Peripheral Nerve Surgery and Chemotherapy: A Review, Index, and Decision Tree for Nerve Surgeons Considering Neurotization After Oncological Nerve Injuries

Authors

• William ElNemer, Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
• Chase H. Foster, Department of Neurosurgery, George Washington University, Washington, District of Columbia, USA.
• Muhammad Ali, Department of Neurosurgery, George Washington University, Washington, District of Columbia, USA.
• Jawad Khalifeh, Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
• Ahmet Hoke, Departments of Neurology and Neuroscience, Johns Hopkins University, Baltimore, Maryland, USA.
• Daniel Lubelski, Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
• Allan J. Belzberg, Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
• Sami Tuffaha, Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland, USA.

Document Type

Journal Article

Publication Date

6-1-2026

Journal

Neurosurgery practice

Volume

7

Issue

2

DOI

10.1227/neuprac.0000000000000206

Keywords

Chemotherapy; Chemotherapy-associated neurotization failure; Chemotherapy-induced peripheral neuropathy; Nerve regeneration; Neurotoxicity; Oncology; Peripheral nerve surgery; Surgical decision-making

Abstract

BACKGROUND AND OBJECTIVES: Chemotherapy-induced peripheral neuropathy (CIPN) is a complication caused by some drugs used to treat cancers including metastatic spine and malignant nerve tumors. Debilitating denervation may result from such tumors directly or from their surgical resection. The inhibitory effects of adjuvant chemotherapy on nerve regeneration in peripheral neurotization surgeries are poorly understood and must be inferred from known mechanisms of CIPN. This narrative review aims to create an index of chemotherapeutics that may cause chemotherapy-associated neurotization failure (CANF) to better inform preoperative counseling, operative timing, and postoperative prognostication by peripheral nerve surgeons. METHODS: A narrative review of published English-language literature on CIPN was performed, focusing on its known pathogenic mechanisms and its clinical manifestations including onset, duration of dysfunction, and effect size. The literature was also searched for existing evidence on the effects of the same agents on nerve regeneration and outcomes after peripheral nerve surgery. RESULTS: CIPN can manifest with sensory, motor, and/or autonomic dysfunction. Platinum-based compounds, taxanes, vinca alkaloids, antimetabolites, and proteasome inhibitors are implicated drug classes, all of which have distinct neurotoxicity profiles. CIPN phenotypes vary in timing, severity, and nerve modalities affected. Some agents are associated with a "coasting" phenomenon, where neuropathy persists even after the offending drug's discontinuation. The neurotoxic milieu induced by chemotherapy likely impairs nerve regeneration, but this has not been addressed in the literature. Data on neurotoxic chemotherapy agents were synthesized and used to create an index and risk-stratified decision tree based on inferred likelihood of CANF. CONCLUSION: Denervated patients on neurotoxic adjuvant chemotherapy regimens pose unique challenges to peripheral nerve surgeons. At least a cursory understanding of CIPN-implicated drugs, mechanisms of neurotoxicity, presentations, and the inferred risk of CANF is recommended before pursuing neurotization surgery. This index serves as a resource for peripheral nerve surgeons in this clinical conundrum.

APA Citation

ElNemer, William; Foster, Chase H.; Ali, Muhammad; Khalifeh, Jawad; Hoke, Ahmet; Lubelski, Daniel; Belzberg, Allan J.; and Tuffaha, Sami, "Peripheral Nerve Surgery and Chemotherapy: A Review, Index, and Decision Tree for Nerve Surgeons Considering Neurotization After Oncological Nerve Injuries" (2026). GW Authored Works. Paper 8999.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8999

Department

School of Medicine and Health Sciences Resident Works