Abstract
Introduction/Aims:
Neuromas come in different shapes and sizes; yet the correlationbetween neuroma morphology and symptomatology is unknown. Therefore, we aimto investigate macroscopic traits of excised human neuromas and assess the validityof a morphological classification system and its potential clinical implications.
Methods:
End-neuroma specimens were collected from prospectively enrolledpatients undergoing symptomatic neuroma surgery. Protocolized images of the speci-mens were obtained intraoperatively. Pain data (Numeric rating scale, 0-10) wereprospectively collected during preoperative interview, patient demographic andcomorbidity factors were collected from chart review. A morphological classificationis proposed, and the inter-rater reliability (IRR) was assessed. Distribution of neuromamorphology with patient factors, was described.
Results:
Forty-five terminal neuroma specimens from 27 patients were included.Residual limb patients comprised 93% of the population, of which 2 were upper(8.0%) and 23 (92.0%) were lower extremity residual limb patients. The proposedmorphological classification, consisting of three groups (bulbous, fusiform, atypical),demonstrated a strong IRR (Cohen's kappa=0.8). Atypical neuromas demonstratedhigher preoperative pain, compared with bulbous and fusiform. Atypical morphologywas more prevalent in patients with diabetes and peripheral vascular disease
Discussion:
A validated morphological classification of neuroma is introduced. Thesefindings may assist surgeons and researchers with better understanding of symptom-atic neuroma development and their clinical implications. The potential relationshipof neuroma morphology with the vascular and metabolic microenvironment requiresfurther investigation.
Neuromas come in different shapes and sizes; yet the correlationbetween neuroma morphology and symptomatology is unknown. Therefore, we aimto investigate macroscopic traits of excised human neuromas and assess the validityof a morphological classification system and its potential clinical implications.
Methods:
End-neuroma specimens were collected from prospectively enrolledpatients undergoing symptomatic neuroma surgery. Protocolized images of the speci-mens were obtained intraoperatively. Pain data (Numeric rating scale, 0-10) wereprospectively collected during preoperative interview, patient demographic andcomorbidity factors were collected from chart review. A morphological classificationis proposed, and the inter-rater reliability (IRR) was assessed. Distribution of neuromamorphology with patient factors, was described.
Results:
Forty-five terminal neuroma specimens from 27 patients were included.Residual limb patients comprised 93% of the population, of which 2 were upper(8.0%) and 23 (92.0%) were lower extremity residual limb patients. The proposedmorphological classification, consisting of three groups (bulbous, fusiform, atypical),demonstrated a strong IRR (Cohen's kappa=0.8). Atypical neuromas demonstratedhigher preoperative pain, compared with bulbous and fusiform. Atypical morphologywas more prevalent in patients with diabetes and peripheral vascular disease
Discussion:
A validated morphological classification of neuroma is introduced. Thesefindings may assist surgeons and researchers with better understanding of symptom-atic neuroma development and their clinical implications. The potential relationshipof neuroma morphology with the vascular and metabolic microenvironment requiresfurther investigation.
| Original language | English |
|---|---|
| Pages (from-to) | 1172-1180 |
| Number of pages | 9 |
| Journal | Muscle & Nerve |
| Volume | 70 |
| Issue number | 6 |
| Early online date | 19 Sept 2024 |
| DOIs | |
| Publication status | Published - Dec 2024 |
Bibliographical note
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