Penn neurosurgeons are regional and national leaders in providing comprehensive medical and surgical care for the most complex disorders of the brain, spinal cord and peripheral nervous system.
The Penn Center for Peripheral Nerve Disorders evaluates and treats patients with a variety of lesions of the peripheral nervous system, the portion of the nervous system outside the brain and spinal cord. These lesions may include nerve tumors, entrapments and injuries.
Diagnostic evaluation of peripheral nerve disorders includes state-of-the-art imaging studies in neuroradiology, and electrodiagnostic studies in Penn Neurology's renowned neuromuscular division.
The multidisciplinary team at Penn Medicine provides expert medical and surgical care for:
- Benign peripheral nerve sheath tumors
- Malignant peripheral nerve sheath tumors
- Nerve entrapments
- Carpal or cubital tunnel syndrome
- Thoracic outlet syndrome (brachial plexus entrapment)
- Radial tunnel or PIN palsy
- Common peroneal nerve entrapment
- Meralgia paresthetica
- Piriformis syndrome
Many nerve injuries are evaluated and treated at the Penn Center for Peripheral Nerve Disorders, including:
- Nerve lacerations
- Brachial plexus injuries and avulsion
- Penetrating trauma
Penn neurosurgeons often perform complex nerve repairs including microsurgical nerve suture, nerve grafting and nerve transfers to repair devastating injuries such as brachial plexus trauma.
Diagnosis and Evaluation
The Penn Center for Peripheral Nerve Disorders' multidisciplinary team uses the latest advances in diagnosis and evaluation, including state-of-the-art imaging studies in neuroradiology as well as electrodiagnostic studies performed by the neuromuscular division within Penn Neurology.
The center's state of the art evaluation and diagnostic techniques include:
- MRI, CT and ultrasound imaging of peripheral nerve injuries, entrapments and tumors.
- Leading electrodiagnostic studies (EMG, NCV)
- Intraoperative nerve monitoring including nerve action potentials (NAPs), compound muscle action potentials (CMAPs), somatosensory-evoked potentials (SSEPs), motor-evoked potentials (MEPs)
Researchers in the Penn Center for Peripheral Nerve Disorders are pushing the boundaries of medical research by developing living, stretched nerve grafts in the laboratory. In preliminary studies, the grafts are able to restore function in damaged nerve segments.
These tissue-engineered, living, dorsal root ganglion axonal nerve constructs have the potential for restoring function in patients who have suffered disabling nerve and spinal cord injuries that are currently not treatable. The center, based within Penn Neurosurgery, is the longest standing and most respected center for brain injury research in the United States.
The Penn Difference
The most recent innovation in Penn's Center for Peripheral Nerve Disorders is the performance of gracilis free functional muscle transfers for restoration of movement in paralyzed upper extremities, including the hand and arm.
Gracilis free functional transfers help patients who have suffered devastating avulsion injuries, in which a ligament or tendon is pulled away from the bone at the brachial plexus. The brachial plexus is a network of nerves that originates from the spinal cord and controls muscle movements and sensation in the shoulder, arm and hand.
If no direct nerve reconstruction is possible, the multidisciplinary team from Penn Medicine's departments of neurosurgery, orthopaedics and plastic surgery perform the procedure in which the gracilis muscle is transplanted from the patient's inner thigh up to the arm to replace the paralyzed biceps muscle.
Using microsurgical techniques, the gracilis muscle's blood supply is connected to local vessels in the chest and a donor nerve from the patient's neck or chest is attached to the gracilis muscle's nerve supply. In approximately 70 percent of cases, useful elbow flexion is restored to the previously paralyzed limb.