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Bilateral peroneal nerve palsy caused by intermittent pneumatic compression
1Department of Neurology, Shizuoka Cancer Center Hospital and Research Institute, Shizuoka.
Internal Medicine (Tokyo, Japan)
|February 18, 2006
Summary
Bilateral peroneal nerve palsies occurred in a patient after surgery for a craniopharyngioma, likely due to intermittent pneumatic compression used during the procedure. Surgeons should be cautious to avoid fibular head compression with these devices.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Surgery
Background:
- Craniotomy is a surgical procedure often requiring prolonged patient positioning.
- Deep vein thrombosis (DVT) and pulmonary embolism (PE) are risks during long surgeries, necessitating prophylactic measures.
- Intermittent pneumatic compression (IPC) devices are commonly used for DVT/PE prophylaxis.
Observation:
- A 63-year-old male patient developed bilateral peroneal nerve palsies post-craniotomy for a craniopharyngioma.
- The patient had undergone surgery with the use of IPC devices.
- The palsy presented as foot drop and sensory deficits in the peroneal nerve distribution bilaterally.
Findings:
- The peroneal nerve palsies are strongly suspected to be caused by intermittent pneumatic compression applied to the lower extremities.
- Compression likely occurred at the fibular head, a vulnerable anatomical site.
- This suggests a direct mechanical effect of the IPC device on the peroneal nerve.
Implications:
- Physicians and surgical teams must be aware of the potential for peripheral nerve injury from IPC devices.
- Careful placement and monitoring of IPC devices are crucial, particularly avoiding pressure on the fibular head.
- This case highlights a rare but significant complication of a common prophylactic measure, emphasizing the need for vigilance in surgical patient care.