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Are schwannomas contraindications for electrostimulation?

Dear colleagues, recently in our unit we had a patient with big schwannoma on his tibial nerve. It was so big , that it needed full resection of the nerve and a subsequent repair with sural graft. The surgeon asked me to provide him with a stimulator for his denervated musculature, but I am hesitant. The tumor was on the proximal part of the nerve and the posterior calf muscles are denervated. As you know, it is usually a benign tumor with very low rate of recurrence after total excision, but who knows... What is your opinion on that case?

Georgi Petrov

1 year ago

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gvpetrov223
gvpetrov223

Dr Ethne Nussbaum said:

Setting aside the concern of stimulating cell growth, there is also doubt that a portable stimulator would be of any use. Portable devices commonly provide pulse durations up to 300ms and newer models likely up to 450-500ms. You do not mention whether there are signs of re-inervation of the calf muscles. Prior to that point, you may not be able to elicit a muscle contraction using a short pulse duration and a current amplitude that the patient can tolerate.

Well, we use stimulators that are capable of producing contractions of fully denervated muscles via long (miliseconds) biphasic impulses. I mean they are specifically created with capability to stimulate denervated muscles.

Dr Ethne Nussbaum
Dr Ethne Nussbaum

Setting aside the concern of stimulating cell growth, there is also doubt that a portable stimulator would be of any use. Portable devices commonly provide pulse durations up to 300ms and newer models likely up to 450-500ms. You do not mention whether there are signs of re-inervation of the calf muscles. Prior to that point, you may not be able to elicit a muscle contraction using a short pulse duration and a current amplitude that the patient can tolerate.

gvpetrov223
gvpetrov223

Interesting read! Thank you prof. Alon

Prof Gad Alon
Prof Gad Alon

There is never a straight answer for a question you ask but read the following: Linkov G, Branski RC, Amin M, Chernichenko N, Chen C-H, Alon G, Langmore S, Richard Wong R, Kraus D. A murine model of neuromuscular electrical stimulation on subcutaneous squamous cell carcinoma: Potential implications for dysphagia therapy. Head Neck. 2012;34:1428-1433.

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