Understanding the Role and Future of Peripheral Nerve Neurosurgery (Podcast)

Peripheral nerve neurosurgery is a subspecialty that’s little understood. However, it can be game-changing for people with acute nerve injuries, entrapment neuropathies, benign nerve tumors and other nerve disorders.

“The best part of my job is working directly with patients and helping them restore function and helping take away pain, which for some of my patients really changes their lives,” says Megan Jack, MD, PhD, a peripheral nerve neurosurgeon and researcher in Cleveland Clinic’s Neuromuscular Center. “It gets them back to work. It gets them back to enjoying the life they had.”

In the most recent episode of Cleveland Clinic’s Neuro Pathways podcast, Dr. Jack talks about the value of peripheral nerve neurosurgery within the nerve injury treatment landscape. She delves into:

• Conditions that are best suited to peripheral nerve neurosurgery
• The importance of a multidisciplinary approach to treating patients with nerve injuries
• The slow pace of nerve regeneration and potential surgical options to speed it up
• A move toward surgeries that restore sensation as well as improve motor skills
• Research into new peripheral nerve surgeries, medications and other treatments

Click the podcast player above to listen to the 21-minute episode now, or read on for a short edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

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Excerpt from the episode

Podcast host Glen Stevens, DO, PhD: This is a loaded question and has a lot of caveats, but who do we intervene on?

Megan Jack, MD: I think early referral to a peripheral nerve neurosurgeon [is important]. One of the unfortunate things that I’ve seen throughout the field is that nerves take a long time to recover. So we watch our patients very closely. But as that continues, it moves them more and more toward being outside that surgical window.

Typically, laceration is something we like to repair within three days, but that’s pretty rare. For most patients, we like to intervene anywhere from three to six months if we haven’t seen recovery either clinically or on an EMG or functionally. And so for those patients, it’s sort of a race against time to where you’re giving them enough time to recover on their own if they’re going to recover, but you don’t want to go so far that the de-innervation changes that occur in the muscle — those more permanent losses of muscle — makes it so you can’t functionally get back any of that muscle weakness that’s occurred even after surgery.

It’s sort of threading the appropriate needle to intervene, when necessary, but doing it in the appropriate time. I always say, refer your patients early to us. We like to get a good exam early on. That way we’re able to follow the patient to determine if they are recovering properly. Take Parsonage-Turner syndrome, for example. Almost 80% of those patients get better on their own, but it’s the 20% of patients who don’t for whom we want to make sure we intervene early enough that we can actually change their outcomes.