Language：English   Publishing type：Research paper (scientific journal)  

Tarsal tunnel syndrome is an entrapment neuropathy at the tarsal tunnel. The diagnosis and the prediction of the surgical outcome are difficult. We compared preoperative magnetic resonance imaging findings with the postoperative results. We examined preoperative magnetic resonance imaging findings in 38 consecutive patients with Tarsal tunnel syndrome (47 feet); their mean age was 73.8 years. We inspected the nerve width on the slice showing the most compressed nerve, and the hyperintensity of that nerve on preoperative T2* fat-suppressed axial magnetic resonance imaging images and examined the role of magnetic resonance imaging in the diagnosis and of the surgical outcomes in patients with Tarsal tunnel syndrome. Postoperatively, there was significant symptom improvement. On preoperative magnetic resonance imaging scans the mean width of the most compressed nerve was 0.99 ± 0.37 mm. There was no significant correlation between the preoperative symptom severity and postoperative symptom improvement. In 29 feet (61.7%) we observed hyperintensity of the compressed nerve. In all but one foot the hyperintense area was displayed on 3 axial slices adjacent to the strongest nerve compression point. There was no significant difference in the preoperative symptom severity in patients with (group 1, n = 29) or without hyperintensity (group 2, n = 18). The nerve width at the point of greatest compression was significantly thinner, and postoperative symptom improvement was significantly greater in group 1 patients. Although there was no correlation between the preoperative nerve compression severity and the surgical results, nerve hyperintensity on magnetic resonance imaging scans may help with the diagnosis of Tarsal tunnel syndrome.

DOI： 10.2176/jns-nmc.2025-0115

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Language：English   Publishing type：Research paper (scientific journal)  

Shaggy aorta refers to an aorta with intimal roughening due to atheromatous aortic plaques. Catheterization and anticoagulation therapy can result in cholesterol emboli, potentially leading to systemic organ infarction. Contrast-enhanced computed tomography (CT) and transesophageal echocardiography are commonly used to diagnose shaggy aorta. A patient in his ninth decade of life had a history of right occipital lobe ischemic stroke, bilateral internal carotid artery stenosis, and shaggy aorta syndrome related to transfemoral cerebral angiography. Dysarthria occurred immediately after the procedure. Brain magnetic resonance imaging (MRI) confirmed cerebral infarction, and anticoagulant therapy was administered. Four days later, after observing numbness of the left 5th finger and purplish discoloration of the tips of the 2nd and 5th fingers, we performed contrast-enhanced CT and diagnosed shaggy aorta. There was no renal impairment or eosinophilia and the patient was discharged 16 days after the examination. Aortic MRI performed 1 month later revealed an unstable plaque in the vessel wall. Although we report our experience with a single patient, we recommend that patients scheduled for cerebral angiography, especially those with severe arteriosclerosis, undergo preprocedural aortic fast spoiled gradient echo MRI screening to avoid shaggy aorta syndrome.

DOI： 10.1272/jnms.JNMS.2025_92-503

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Language：English   Publishing type：Research paper (scientific journal)  

Lower back and lower limb pain can hamper the rehabilitation of cerebral stroke patients. We report that peripheral nerve blocks enabled two patients to continue rehabilitation. Case 1 was an 83-year-old female with left hemiparesis due to cerebral infarction of the right basal ganglia. Rehabilitation started on the day after the stroke onset. On the 7th post-stroke day, she reported right buttock and dorsal thigh pain. Lumbar MRI demonstrated no lumbar spinal canal stenosis and no nerve impingement. The middle cluneal nerve block alleviated her buttock pain. On the 29th post-stroke day, she suffered severe pain on the medial side of the right knee. Blocking the infrapatellar branch of the saphenous nerve lessened that pain, she was able to walk without assistance, and rehabilitation was resumed. Case 2 was an 87-year-old female with sudden-onset left hemiparesis due to cardiogenic cerebral infarction. Intravenous thrombolysis and mechanical thrombectomy were performed. She presented with left hemiparesis due to infarcts at the right basal ganglia and the right temporal and parietal lobes. Her chronic low back pain worsened after admission and walking was difficult. Bilateral superior and middle cluneal nerve blocks improved her right lower back pain. Left low back pain was alleviated by sacroiliac joint blockage and rehabilitation was possible due to the absence of back pain. The strain on the lower back and lower limbs attributable to paresis due to stroke may lead to entrapment neuropathy. Peripheral nerve blockage is relatively simple and safe and may be useful in acute stroke patients whose rehabilitation is difficult due to pain.

DOI： 10.7759/cureus.68114

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Language：English   Publishing type：Research paper (scientific journal)  

The flexor digitorum accessorius longus muscle (ALM) can be overlooked as the eliciting factor in patients with tarsal tunnel syndrome (TTS), an entrapment neuropathy of the posterior tibial nerve that elicits sole numbness and pain. Most elicitations are idiopathic, however, mass lesions within the tarsal tunnel can be also implicated. We report an 80-year-old woman whose flexor digitorum ALM led to the onset of bilateral TTS. She had suffered numbness in both soles for 3 years. Magnetic resonance imaging (MRI) of the bilateral tarsal tunnel showed that the posterior tibial nerve was compressed by the arteriovenous complex and in contact with the flexor digitorum ALM. We diagnosed bilateral TTS based on her symptoms and imaging findings, and performed bilateral decompression surgery of the posterior tibial nerve under local anesthesia. The artery on both sides was dislocated for nerve decompression. Because the posterior tibial nerve on the right side was strongly compressed in ankle plantar flexion we excised a portion of the tendon compressing the nerve. Postoperatively her symptoms gradually improved and she reported surgical satisfaction 6 months after the operation. In patients with flexor digitorum ALM-related TTS, the effect of dynamic factors on MRI findings and on surgical treatment decisions must be considered. Intraoperatively, not only the flexor digitorum ALM, but also other potential etiologic factors eliciting TTS must be kept in mind.

DOI： 10.2176/jns-nmc.2023-0136

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Tarsal tunnel syndrome (TTS) is a common entrapment neuropathy that is sometimes elicited by ganglia in the tarsal tunnel. METHODS: Between August 2020 and July 2022, we operated on 117 sides with TTS. This retrospective study examined data from 8 consecutive patients (8 sides: 5 men, 3 women; average age 67.8 years) with an extraneural ganglion in the tarsal tunnel. We investigated the clinical characteristics and surgical outcomes for these patients. RESULTS: The mass was palpable through the skin in 1 patient, detected intraoperatively in 1 patient, and visualized on MRI scanning in the other 6 patients. Symptoms involved the medial plantar nerve area (n = 5), lateral plantar nerve area (n = 1), and medial and lateral plantar nerve areas (n = 2). The interval between symptom onset and surgery ranged from 4 to 168 months. Adhesion between large (≥20 mm) ganglia and surrounding tissue and nerves was observed intraoperatively in 4 patients. Of the 8 patients, 7 underwent total ganglion resection. There were no surgery-related complications. On their last postoperative visit, 3 patients with a duration of symptoms not exceeding 10 months reported favorable outcomes. CONCLUSIONS: Because ganglia eliciting TTS are often undetectable by skin palpation, imaging studies may be necessary. Early surgical intervention appears to yield favorable outcomes.

DOI： 10.1272/jnms.JNMS.2024_91-203

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Language：Japanese   Publisher：The Japanese Society of Spinal Surgery  

DOI： 10.2531/spinalsurg.39.207

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