Peripheral nerves : Delayed management leads to slow recoveryDelayed recovery

According to neurosurgeons, patients are often misdirected and this could explain the presence of some irreparable cases in our society.

Ghislaine DEUDJUI

When a nerve is paralysed, the first person to see is not the physiotherapist, the first person to see is the neurosurgeon, who will ask for examinations, and it is from there that we start the treatment,” said Professor Mathieu Motah, Neurosurgeon. He was speaking at the second edition of the Neurosurgery Days, held from 21 to 22 April 2023 at the Laquintinie Hospital in Douala. The meeting was attended by Prof. Haidara, Vice President for West Africa and Prof. Ntsambi, Vice President for Central Africa of the Continental Association of African Neurosurgical Societies. The aim of this meeting was to share experiences and to draw the attention of the general public and health professionals to certain details that can be detrimental
to the proper management of the patient. The case of Peripheral Nerve Surgery was taken
as an example. According to neurosurgeons, 90% of patients suffering from peripheral nerve pathologies are very often misdirected.
“Peripheral nerve surgery is a surgery that is part of plastic surgery, it is a hyper specialty. So we operate in our modest experience
all the peripheral nerves of the upper and lower limb… These pathologies are generally due to road accidents, knife or firearm attacks,” says Professor Mathieu Motah.. He continued: “This surgery is very poorly managed because there is not a good orientation. When you have paralysis of a limb, the victims go directly to the physiotherapist who thinks he will solve the problem, whereas
it should be well coordinated to do the examinations, to see that the nerve is affected to such and such a degree and to see if it requires surgery or physiotherapy ». Because of this ignorance, patients arrive at the neurosurgeon’s office very late. As a result, the patient suffers delays in recovery.
It is therefore necessary to have a good support plan for the administration and this intervention
also requires the expertise of psychologists, in most cases. In short, it is a team of experts and adapted equipment that are required in this intervention. “To do peripheral surgery you need a team with neurosurgeons, even orthopaedists, because there are cases that do not require the distribution of nerves but rather transfers of muscles… You also need good neurologists who will do the electromyography and you need good MRIs that can see the path of the nerve and you also need a team of specialised nurses who work with the surgeon and above all a good technical platform, especially the microscope,” says Professor Mathieu Motah, a neurosurgeon who has performed more than 300 peripheral nerve operations.
Surgical indication During the second days of neurosurgery, Prof. Mathieu Motah who donned the coat of coordinator
of this meeting held last week in Douala also shared with his peers his experience with this type of surgery in Cameroon. In the end, he said that the success in terms of recovery of pain, motor function, finger function and sensitivity is “statistically significant”,
but that what delays is the recovery. The patient’s late arrival at the neurosurgeon’s is a hindrance. However, “when you have a severed nerve, you have to operate on it within the first 10 months, maybe within the first 10 weeks. If you arrive after two years, the recovery is practically zero,” says the neurosurgeon. Peripheral nerve surgery aims to restore motor and sensory function
to the affected limb. The indication for surgery is based on clinical examination data coupled with nerve imaging and electromyographic
explorations.