Arch Hand Microsurg.  2018 Dec;23(4):301-305. 10.12790/ahm.2018.23.4.301.

Microscopic Decompression of Digital Nerve Surrounded by Hemangioma: A Case Report

• Ko JG
• Kim JH
• Rha EY
• Lee JY
• Yoo G
• Baek SO

• KMID: 2427399
• DOI: http://doi.org/10.12790/ahm.2018.23.4.301

Abstract

Hemangiomas are benign neoplasms of endothelial cells origin, rarely found in hand region. Authors report a 62-year-old female with capillary hemangioma of right index finger causing a neuropathic symptom via nerve compression. A space-occupying vascular lesion surrounding the radial digital nerve was revealed in magnetic resonance imaging (MRI), which was removed under microscopic assist. The digital nerve was decompressed consequently. The mass was firmly attached to both the digital nerve and digital artery, requiring a meticulous microscopic dissection to preserve the nerve and artery. Compression neuropathy caused by space-occupying lesions is rare and its diagnosis is often difficult. A microscopic surgical approach can be used to successfully relieve neuropathic pain after proper diagnosis established by diagnostic tools such as MRI as in this case.

Keyword

Microvascular decompression surgery; Hemangioma; Finger

MeSH Terms

Arteries
Decompression*
Diagnosis
Endothelial Cells
Female
Fingers
Hand
Hemangioma*
Hemangioma, Capillary
Humans
Magnetic Resonance Imaging
Microvascular Decompression Surgery
Middle Aged
Neuralgia

Figure

• 

  Fig. 1 Preoperative clinical photo. Mild bulging was observed on radial side of right index finger at proximal phalangeal level. No other abnormalities were observed.

• 

  Fig. 2 (A, B) Preoperative magnetic resonance imaging. A well-enhanced vascular lesion of multinodular contour with 0.7×0.5×1.0 cm size was observed on volar side of index finger at proximal phalangeal level (arrowheads).

• 

  Fig. 3 (A) Microscopic view. Space-occupying vascular tumor between radial digital artery and nerve caused distortion of digital artery and compression of digital nerve (white arrowhead: radial digital nerve, black arrowhead: radial digital artery, white arrow: vasscular tumor). (B) Feeding vessels of the vascular tumor were identified up to the A2 pulley level (black arrows: feeding vessel).

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  Fig. 4 Resected tumor. 0.5×0.4 cm sized vascular tumor was totally excised.

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