NEUROMA

From Big Medical Encyclopedia

NEUROMA (neuroma, grech, neuron a nerve + - oma) — tumorous, preferential regenerative growth of nervous trunks. Along with true N. distinguish false, to-rye consist preferential of connecting, mucous or fatty tissue and are connected with nerves (neurofibromas, neuromyxomas, neurolipomas).

Depending on dominance of nerve fibrils or cells distinguish fibrillar, cellular and ganglionic true N., and depending on extent of differentiation of the cells making a tumor — mature and unripe. In most cases N. is result of an injury of a nerve, amputations of an extremity, edges can be followed by emergence of trailer (amputating) intra barreled, side or pristenochny N. N.'s formation is influenced by the nature of processing of a stump of a nerve (mechanical, physical, chemical, combined).

Fig. 1. The diagrammatic representation of the regeneration neuroma of the central end of a nerve formed after a full anatomic break of a nerve.
Fig. 2. Microdrug of a traumatic neuroma: growth of dense connecting fabric (1) between nerve fibrils (2) is visible; coloring hematoxylin - peak - rofuksinom, x 300
Mikropreparat of a posttraumatic neuroma: growths of nerve fibrils and cicatricial fabric; triple coloring according to Masson; X 60.

Histologically traumatic N. consists of accumulations of flasks of growth, Perrikonchito's spirals and axial cylinders which are growing from the cut nervous trunk, having the most various direction and situation (fig. 1). Around nervous elements a large amount of connecting tissue of Endo of a perineurium (fig. 2) is noted. Often inflammatory infiltrates, the phenomena of an endarteritis of vessels of a nerve, an union of epinevralny connecting fabric with surrounding muscles, an adjacent bone are found.

At the same time if in the central part H. inflammatory changes often prevail, then on the periphery connecting fabric is more developed, the regenerated posterior nervous pyramids quite often meet. Depending on the term of amputation the size of a neuroma and development of nervno-dis-trophic process are various.

In 2 weeks after amputation a large number of flasks of growth and spirals already comes to light. In 1 — 2 month dystrophy of fabric accrues, chaoticity of an arrangement of the fibers forming the confused ball with a large number of flasks of growth and spirals amplifies. In a year a bigger number of flasks of growth and spirals among powerfully developed connecting fabric is defined.

It is supposed that there is a communication of amputating pains with N.'s germination in a hem and infringement of axons cicatricial connecting fabric.

Clinically N. after amputation can be shown by a pain syndrome in the form of amputating, stump neuralgias, more rare kauzalgiya (see). At stump neuralgias of N. are quite often combined with diseases stumps of an extremity (see) — hron. narusheniyekhm blood circulations and trophic frustration in soft tissues, osteoporosis. A pain syndrome of subjects vyrazhenny, than big prescription of wound more roughly the connecting fabric formed around a nerve.

The diagnosis is based on existence of the trailer tumor of a nerve defined at a palpation, quite often sharply painful, amputating or stump neuralgia and also on data of a low-voltage X-ray analysis, electrox-ray analysis, the electrodiagnoses allowing to specify intra stem

N. N. character are subject to treatment at permanent dysfunction of a nerve, existence of a pain syndrome and in cases when oHPi interfere with prosthetics of an extremity. More often it takes place at N. soldered to surrounding fabrics or soldered to a bone oiil or at N. surrounded with extensive hems. Unlike soldered mobile N. meet, to-rye have rounded shape, are painless and often do not demand treatment. Conservative treatment precedes operation and consists in reception of analgetics, spasmolysants, the desensibilizing drugs, vitamins. For the purpose of an analgesia apply physiotherapeutic methods (UVCh, diadynamic currents, an electrophoresis, dirt, massage), compresses, salve dressings, at severe and persistent pains — a roentgenotherapy, novocainic blockade. The effect of blockade is extended with chemical denervation alcohol, phenol, siaz-molitiny. At unsuccessfulness of conservative treatment of N. delete with the subsequent sewing together of separate yarns of a nerve by means of atraumatic needles and the microneurosurgical equipment (see. Microsurgery ).

Prevention of a pain syndrome and early education of N. at amputations of an extremity is the corresponding processing of a stump of a nerve. Higher is for this purpose recommended (8 — 10 cm above than the level of amputation) its atraumatic section, the prevention of involvement of a stump of a nerve in a hem and its infringements, the prevention of development of an infection in a stump, prevention of generalization of a pain syndrome by use of early operations on a nerve.



Bibliography: Grigorovich K. A. Surgery of nerves, JI., 1969; Experience of the Soviet medicine in the Great Patriotic War of 1941 — 1945, t. 20, M., 1952; Favorskii B. A. To a question of a histopathology of traumatic neuromas, Arkh. biol, sciences, t. 33, No. 3-4, page 573, 1933; In of a d-1 e at W. G. Disorders of peripheral nerves, Oxford, 1974; The peripheral nervous system, ed. by J. I. Hubbard, N. Y., 1974; Swanson A. B., Boeve N. R. a. Lumsden R. M. The prevention and treatment of amputation neuromata by silicone capping, J. Hand Surg., v. 2, p. 70, 1977.


V. S. Mikhaylovsky.

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