Neurosurgery
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A clinical and light and electron microscopic study of three cases of painful neuroma, surgically resected, was made. It was found (a) that painful neuromas contain large numbers of small diameter, unmyelinated fibers, in an apparently much larger proportion than myelinated fibers and (b) that a consistent, unrestrained growth of perineurial cells parallels the constant regeneration of axis cylinders. ⋯ It is suggested that the increased numbers of unmyelinated axis cylinders in traumatic neuromas could be related to the painful symptoms in some patients. It is further postulated that the unrestricted growth of perineurial cells is an attempt to contain the regeneration of axis cylinders and that the maintenance of perineurial integrity by fascicle ligation is important in the relief of painful human neuromas.
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Light and electron microscopic studies of the cut sciatic nerve in the rat showed typical neuroma formation. If the nerve was cut and the proximal segment was ligated as a whole, the neuromatous process appeared to be even more severe than that in the simply cut nerve. ⋯ The mechanism by which fascicle ligation limits axonal regeneration is unknown, but could involve peripheral as well as central mechanisms. Such a limitation of neuroma formation by fascicle ligation as was found in the rat might also apply to painful human neuromas.