02493nas a2200373   4500000000100000008004100001260001300042653002200055653001500077653001000092653001000102653003700112653001100149653001400160653001100174653002400185653000900209653001700218653001600235653002200251653003900273653002300312100001300335700001600348700001700364700001400381700001100395245017600406856004100582300001100623490000700634520146400641022001402105       1995                            d  c1995 Sep10aAction Potentials10aAdolescent10aAdult10aChild10aEvoked Potentials, Somatosensory10aFemale10aGranuloma10aHumans10aLeprosy, Borderline10aMale10aMedian Nerve10aMiddle Aged10aNeural Conduction10aPeripheral Nervous System Diseases10aSpinal Nerve Roots1 aTurkof E1 aTambwekar S1 aMansukhani K1 aMillesi H1 aMayr N00aIntraoperative electroneurodiagnostics to detect a second granuloma in the cubital area of median nerves affected by leprosy: a new approach to prevent incomplete surgery.  uhttp://ila.ilsl.br/pdfs/v63n3a05.pdf  a409-160 v633 a<p>A recent work reports on the necessity to localize the most proximal site of leprous ulnar neuritis with intraoperative electroneurodiagnostics. In the present study we wanted to verify the applicability of this method on leprous median nerves. In six patients, seven median nerves were exposed at the wrist, all showing a typical leprous granuloma there. Spinal roots C5 to Th1 were then stimulated intraoperatively, evoking efferent mixed nerve compound action potentials (NCAPs) which were registered from the nerve's surface. No recordings could be obtained on the granuloma in all patients, neither distally nor shortly proximal from it, nor even further central at the forearm's proximal third where the median nerve exits the cubital area. Prior to dissecting the nerves in this precarious region, they were exposed at the arm's distal third, looking inconspicuous in all cases. Recordings could finally be obtained there, and subsequent exposure further proximal showed no increase in amplitude of the NCAPs, but there was a sharp decrease distally. In all cases, subsequent dissection of the cubital area revealed a second leprous granuloma extending variably from the distal third of the arm to the two heads of the pronator teres muscle, requiring microsurgical release. Intraoperative spinal root stimulation is an effective method to detect a second leprous granuloma and to avoid incomplete surgery in median nerves affected by leprosy.</p>
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