NEUROMANON-SURGICAL MANAGEMENT

DR TONI HUNDLE

NEUROMA• Ancient Greek for nerve (neuro-) and tumour (suffix –

oma) • plural neuromas, also neuromata• 1:  a tumour or mass growing from a nerve and

usually consisting of nerve fibres• 2:  a mass of nerve tissue in an amputation stump

resulting from abnormal regrowth of the stumps of severed nerves—called also stump neuroma

Acknowledgement to Stahl's essential psychopharmacology. 2008

•Acknowledgement to Stahl's essential psychopharmacology. 2008

CLINICAL DIAGNOSIS

• Palpation sensitivity, allodynia and hyperalgesia• Pain• Tingling, burning, or numbness• Tinel’s sign

INVESTIGATION

• Diagnostic local anaesthesia• MRI• Ultrasound• Nerve conduction studies

TREATMENT OPTIONS• Medical vs surgical• Palliative vs curative• Drugs• Patches• Neuromodulation• Radiofrequency ablation• Chemical neurolysis

DRUGS• Gabapentinoids• Opiates – Tapentadol (Palexia)• Anti-epileptics• Antidepressants• Lidocaine infusions

CAPSAICIN AND QUTENZA

- 8% capsaicin patch - 1 hour, daycase application - Sensitivity for 3-5 days - Relief for 4-6 months – hopefully! - Repeat

1 week after high-dose

topical capsaicin1 week after control

100

μm

CHEMICAL NEUROLYSIS

• Alcohol• Glycerol• Phenol

RADIOFREQUENCY ABLATION

PERCUTANEOUS NEUROMODULATION