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Modeling the management of a flexor sheath ganglion.

ABSTRACT: INTRODUCTION: In a published cost analysis of the management of flexor sheath ganglia, it was found that two attempts at aspiration, followed by surgical removal for those who failed, was the least costly alternative. We used this report as a template to create a model of the management that could be used in decision analysis. METHOD: Using the published cohort study as a guide, a decision tree and Markov model of the management of flexor sheath ganglia were created. RESULTS: When compared to the results of a large cohort of patients reported in the literature, we accurately modeled the management of flexor sheath ganglia using both approaches. DISCUSSION: Creating a model of the management of a disease provides the opportunity to understand and explore questions efficiently and inexpensively. Many disorders of the upper extremity have commonality in their management, making the modeling approach attractive and potentially very valuable. This simple example illustrates two common methods used and is important because it builds confidence in the method by accurately modeling actual clinical experience.

SUBMITTER: Xu P

PROVIDER: S-EPMC2527220 | biostudies-other | 2007 Dec

REPOSITORIES: biostudies-other

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Project description:Retinal ganglion cell (RGC) axons converge at the optic nerve head to convey visual information from the retina to the brain. Pathologies such as glaucoma, trauma, and ischemic optic neuropathies injure RGC axons, disrupt transmission of visual stimuli, and cause vision loss. Animal models simulating RGC axon injury include optic nerve crush and transection paradigms. Each of these models has inherent advantages and disadvantages. An optic nerve crush is generally less severe than a transection and can be used to assay axon regeneration across the lesion site. However, differences in crush force and duration can affect tissue responses, resulting in variable reproducibility and lesion completeness. With optic nerve transection, there is a severe and reproducible injury that completely lesions all axons. However, transecting the optic nerve dramatically alters the blood brain barrier by violating the optic nerve sheath, exposing the optic nerve to the peripheral environment. Moreover, regeneration beyond a transection site cannot be assessed without reapposing the cut nerve ends. Furthermore, distinct degenerative changes and cellular pathways are activated by either a crush or transection injury. The method described here incorporates the advantages of both optic nerve crush and transection models while mitigating the disadvantages. Hydrostatic pressure delivered into the optic nerve by microinjection completely transects the optic nerve while maintaining the integrity of the optic nerve sheath. The transected optic nerve ends are reapposed to allow for axon regeneration assays. A potential limitation of this method is the inability to visualize the complete transection, a potential source of variability. However, visual confirmation that the visible portion of the optic nerve has been transected is indicative of a complete optic nerve transection with 90-95% success. This method could be applied to assess axon regeneration promoting strategies in a transection model or investigate interventions that target the axonal compartments.

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Modeling the management of a flexor sheath ganglion.

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