The almost-invisible perineurioma

Neurosurgical Focus
Carlos E RestrepoRobert J Spinner

Abstract

Intraneural perineurioma is a rare, benign slow-growing lesion arising from the perineurial cells that surrounds the peripheral nerve fibers. Typically it presents during childhood and young adulthood as a motor mononeuropathy. MRI plays an essential role in the diagnosis and localization of the lesion, which appears as a fusiform enlargement of the nerve fascicles that enhances intensely with gadolinium. Despite the typical clinical and radiological features, intraneural perineurioma remains largely underdiagnosed because of the lack of familiarity with this entity, but also as a result of technical limitations with conventional MRI that is typically performed as a screening test over a large field of view and without contrast sequences. The purpose of this article is to present the pitfalls and pearls learned from years of experience in the diagnosis and management of this relatively rare condition. Clinical suspicion and detailed neurological examination followed by high-quality electrophysiological studies (EPS) must lead to an adequate preimaging localization of the lesion and narrowing of the imaging area. The use of high-resolution (3-T) MRI combined with gadolinium administration will allow adequate visualization of the...Continue Reading

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Citations

Apr 18, 2016·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Hugh J McMillanP R Bourque
Nov 3, 2017·Journal of the Peripheral Nervous System : JPNS·Luciana León CejasRicardo Reisin
Dec 2, 2017·Journal of Neurosurgery·Thomas J WilsonKimberly K Amrami
Nov 28, 2018·Neurosurgery·Thomas J WilsonRobert J Spinner
Feb 15, 2020·BMC Neurology·Anne-Kathrin UerschelsOliver Gembruch
Feb 9, 2017·Neurosurgery·Nikhil K PrasadRobert J Spinner
Jan 7, 2021·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Amanda YaworskiHugh J McMillan
Dec 4, 2020·World Journal of Clinical Cases·Hai-Ying ZhouHui Lu
Sep 25, 2019·World Neurosurgery·Maria Teresa PedroRalph Werner Koenig
May 25, 2021·Journal of Neurological Surgery. Part A, Central European Neurosurgery·Christine BrandGregor Antoniadis

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Methods Mentioned

BETA
biopsy
imaging techniques
biopsies

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