Bilateral Mini-Open Decompression in the Treatment of Carpal Tunnel Syndrome Caused by Persistent Median Artery: Case Report

Abstract

Carpal tunnel syndrome (CTS) is a common peripheral entrapment neuropathy that is caused by increased pressure within the carpal tunnel resulting in a chronic process of median nerve ischemia and segmental demyelination. We report on a patient with bilateral patent persistent median artery (PMA) affected by typical symptomatic CTS who was treated by bilateral mini-open decompression with complete improvement. For PMA-associated CTS, standard decompression is considered the treatment of choice, whereas resection should be reserved for pathological PMA. Mini-open decompression can be an alternative, as we have verified in this first description.

Keywords

carpal tunnel syndrome - management - mini-open - persistent median artery - surgery

• References

• 1 Katz JN, Simmons BP. Clinical practice. Carpal tunnel syndrome. N Engl J Med 2002; 346: 1807-1812
• 2 Bilgin SS, Olcay SE, Derincek A, Adiyaman S, Demirtas AM. Can simple release relieve symptoms of carpal tunnel syndrome caused by a persistent median artery? Clinical experience. Arch Orthop Trauma Surg 2004; 124: 154-156
• 3 Feldkamp MM, Gentili F, Hudson AR, Guha A. A persistent median artery causing carpal tunnel syndrome in a patient with chronic renal failure: case report. Neurosurgery 1995; 37: 140-143
• 4 Spinner RJ. Median nerve. In: Kim DH, Midha R, Murovic JA, Spinner RJ. Kline & Hudson's Nerve Injuries. 2nd ed. Philadelphia: Elsevier; 2008: 139-170
• 5 Barfred T, Højlund AP, Bertheussen K. Median artery in carpal tunnel syndrome. J Hand Surg Am 1985; 10 (6 Pt 1) 864-867
• 6 Mauersberger W, Meese W. Carpal tunnel syndrome caused by the persistence of the median artery. Neurochirurgia (Stuttg) 1975; 18: 15-19
• 7 Kele H, Verheggen R, Reimers CD. Carpal tunnel syndrome caused by thrombosis of the median artery: the importance of high-resolution ultrasonography for diagnosis. Case report. J Neurosurg 2002; 97: 471-473
• 8 Luyendijk W. The carpal tunnel syndrome. The role of a persistent median artery. Acta Neurochir (Wien) 1986; 79: 52-57
• 9 Tsagarakis M, Tarabe M, Minoyiannis N, Tserotas P, Komninakis E. Management of traumatic complete laceration of the median artery at the carpal tunnel: repair or ligate?. Plast Reconstr Surg 2004; 114: 1014-1015
• 10 Huang JH, Zager EL. Mini-open carpal tunnel decompression. Neurosurgery 2004; 54: 397-399 , discussion 399–400
• 11 Proubasta IR, Lluch A, Lamas CG, Oller BT, Itarte JP. “Fat pad” and “little finger pulp” signs are good indicators of proper release of carpal tunnel. Neurosurgery 2007; 61: 810-813 , discussion 813–814
• 12 Eid N, Ito Y, Shibata MA, Otsuki Y. Persistent median artery: cadaveric study and review of the literature. Clin Anat 2011; 24: 627-633
• 13 Rodríguez-Niedenführ M, Sañudo JR, Vázquez T, Nearn L, Logan B, Parkin I. Median artery revisited. J Anat 1999; 195 (Pt 1) 57-63
• 14 Coleman SS, Anson BJ. Arterial patterns in the hand based upon a study of 650 specimens. Surg Gynecol Obstet 1961; 113: 409-424
• 15 Pierre-Jerome C, Smitson Jr RD, Shah RK, Moncayo V, Abdelnoor M, Terk MR. MRI of the median nerve and median artery in the carpal tunnel: prevalence of their anatomical variations and clinical significance. Surg Radiol Anat 2010; 32: 315-322
• 16 Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999; 282: 153-158
• 17 Scholten RJ, Mink van der Molen A, Uitdehaag BM , et al. Surgical treatment options for carpal tunnel syndrome. Cochrane Database Syst Rev 2007; 2: CD003905
• 18 Jimenez DF, Gibbs SR, Clapper AT. Endoscopic treatment of carpal tunnel syndrome: a critical review. Neurosurg Focus 1997; 3: e6
• 19 Oertel J, Schroeder HW, Gaab MR. Dual-portal endoscopic release of the transverse ligament in carpal tunnel syndrome: results of 411 procedures with special reference to technique, efficacy, and complications. Neurosurgery 2006; 59: 333-340 , discussion 333–340