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Maldonado AA, Planchard RF, Jack MM, Smith BW, Carter JM, Spinner RJ. Lipomatosis of the Nerve and Neuromuscular Choristoma: Two Rare Entities and Their Call for an Animal Model to Understand and Mitigate Nerve-Territory Sequelae. World Neurosurg 2021; 159:56-62. [DOI: 10.1016/j.wneu.2021.12.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
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Spinner RJ. A novel mechanism for the formation and propagation of neural tumors and lesions through neural highways. Clin Anat 2021; 34:1165-1172. [PMID: 34309059 DOI: 10.1002/ca.23768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 12/25/2022]
Abstract
By recognizing anatomic and radiologic patterns of rare and often misdiagnosed peripheral nerve tumors/lesions, we have defined mechanisms for the propagation of neural diseases. The novel concept of the nervous system serving as a complex system of "highways" driving the neural and perineural spread of these lesions is described in three examples: Intraneural dissection of joint fluid in intraneural ganglion cysts, perineural spread of cancer cells, and dissemination of unknown concentrations of neurotrophic/inhibitory factors for growth in hamartomas/choristomas of nerve. Further mapping of these pathways to identify the natural history of diseases, the spectrum of disease evolution, the role of genetic mutations, and how these neural pathways interface with the lymphatic, vascular, and cerebrospinal systems may lead to advances in targeted treatments.
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Affiliation(s)
- Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Marek T, Mahan MA, Carter JM, Howe BM, Bartos R, Amrami KK, Spinner RJ. What's known and what's new in adipose lesions of peripheral nerves? Acta Neurochir (Wien) 2021; 163:835-842. [PMID: 33089450 DOI: 10.1007/s00701-020-04620-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/12/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adipose lesions of nerve primarily include intra- and extraneural lipomas and lipomatosis of nerve (LN). This paper will summarize the advances that have been made in the past decade, particularly related to LN and nerve territory overgrowth that have improved our understanding of the natural history, genetic background, diagnosis, imaging features, and clinical management. METHODS AND MATERIALS Articles about adipose lesions of nerve were reviewed from 2011, when the last comprehensive review on this topic was published. Papers reporting advances on natural history, genetic background, diagnosis, imaging features, and clinical management were screened using PubMed and Google Scholar databases and then analyzed. Case reports and small case series were included only if they reported model examples of discussed pathologies, as these types of articles were summarized in recent systematic reviews on intraneural lipomas and LN. All eligible papers were assessed by the authors, who are subject matter experts. RESULTS The first screen revealed 404 articles. After careful evaluation, a total of 53 articles were analyzed which includes advances in diagnosis (especially imaging), classification of the lesions, the role of somatic mutations in PIK3CA in LN, and treatment approaches for all adipose lesions of the peripheral nerve. CONCLUSION Many advances have been made in the understanding of adipose lesions of nerve in the past decade. These pathologic entities are more readily recognized as a spectrum of lesions that share common phenotypic features.
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Affiliation(s)
- Tomas Marek
- Department of Neurologic Surgery, Mayo Clinic, Gonda 8-214, Rochester, MN, 55905, USA
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Mark A Mahan
- Department of Neurologic Surgery, University of Utah, Salt Lake City, UT, 84132, USA
| | - Jodi M Carter
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Benjamin M Howe
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Robert Bartos
- First Faculty of Medicine, Charles University, Prague, Czech Republic
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Neurologic Surgery, Masaryk Hospital, Usti nad Labem, Czech Republic
| | | | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Gonda 8-214, Rochester, MN, 55905, USA.
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Marek T, Spinner RJ, Syal A, Mahan MA. Strengthening the association of lipomatosis of nerve and nerve-territory overgrowth: a systematic review. J Neurosurg 2020; 132:1286-1294. [PMID: 30925468 DOI: 10.3171/2018.12.jns183050] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 12/26/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Lipomatosis of nerve (LN) is a massive enlargement of a nerve due to abundant proliferation of adipose and fibrotic tissue within the epineurium-part of the spectrum of adipose lesions of nerves, including intra- and extraneural lipomas. LN has been frequently associated with soft-tissue and/or osseous overgrowth. Unfortunately, much confusion exists since many names have been used for LN (e.g., fibrolipomatous hamartoma, macrodystrophia lipomatosa, and so on). To better understand this condition and to evaluate its association with nerve-territory overgrowth, the authors attempted to compile the world's literature on published LN cases. METHODS PubMed and Google Scholar databases were searched to identify published articles on LN cases, using a variety of terms. Publications in all languages were assessed. All publications with cases determined likely to be LN were read. Cases that provided clear clinicopathological and/or radiological evidence of LN were labeled as "definite" and cases that demonstrated features of LN (e.g., nerve-territory overgrowth) but lacked definite proof of nerve involvement were labeled as "probable." RESULTS Initial screening revealed a total of 2465 papers. After exclusions, 281 publications reported cases with a definite diagnosis of LN and 120 articles reported cases with a probable diagnosis of LN. The authors identified 618 definite and 407 probable cases of LN. Sex distribution was balanced (51% female). Early diagnosis was common, with two-thirds of patients having symptoms in the 1st decade of life. The most commonly affected nerve was the median nerve (n = 391). Nerve-territory overgrowth was common (62% definite LN; 78% combined cases); overgrowth was exclusive to the territory of the affected nerve in all cases but 5. CONCLUSIONS The authors present a comprehensive review and analysis of the literature of LN cases. One of the main findings was the nerve-territory overgrowth was associated with LN, especially when present earlier in life. The authors believe that all cases of LN associated with overgrowth can be explained on anatomical grounds, even in the few reported cases in which this is not immediately obvious.
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Affiliation(s)
- Tomas Marek
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Robert J Spinner
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Akshay Syal
- 3New York Medical College School of Medicine, Valhalla, New York
| | - Mark A Mahan
- 2Department of Neurologic Surgery, University of Utah, Salt Lake City, Utah; and
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Marek T, Mahan MA, Carter JM, Amrami KK, Atkinson JL, Spinner RJ. Can Lipomatosis of the Nerve Occur or Extend Intradurally? World Neurosurg 2019; 129:e555-e560. [DOI: 10.1016/j.wneu.2019.05.213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 12/24/2022]
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Marek T, Spinner RJ, Syal A, Wahood W, Mahan MA. Surgical Treatment of Lipomatosis of Nerve: A Systematic Review. World Neurosurg 2019; 128:587-592.e2. [DOI: 10.1016/j.wneu.2019.04.110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 10/27/2022]
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Vetrano IG, Sconfienza LM, Devigili G, Nazzi V. Lipomatosis of nerve and overgrowth syndrome: an intriguing and still unclear correlation. Acta Neurochir (Wien) 2019; 161:1085-1086. [PMID: 31044277 DOI: 10.1007/s00701-019-03916-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/17/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Ignazio G Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via G. Celoria 11, 20133, Milan, Italy.
| | - Luca Maria Sconfienza
- Department of Biomedical Sciences for Health, University of Milano, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Grazia Devigili
- Neurological Unit 1, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Vittoria Nazzi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via G. Celoria 11, 20133, Milan, Italy
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Marek T, Mahan MA, Carter JM, Amrami KK, Benarroch EE, Spinner RJ. Lipomatosis of nerve and overgrowth: is there a preference for motor (mixed) vs. sensory nerve involvement? Acta Neurochir (Wien) 2019; 161:679-684. [PMID: 30798481 DOI: 10.1007/s00701-019-03854-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 02/13/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lipomatosis of nerve (LN) is a peripheral nerve disorder characterized by fibroadipose proliferation within the epineurium. It has been associated with nerve-territory overgrowth affecting soft tissue and/or bony structures. We sought to understand if there is an anatomical relationship associated with nerve-territory overgrowth. METHODS A review of the literature and our institutional LN cases was performed to determine the prevalence of nerve-territory overgrowth. Only cases with sufficient clinical and/or imaging data were selected. The cases were then subdivided into two groups and analyzed: (1) motor (mixed) nerve and (2) predominant sensory nerve, based on the anatomical location of the LN lesion. Subgroup analysis was performed on median nerves affected by LN, for a more homogenous population. RESULTS We identified 329 LN cases with sufficient information for analysis. Motor (mixed) nerve group (M) consisted of 287 cases (155 with overgrowth and 132 without overgrowth). Sensory nerve group (S) revealed group of 42 cases (4 cases with overgrowth and 38 without overgrowth). Statistical analysis comparing overgrowth status in the M and S nerve groups showed a statistically significant difference in overgrowth, favoring the M group for overgrowth (p < 0.0001). The analysis of median nerve group consisted of 225 cases in the M group (106 with overgrowth and 119 without overgrowth) and 20 cases in the S group (3 with overgrowth and 17 cases without overgrowth). A statistically significant difference in nerve-territory overgrowth status was present in the M vs. the S group, again favoring the M group for overgrowth. (p = 0.0083). Cases from our institution included 44 cases for this analysis. Forty-two cases in the M group (28 with overgrowth and 14 without overgrowth) and 2 cases in the S group (all 2 without overgrowth). CONCLUSION We believe the association of LN and nerve-territory overgrowth might be explained by involvement of mixed motor nerves; however, the exact underlying mechanism is not known.
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Affiliation(s)
- Tomas Marek
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Mark A Mahan
- Department of Neurologic Surgery, University of Utah, Salt Lake City, UT, 84132, USA
| | - Jodi M Carter
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | | | | | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
- Mayo Clinic, Gonda 8-214, Rochester, MN, 55905, USA.
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Mahan MA, Amrami KK, Spinner RJ. Sciatic nerve lipomatosis and knee osteochondroma. J Neurosurg 2013; 119:934. [DOI: 10.3171/2013.7.jns13537] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Mark A. Mahan
- 1Barrow Neurological Institute, Phoenix, Arizona; and
| | | | - Robert J. Spinner
- 2Departments of Neurologic Surgery,
- 4Anatomy, and
- 5Orthopedics, Mayo Clinic, Rochester, Minnesota
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Mahan MA, Amrami KK, Spinner RJ. Fibroproliferative Neuromas May Occur After Iatrogenic Injury for Lipomatosis of Nerve. Neurosurgery 2013; 73:271-81; discussion 281. [DOI: 10.1227/01.neu.0000430289.93304.e5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Lipomatosis of nerve (LN) is a condition associated with nerve-territory overgrowth. We have noted a unique type of neuroma at sites of LN injury; the neuroma extends beyond the epineurium, enhances, and appears to enlarge over time.
OBJECTIVE:
We sought to understand the relationship between fibroproliferative scarring and surgery performed on the nerve.
METHODS:
A review of the searchable records for LN at our institution found 52 cases, confirmed by pathology or pathognomonic appearance on magnetic resonance imaging (MRI). Clinical histories were reviewed to categorize the surgeries performed by the degree of iatrogenic injury to the nerve. Postoperative MRI was performed in 22 of the 46 patients who had surgery, which was then retrospectively reviewed for fibroproliferative neuromas.
RESULTS:
Complex and masslike neuromas were found on MRI, correlating with the degree of iatrogenic injury to the nerve. These fibrous neuromas proliferated beyond the epineurium, disrupted fascicular architecture, were contrast enhancing when contrast was administered, indicative they were unique and unlike stump or traction neuromas. Of the 8 patients who underwent surgery involving nerve decompression alone, none developed fibroproliferative neuromas. Of the 7 patients who underwent surgery involving nerve debulking, fibroproliferative neuromas developed in 4. Of the 11 patients who underwent surgery involving nerve transection, all developed fibroproliferative neuromas (P < .001). There was also a high incidence of hypertrophic scarring of the skin incision (21.3%).
CONCLUSION:
Surgical injury of LN appears to be strongly associated with the development of fibroproliferative neuromas. It is possible that the pathological overgrowth stimulus associated with LN promotes exuberant scar formation.
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Affiliation(s)
- Mark A. Mahan
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | | | - Robert J. Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Orthopedics, Mayo Clinic, Rochester, Minnesota
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