ULTRASONOGRAPHY OF PERIPHERAL NERVES DURING WALLERIAN DEGENERATION AND REGENERATION FOLLOWING TRANSECTION

Ultrasonography was performed on sciatic, tibial and/or peroneal nerves and interosseous muscles in 7 dogs using a ultrasound machine with a 7.5 MHz linear array transducer. A tibial nerve was transected near the distal aspect of the bellies of the gastroenemius muscle. Serial neurologic examinations, electromyography, and ultrasonography were performed before and after surgery. Dogs were euthanized at variable intervals and histopathology performed on nerve samples. In sagittal images, normal nerves had hyperechoic walls with multiple internal linear echoes. In transverse images, the nerves were round or oval hyperechoic structures with internal punctate echoes. After transection, the proximal stump was consistently seen whereas the distal stump and nerve were harder to identify. Neuromas were present in all 5 dogs followed beyond 2 days and appeared as hypoechoic bulbous swellings most apparent at 3 weeks after surgery. Only 1 dog developed a neuroma large enough to be considered of potential clinical significance. Four dogs were followed beyond 2 months. Regeneration was evidenced by a steady growth of nerve with an irregular outline (2 dogs) or by a knobby connection between the proximal and distal stumps (1 dog). Regeneration was not detected in 1 dog.