Introduction: Neurofibromatosis 1 (NF1) is a chronic neurocutaneous disease known to profoundly affect quality of life (QoL). We have performed an analysis of disease severity, mental and physical QoL and compare the different subclasses among patients with neurofibromatosis 1 (NF1).Patients and methods: We conducted a prospective analysis of 89 NF1 patients between January 2016 and March 2018. Data sourced from local records including demographic information, employment status, education level, and marital status. All patients completed 36-Item Short Form Health Survey (SF-36) and additionally the numerical pain rating scale (NPS). Patients were stratified based on severity of NF1, visibility and disease severity.Results: Among 89 patients, severity was classified as grade 4 was identified in 42 (47.2%), moderate in 17 (19.1%), mild in 23 (25.8%) and minimal in 7 (7.9%) cases. According to visibility scale, severe grade 3 was found in 28 (31.5%), moderate grade 2 in 26 (29.2%) and mild grade in 35 (39.3%) cases. SF-36 data, except for pain, showed significantly lower values, if compared to the standard German population (P < 0.001, physical component summary P = 0.045). Sex, marital status and education level did not significantly influence results. Employment was significantly associated with better mental and physical status (P = 0.028 and P = 0.01 respectively) and age >40 was linked to lower physical (P = 0.027) but not mental component scores (P = 0.362). The numerical pain rating scale indicated pain levels of 7–10 in 9 cases (10,1%), 5–6 in 10 patients (11.2%), 1–4 in 26 patients (29.2%) and no pain in 44 cases (49.4%). Physical component scores significantly differed across different NPS grades (P < 0.001) but not in mental component scores (P = 0.06). Finally, no significant differences were found in mental component scores across severity or visibility grades.Conclusion: Severity and visibility grades of patients with NF1 may not necessarily result in poor mental health. Symptomatic treatment should be considered even for severely disabled patients as they may have comparable QoL to less severely affected patients with NF1. Employment was linked to better quality of life outcomes in our findings.

Background: This study aims to analyze potential risk factors that may influence the clinical outcomes following surgical treatment of traumatic peroneal nerve lesions. Methods: We conducted a retrospective analysis of patients with traumatic peroneal nerve injuries treated with decompression, split repair, or nerve grafting between 2010 and 2020. Motor function and potential risk factors were evaluated. Results: Out of 93 patients, 42 (45%) underwent decompression, 15 (16%) received split repair, and 36 (39%) required autologous nerve grafting. Up to one year after surgery, weakness of the anterior tibial muscle improved from a median of M0 to M3. After one year following nerve decompression, functional recovery was observed in 28 (65%) cases, in 9 (21%) cases after split repair, and in 7 (16%) cases following autologous nerve grafting. A defect greater than 8 cm was associated with significantly poorer improvement of extensor hallucis longus (p = 0.037, HR 0.109). We found no significant associations between age, diabetes mellitus, arterial hypertension, obesity, and postoperative outcomes. Conclusions: According to the present data, a significant number of patients achieved functional improvement following surgical treatment, indicating that this procedure should be considered an important treatment option in selected cases.

Surgical treatment for Meralgia paresthetica is indicated in patients showing deficient effects of conservative interventions and merely temporary positive responses after local infiltrations of the lateral femoral cutaneous nerve (LFCN). To improve clinical outcome data, especially with focus on the long-term effect of such procedures, we evaluated patients in two neurosurgical centers with regard to their satisfaction and reduction of symptoms. Retrospective analysis of perioperative characteristics and follow-up telephone survey concerning subjective satisfaction after surgery using the Patient Satisfaction Index (PSI), subjective complaint reduction (percentage) and pain response (Numeric Rating Scale). In addition, health-related quality of life and sensation at the thigh were evaluated. Regression analysis concerning risk factors for an insufficient outcome was applied. A total of 108 surgeries were performed on 94 patients (50% female, median age 56 years, BMI 27.9 kg/m²). 98 operations were neurolysis of the LFCN, 4 secondary neurectomies and 6 other revisions. A satisfying outcome at follow-up (PSI 1 + 2) was achieved at 84.4% of the patients, whereas 10.4% had no relevant symptom reduction (PSI 4). The average permanent complaint reduction was 72.7%. Concerning the residual pain intensity at the thigh at rest/under strain, 80.6%/72.0% showed favorable values (NRS≤3). Regression analysis revealed nicotine abuse as independent risk factor for an unsatisfactorily outcome (OR 6.490; p = 0.027) Surgical treatment of Meralgia paresthetica significantly improves associated complaints in the majority of patients leading to a high amount of satisfying results. Nicotine abuse seems to be a risk factor for insufficient outcomes.

Peripheral nerve stimulation using a wireless high-frequency system offers an alternative to neurostimulator implantation. This approach has the potential to reduce the treatment's risk profile and improve overall quality of life. Between January 2021 and October 2024, 21 patients were treated at our clinic using a wireless high-frequency system for peripheral nerve stimulation (PNS). The system was implanted under local anesthesia via a Tuohy needle puncture, with ultrasound guidance. The mean surgical time was 36 min (range 16 - 60 min). All patients presented with long history of chronic pain syndromes (mean 49 months, range 8-96 months) and had previously undergone multimodal pain therapy in specialized centers. The most common causes of pain were patients after traumatic peripheral nerve surgery (n = 10, 47.7%) followed by pain after previous surgeries (n = 8, 38.1%) and 3 patients (14.1%) with peripheral nerve tumors. The most common nerve targeted for stimulation was ulnar nerve (n = 7, 33.3%), followed by peroneal nerve (n = 4, 19%), tibial nerve (n = 3, 14.3%), median nerve (n = 3, 14.3%), occipital nerve (n = 2, 9.5%), infrapatellar nerve (n = 1, 4.8%) and medial antebrachii cutaneous nerve (n = 1, 4.8%). All patients reported preoperative neuropathic pain, with NRS (Numeric Rating Scale) scores ranging from 7/10 to 10/10 (mean 8.2/10). Pain reduction was achieved in 17 (81%) patients, with NRS scores decreasing from 8.2/10 preoperatively to 4.3/10 postoperatively (mean reduction of 5.2/10). Additionally, 14 (66.7%) patients experienced a reduction in their pain medication use, with some patients completely discontinuing their medication. However, no positive effects were observed in the patient receiving median nerve stimulation due to a tumor and previous fascicle biopsy, nor in the two patients with a history of lacerations and partial nerve transplants, despite correct pain area coverage. 19 (90.5%) patients would choose peripheral nerve stimulation again. In most patients (94%, n = 16/17), stimulation was applied twice daily for 30 min. Additionally, 7/17 (41.2%) patients used the system to manage acute pain attacks. No infections, wound healing or other complications were reported in any patient. Peripheral wireless high frequency stimulation is a simple and feasible option for patients with chronic pain syndrome within the territory of a specific peripheral nerve. In patients with prior partial nerve grafting, seems to be the introduced system less effective, despite correct coverage of the pain area.

Zusammenfassung Hintergrund Die periphere Nervenstimulation (PNS) ist seit Jahrzehnten Teil der Neuromodulation. Neue Systeme und Weiterentwicklungen rücken dieses Teilgebiet wieder mehr in den Fokus. Fragestellung Aufzeigen des Wirkmechanismus, Darstellung der Stimulationsmöglichkeiten, Anwendungsgebiete und Zukunftsperspektiven. Material und Methoden Darlegung momentaner Möglichkeiten und Systeme zur PNS unter Berücksichtigung der Literatur. Ergebnisse Die PNS ist eine fokussierte und einfache Methode zur Therapie bestimmter Schmerzsyndrome. Neue Stimulationsparameter und -formen sowie die Verwendung neuer drahtloser Systeme oder speziell entwickelter Systeme mit sehr kleinen Impulsgebern bieten bei dieser Stimulation neue Perspektiven. Schlussfolgerung Die direkte Stimulation des betroffenen Nervs kann für den Patienten eine individuell angepasste Lösung sein. Neue Systeme und Stimulationsformen sind in diesem Teilgebiet der Neuromodulation ein Meilenstein. Die Überwindung der Einschränkungen älterer Technologien führt zu mehr Patientensicherheit und Komfort. Somit kann die PNS ein wichtiger Grundpfeiler in der Therapie chronischer Schmerzen werden.

Introduction Neurofibromatosis 1 (NF1) is a chronic neurocutaneous disease with tremendous impact on quality of life (QoL). We have performed an analysis of disease severity, mental and physical QoL and compared the different severity classes of patients with neurofibromatosis 1 (NF1). Patients and methods We performed a prospective analysis of 89 patients with NF-1 which are included in the period of 1/2016 - 3/2018. Local records served as data source including demographic data, employment status, level of education, and marital status were evaluated. All patients received 36-Item Short Form Health Survey (SF-36). Additionally, numerical pain rating scale (NPS) Patients were stratified according to different severity of NF-1 and different visibility and severity of disease. Results: Out of 89 patients, severity grad 4 was identified in 42 (47.2%), moderate in 17 (19.1%), mild in 23 (25.8%) and minimal in 7 (7.9%) cases. According to visibility scale, severe grade 3 was found in 28 (31.5%), moderate grade 2 in 26 (29.2%) and mild grade in 35 (39.3%) cases. All SF-36 related data except for pain showed significantly lower values, if compared to the standard German population (p40 was significantly associated with lower physical (p=0.027) but not mental component (p=0.362). According to the numerical pain rating scale, 7-10 were noted in 9 cases (10,1%), 5-6 in 10 patients (11.2%), 1-4 in 26 patients (29.2%) and no pain in 44 cases (49.4%). Physical component showed significant difference between different NPS grades (p<0.001) but no significance in mental component summery (p=0.06). Finally, we found no significant difference between different severity grades and visibility grades in mental component summery. Conclusion: The severity grade and visibility grade of patients with NF-1 does not necessarily results in decreased mental components and physical limitations in comparison with lower grades, so that symptomatic treatment should be considered even in patients with severe disability, since these still may have comparable QoL to less severe disabled patients with NF-1. Employment was associated with better QoL according to our results.