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Simple Endoscopic Decompression of Cubital Tunnel Syndrome With the Agee System: Anatomic Study and First Clinical Results

Stadie, Axel Thomas MD; Keiner, Doerthe MD; Fischer, Gerrit MD; Conrad, Jens MD; Welschehold, Stefan MD; Oertel, Joachim MD

doi: 10.1227/01.NEU.0000369949.97016.B1

BACKGROUND: Simple decompression in ulnar nerve compression syndromes offers options for endoscopic applications.

OBJECTIVE: The authors present their initial experience with the Agee device.

PATIENTS AND METHODS: The monoportal endoscopic technique (Agee system) was evaluated on 10 cadaveric arms. Subsequently, 32 arms of 29 patients were operated on between January 2006 and March 2009. All patients presented with typical clinical signs and neurophysiologic studies. Long-term follow-up examinations were obtained in 27 of 32 arms.

RESULTS: In the cadaver study, the ulnar nerve was always correctly identified. No nerve damage occurred, and sufficient decompression of the ulnar nerve was always achieved. In the clinical series, no intraoperative complications were observed. A change to open technique was not required, and no worsening of the cubital tunnel syndrome occurred. Two wound infections required surgical wound cleaning. Wound hematomas treated conservatively were found in 5 cases. On long-term follow-up, an improvement in the McGowan-Classification was achieved in 22 of 27 cases. One patient was operated on by open surgery after endoscopic surgery.

CONCLUSION: The endoscopic technique for ulnar nerve entrapment syndrome using an Agee device appears to be safe and efficient. The results are comparable to those achieved with simple open decompression. A randomized prospective study should be performed to further evaluate the value of new technique in ulnar nerve entrapment syndrome.

Neurochirurgische Klinik und Poliklinik, Universitaetsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstrasse 1, D-55101 Mainz, Germany

Reprint requests: Axel Thomas Stadie, MD, Neurochirurgische Klinik und Poliklinik, Universitaetsklinikum, Johannes Gutenberg-Universität Mainz, Langenbeckstrasse 1, D-55101 Mainz, Germany. E-mail:

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Received, August 26, 2009.

Accepted, December 28, 2009.

Copyright © by the Congress of Neurological Surgeons