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. 2022 Mar 28;11(4):e705-e710.
doi: 10.1016/j.eats.2021.12.027. eCollection 2022 Apr.

Minimally Invasive Surgical Approach for Open Common Peroneal Nerve Neurolysis in the Setting of Previous Posterior Schwannoma Removal

Benjamin Kerzner  1 , Hasani W Swindell  1 , Michael P Fice  1 , Felicitas Allende  1 , Zeeshan A Khan  1 , Luc M Fortier  1 , Alan T Blank  1   2 , Jorge Chahla  1   2
Affiliations

Minimally Invasive Surgical Approach for Open Common Peroneal Nerve Neurolysis in the Setting of Previous Posterior Schwannoma Removal

Benjamin Kerzner et al. Arthrosc Tech. .

Abstract

The common peroneal nerve (CPN) runs laterally around the fibular neck and enters the peroneal tunnel, where it divides into the deep, superficial, and recurrent peroneal nerves. CPN entrapment is the most common neuropathy of the lower extremity and is vulnerable at the fibular neck because of its superficial location. Schwannomas are benign, encapsulated tumors of the nerve sheath that can occur sporadically or in cases of neurocutaneous conditions, such neurofibromatosis type 2. In cases with compressive neuropathy resulting in significant or progressive motor loss, decompression and neurolysis should be attempted. We present a technical note for the treatment of CPN compressive neuropathy in the setting of a previous ipsilateral schwannoma removal with a minimally invasive surgical approach and neurolysis of the CPN at the fibular neck.

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Figures

Fig 1
Fig 1
Surgical landmarks and approach to the left knee. (A) Pre-incision landmarks made of the left knee including the outline of the proximal fibula, common peroneal nerve (CPN) trajectory along the proximal and lateral aspect of the fibula, and the vertical incisional outline. (B) A 5 cm superficial vertical incision directly perpendicular to the common peroneal nerve trajectory is made. (C) The fascial layer is encountered deep to the skin layer and superficial to the underlying CPN sheath.
Fig 2
Fig 2
Common peroneal nerve neurolysis of the left knee. (A) A small opening in the fascia is made superficial to the nerve and released proximally and (B, C) distally around both the superior and inferior margins of the nerve. Surrounding fascial bands composing a fibrotic ring on the fibular neck are released proximal and distal to where the nerve is incised. (D) At the completion of neurolysis, the mobility of the nerve is confirmed without evidence of tethering.
See this image and copyright information in PMC

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