J Korean Neurosurg Soc.  2015 Sep;58(3):286-290. 10.3340/jkns.2015.58.3.286.

Neurilemmoma of Deep Peroneal Nerve Sensory Branch : Thermographic Findings with Compression Test

• Ryu SJ
• Zhang HY

• KMID: 2191385
• DOI: http://doi.org/10.3340/jkns.2015.58.3.286

Abstract

We report a case of neurilemmoma of deep peroneal nerve sensory branch that triggered sensory change with compression test on lower extremity. After resection of tumor, there are evoked thermal changes on pre- and post-operative infrared (IR) thermographic images. A 52-year-old female presented with low back pain, sciatica, and sensory change on the dorsal side of the right foot and big toe that has lasted for 9 months. She also presented with right tibial mass sized 1.2 cm by 1.4 cm. Ultrasonographic imaging revealed a peripheral nerve sheath tumor arising from the peroneal nerve. IR thermographic image showed hyperthermia when the neurilemoma induced sensory change with compression test on the fibular area, dorsum of foot, and big toe. After surgery, the symptoms and thermographic changes were relieved and disappeared. The clinical, surgical, radiographic, and thermographic perspectives regarding this case are discussed.

Keyword

Neurilemmoma; Peroneal nerve; Nerve compression test; Infrared thermography; Sciatica

MeSH Terms

Female
Fever
Foot
Humans
Low Back Pain
Lower Extremity
Middle Aged
Neurilemmoma*
Peripheral Nerves
Peroneal Nerve*
Sciatica
Toes

Figure

• 

  Fig. 1 Ultrasonographic image of the right leg suggesting approximately 1.42×0.77×1.12 cm sized, probably benign peripheral nerve sheath tumor (PNST) arising from right deep peroneal nerve sensory branch.

• 

  Fig. 2 Computed tomography (CT) scan with contrast. An axial (A) and sagittal (B) cut of CT scan with contrast shows a well-defined, enhanced lesion located near to the deep peroneal nerve sensory branch. A soft tissue mass, within the sensory branch of right deep peroneal nerve, was enhanced by contrast material.

• 

  Fig. 3 IR thermography Images show thermal changes in pre-op (A and C) and post-op (B and D) as well as before and after compression of mass (thermography was taken at 23℃). A : Preop thermography (2013 December 19). B : Post operation date 1 month thermography (2014 January 20). C : Pre-op image 4, 8. IR thermography taken before operation. Right leg lateral side. Resting state and compression on subcutaneous mass. When the palpable mass was compressed, temperature of the fibular area was elevated by 0.75℃. D : Pre-op image 4, 8, IR thermography 1 month after operation. Right leg lateral side. There is no definite thermal changes between resting and compression state.

• 

  Fig. 4 An intraoperative photograph of the mass. A : The tumor mass, shaped like a pigeon egg, arising from sensory branch of the right deep peroneal nerve. B : Excised tumor mass and preserved nerve.

Reference

1. Byun JH, Hong JT, Son BC, Lee SW. Schwannoma of the superficial peroneal nerve presenting as sciatica. J Korean Neurosurg Soc. 2005; 38:306–308.

2. Cho YE, Kim YS, Zhang HY. Clinical efficacy of digital infrared thermographic imaging in multiple lumbar disc herniations. J Korean Neurosurg Soc. 1998; 27:237–245.

3. De Vita VT, Hellman S, Rosenberg SA. Cancer : Principle and Practice of Oncology. Philadelphia: Lippincott-Raven;1997. p. 964–965.

4. Gross D. Pain and the autonomic nervous system. In : Bonica JJ, editor. Advances in neurology. New York: Raven Press;1974. Vol 4:p. 93–104.

5. Kim DH, Kline DG. Management and results of peroneal nerve lesions. Neurosurgery. 1996; 39:312–319. discussion 319-320PMID: 8832668.

6. Kim YS, Cho YE, Zhang HY. Thermatomes of the lumbosacral nerve roots. J Korean Neurosurg Soc. 1995; 24:33–46.

7. Kräuchi K, Wirz-Justice A. Circadian rhythm of heat production, heart rate, and skin and core temperature under unmasking conditions in men. Am J Physiol. 1994; 267(3 Pt 2):R819–R829. PMID: 8092328.

8. Lawson R. Implications of surface temperatures in the diagnosis of breast cancer. Can Med Assoc J. 1956; 75:309–311. PMID: 13343098.

9. Lin HP, Lin HY, Lin WL, Huang AC. Effects of stress, depression, and their interaction on heart rate, skin conductance, finger temperature, and respiratory rate : sympathetic-parasympathetic hypothesis of stress and depression. J Clin Psychol. 2011; 67:1080–1091. PMID: 21905026.

10. Mahajan M, Sharma R, Sharma P, Gupta A. Schwannoma of superficial peroneal nerve presenting as leg pain. J Case Rep. 2012; 2:79–82.

11. Maleux G, Brys P, Samson I, Sciot R, Baert AL. Giant schwannoma of the lower leg. Eur Radiol. 1997; 7:1031–1034. PMID: 9265669.

12. Matoković D, Cesarik M, Drkulec V, Tomić Rajić M. Neurinoma of the superficial peroneal nerve-case report. Neurol Croat. 2010; 59:3–4.

13. Milnes HL, Pavier JC. Schwannoma of the tibial nerve sheath as a cause of tarsal tunnel syndrome--a case study. Foot (Edinb). 2012; 22:243–246. PMID: 22560193.

14. Odom RD, Overbeek TD, Murdoch DP, Hosch JC. Neurilemoma of the medial plantar nerve : a case report and literature review. J Foot Ankle Surg. 2001; 40:105–109. PMID: 11324666.

15. Oh JI, Park YK, Lim DJ, Chung HS, Lee KC, Lee HK. MRI diagnosis of a ganglion cyst of the peroneal nerve. J Korean Neurosurg Soc. 1997; 26:1723–1726.

16. Sato A, Schmidt RF. Somatosympathetic reflexes : afferent fibers, central pathways, discharge characteristics. Physiol Rev. 1973; 53:916–947. PMID: 4355517.

17. Spinner RJ, Atkinson JL, Tiel RL. Peroneal intraneural ganglia : the importance of the articular branch. A unifying theory. J Neurosurg. 2003; 99:330–343. PMID: 12924708.

18. Uematsu S. Thermographic imaging of cutaneous sensory segment in patients with peripheral nerve injury. Skin-temperature stability between sides of the body. J Neurosurg. 1985; 62:716–720. PMID: 2985769.

19. Wakisaka S, Kajander KC, Bennett GJ. Abnormal skin temperature and abnormal sympathetic vasomotor innervation in an experimental painful peripheral neuropathy. Pain. 1991; 46:299–313. PMID: 1661885.

20. Zhang HY, Chin DK, Cho YE, Kim YS. Correlation between pain scale and infrared thermogram in lumbar disc herniations. J Korean Neurosurg Soc. 1999; 28:253–258.

21. Zhang HY, Kim YS, Cho YE. Thermatomal changes in cervical disc herniations. Yonsei Med J. 1999; 40:401–412. PMID: 10565248.