrophy of small hand muscles of median and ulnar nerve  innervated muscles).

Keywords

• Plexus surgery, brachial plexus, lumbosacral plexus
• Thoracic-outlet syndrome, TOS
• Metastasis to brachial plexus
• Schwannoma& Neurofibroma
• Peripheral nerve sheath tumor, PNST
• Nerve grafting (transplantation), nerve reconstruction
• Carpal tunnel syndrome, CTS
• Cubital tunnel syndrome, CUTS, ulnar sulcus syndrome
• Piriformis syndrome
• Incisura scapulae syndrome
• Intraneural ganglion cyst
• Reconstructive neurosurgery
• Neurofibromatosis