{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T04:40:35Z","timestamp":1770352835415,"version":"3.49.0"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","license":[{"start":{"date-parts":[[2024,1,15]],"date-time":"2024-01-15T00:00:00Z","timestamp":1705276800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,15]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Lipomatosis of the nerve (LN) is a rare congenital hamartoma in which abundant fibroadipose tissue is found within the epineurium of peripheral nerves. It is frequently associated with nerve territory overgrowth affecting bones or soft tissues. The clinicoradiological features are well known and pathognomonic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 38-year-old female was evaluated via telehealth for worsened sciatica after the resection of a sciatic notch lipoma, after having been evaluated over a decade for symptoms. Virtual physical examination revealed previously unrecognized subtle limb discrepancy (i.e., overgrowth). Although preoperative radiographs were unavailable during the initial evaluation, postoperative magnetic resonance imaging studies showed evidence of sciatic nerve LN. A diagnosis of LN and nerve territory overgrowth was established.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Despite its limitations, telehealth can be an effective alternative or adjunct to in-person evaluations in making complex diagnoses. Dedicated examination without clinical suspicion can miss subtle findings. An iterative process prompted by a focused history, knowledge of clinical associations, and pattern recognition can facilitate an accurate diagnosis without obvious face-to-face visual clues. In patients with rare disorders, asynchronous evaluation allows in-person visits to be supplemented by subsequent telehealth virtual physical exam findings. This case illustrates how examination via telehealth can be used to effectively diagnose a rare syndrome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case23609","type":"journal-article","created":{"date-parts":[[2024,1,15]],"date-time":"2024-01-15T18:54:16Z","timestamp":1705344856000},"source":"Crossref","is-referenced-by-count":1,"title":["Unrecognized sciatic lipomatosis of the nerve diagnosed by telehealth: illustrative case"],"prefix":"10.3171","volume":"7","author":[{"given":"Tomas","family":"Marek","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noah D","family":"Spinner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert J","family":"Spinner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"World Health Organisation classification of tumours.","year":"2002","unstructured":"Fletcher C, Unni K, Mertens F, eds. Pathology and genetics: Tumours of soft tissue and bone. World Health Organisation classification of tumours. IARC Press; 2002."},{"issue":"1","key":"b2","series-title":"Am J Surg Pathol","first-page":"7","article-title":"Fibrolipomatous hamartoma of nerve. A clinicopathologic analysis of 26 cases","volume":"9","author":"Silverman TA","year":"1985","unstructured":"Silverman TA, Enzinger FM Fibrolipomatous hamartoma of nerve. A clinicopathologic analysis of 26 cases. Am J Surg Pathol. 1985;9(1):7\u201314."},{"issue":"5","key":"b3","series-title":"J Bone Joint Surg Am","first-page":"984","article-title":"Lipofibromatous hamartoma of the median nerve","volume":"51","author":"Johnson RJ","year":"1969","unstructured":"Johnson RJ, Bonfiglio M Lipofibromatous hamartoma of the median nerve. J Bone Joint Surg Am. 1969;51(5):984\u2013990."},{"issue":"3","key":"b4","series-title":"Acta Neurochir (Wien)","first-page":"835","article-title":"What\u2019s known and what\u2019s new in adipose lesions of peripheral nerves?","volume":"163","author":"Marek T","year":"2021","unstructured":"Marek T, Mahan MA, Carter JM, et\u00a0al. What\u2019s known and what\u2019s new in adipose lesions of peripheral nerves? Acta Neurochir (Wien). 2021;163(3):835\u2013842."},{"issue":"4","key":"b5","series-title":"J Neurosurg","first-page":"1286","article-title":"Strengthening the association of lipomatosis of nerve and nerve-territory overgrowth: a systematic review","volume":"132","author":"Marek T","year":"2019","unstructured":"Marek T, Spinner RJ, Syal A, Mahan MA Strengthening the association of lipomatosis of nerve and nerve-territory overgrowth: a systematic review. J Neurosurg. 2019;132(4):1286\u20131294."},{"issue":"3","key":"b6","series-title":"Mod Pathol","first-page":"420","article-title":"PIK3CA mutations in lipomatosis of nerve with or without nerve territory overgrowth","volume":"33","author":"Blackburn PR","year":"2020","unstructured":"Blackburn PR, Milosevic D, Marek T, et\u00a0al. PIK3CA mutations in lipomatosis of nerve with or without nerve territory overgrowth. Mod Pathol. 2020;33(3):420\u2013430."},{"issue":"2","key":"b7","series-title":"Am J Med Genet A","first-page":"287","article-title":"PIK3CA-related overgrowth spectrum (PROS): diagnostic and testing eligibility criteria, differential diagnosis, and evaluation","volume":"167A","author":"Keppler-Noreuil KM","year":"2015","unstructured":"Keppler-Noreuil KM, Rios JJ, Parker VE, et\u00a0al. PIK3CA-related overgrowth spectrum (PROS): diagnostic and testing eligibility criteria, differential diagnosis, and evaluation. Am J Med Genet A. 2015;167A(2):287\u2013295."},{"issue":"5","key":"b8","series-title":"Skeletal Radiol","first-page":"260","article-title":"Fibrolipomatous hamartoma: pathognomonic on MR imaging","volume":"28","author":"Marom EM","year":"1999","unstructured":"Marom EM, Helms CA Fibrolipomatous hamartoma: pathognomonic on MR imaging. Skeletal Radiol. 1999;28(5):260\u2013264."},{"issue":"3","key":"b9","series-title":"Skeletal Radiol","first-page":"180","article-title":"Lipomatosis of the sciatic nerve: typical and atypical MRI features","volume":"35","author":"Wong BZ","year":"2006","unstructured":"Wong BZ, Amrami KK, Wenger DE, Dyck PJ, Scheithauer BW, Spinner RJ Lipomatosis of the sciatic nerve: typical and atypical MRI features. Skeletal Radiol. 2006;35(3):180\u2013184."},{"issue":"1","key":"b10","series-title":"Microsurgery","first-page":"66","article-title":"Lipomatosis of the sciatic nerve: report of a case and review of the literature","volume":"29","author":"Fandridis EM","year":"2009","unstructured":"Fandridis EM, Kiriako AS, Spyridonos SG, Delibasis GE, Bourlos DN, Gerostathopoulos NE Lipomatosis of the sciatic nerve: report of a case and review of the literature. Microsurgery. 2009;29(1):66\u201371."},{"issue":"7","key":"b11","series-title":"Skeletal Radiol","first-page":"963","article-title":"Occult radiological effects of lipomatosis of the lumbosacral plexus","volume":"43","author":"Mahan MA","year":"2014","unstructured":"Mahan MA, Howe BM, Amrami KK, Spinner RJ Occult radiological effects of lipomatosis of the lumbosacral plexus. Skeletal Radiol. 2014;43(7):963\u2013968."},{"issue":"2","key":"b12","series-title":"J Neurosurg","first-page":"418","article-title":"Adipose lesions of nerve: the need for a modified classification","volume":"116","author":"Spinner RJ","year":"2012","unstructured":"Spinner RJ, Scheithauer BW, Amrami KK, Wenger DE, H\u00e9bert-Blouin MN Adipose lesions of nerve: the need for a modified classification. J Neurosurg. 2012;116(2):418\u2013431."},{"key":"b13","series-title":"Ann Med Surg (Lond)","first-page":"104542","article-title":"Lipofibromatous hamartoma of sciatic nerve: a case report","volume":"81","author":"Khadka S","year":"2022","unstructured":"Khadka S, Adhikari P, Regmi PR, et\u00a0al. Lipofibromatous hamartoma of sciatic nerve: a case report. Ann Med Surg (Lond). 2022;81:104542."},{"issue":"2","key":"b14","series-title":"J Neurosurg Case Lessons","first-page":"CASE22463","article-title":"Occult lipomatosis of the nerve as part of macrodystrophia lipomatosa: illustrative case","volume":"5","author":"Marek T","year":"2023","unstructured":"Marek T, Amrami KK, Spinner RJ Occult lipomatosis of the nerve as part of macrodystrophia lipomatosa: illustrative case. J Neurosurg Case Lessons. 2023;5(2):CASE22463."},{"issue":"8","key":"b15","series-title":"Clin Anat","first-page":"1210","article-title":"Unrecognized lipomatosis of the femoral nerve and nerve-territory overgrowth","volume":"31","author":"Marek T","year":"2018","unstructured":"Marek T, Howe BM, Amrami KK, Taunton MJ, Spinner RJ Unrecognized lipomatosis of the femoral nerve and nerve-territory overgrowth. Clin Anat. 2018;31(8):1210\u20131214."},{"issue":"2","key":"b16","series-title":"Invest Radiol","first-page":"133","article-title":"Satisfaction of search in diagnostic radiology","volume":"25","author":"Berbaum KS","year":"1990","unstructured":"Berbaum KS, Franken EA Jr, Dorfman DD, et\u00a0al. Satisfaction of search in diagnostic radiology. Invest Radiol. 1990;25(2):133\u2013140."},{"issue":"1","key":"b17","series-title":"NEJM Catalyst","article-title":"What is telehealth?","volume":"4","year":"2018","unstructured":"What is telehealth? NEJM Catalyst. 2018;4(1)."},{"issue":"5","key":"b18","series-title":"Acta Neurochir (Wien)","first-page":"1317","article-title":"Validity of range of motion, muscle strength, sensitivity, and Tinel sign tele-assessment in adults with traumatic brachial plexus injury","volume":"164","author":"Gushikem A","year":"2022","unstructured":"Gushikem A, Gomes Costa RR, Lima Cabral AL, Lopes Bomtempo LF, de Mendon\u00e7a Cardoso M Validity of range of motion, muscle strength, sensitivity, and Tinel sign tele-assessment in adults with traumatic brachial plexus injury. Acta Neurochir (Wien). 2022;164(5):1317\u20131328."},{"key":"b1","series-title":"World Health Organisation classification of tumours.","year":"2002","unstructured":"Fletcher C, Unni K, Mertens F, eds. Pathology and genetics: Tumours of soft tissue and bone. World Health Organisation classification of tumours. 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J Bone Joint Surg Am. 1969;51(5):984\u2013990."},{"issue":"3","key":"b4","series-title":"Acta Neurochir (Wien)","first-page":"835","article-title":"What\u2019s known and what\u2019s new in adipose lesions of peripheral nerves?","volume":"163","author":"Marek T","year":"2021","unstructured":"Marek T, Mahan MA, Carter JM, et\u00a0al. What\u2019s known and what\u2019s new in adipose lesions of peripheral nerves? Acta Neurochir (Wien). 2021;163(3):835\u2013842."},{"issue":"4","key":"b5","series-title":"J Neurosurg","first-page":"1286","article-title":"Strengthening the association of lipomatosis of nerve and nerve-territory overgrowth: a systematic review","volume":"132","author":"Marek T","year":"2019","unstructured":"Marek T, Spinner RJ, Syal A, Mahan MA Strengthening the association of lipomatosis of nerve and nerve-territory overgrowth: a systematic review. J Neurosurg. 2019;132(4):1286\u20131294."},{"issue":"3","key":"b6","series-title":"Mod Pathol","first-page":"420","article-title":"PIK3CA mutations in lipomatosis of nerve with or without nerve territory overgrowth","volume":"33","author":"Blackburn PR","year":"2020","unstructured":"Blackburn PR, Milosevic D, Marek T, et\u00a0al. PIK3CA mutations in lipomatosis of nerve with or without nerve territory overgrowth. Mod Pathol. 2020;33(3):420\u2013430."},{"issue":"2","key":"b7","series-title":"Am J Med Genet A","first-page":"287","article-title":"PIK3CA-related overgrowth spectrum (PROS): diagnostic and testing eligibility criteria, differential diagnosis, and evaluation","volume":"167A","author":"Keppler-Noreuil KM","year":"2015","unstructured":"Keppler-Noreuil KM, Rios JJ, Parker VE, et\u00a0al. PIK3CA-related overgrowth spectrum (PROS): diagnostic and testing eligibility criteria, differential diagnosis, and evaluation. Am J Med Genet A. 2015;167A(2):287\u2013295."},{"issue":"5","key":"b8","series-title":"Skeletal Radiol","first-page":"260","article-title":"Fibrolipomatous hamartoma: pathognomonic on MR imaging","volume":"28","author":"Marom EM","year":"1999","unstructured":"Marom EM, Helms CA Fibrolipomatous hamartoma: pathognomonic on MR imaging. Skeletal Radiol. 1999;28(5):260\u2013264."},{"issue":"3","key":"b9","series-title":"Skeletal Radiol","first-page":"180","article-title":"Lipomatosis of the sciatic nerve: typical and atypical MRI features","volume":"35","author":"Wong BZ","year":"2006","unstructured":"Wong BZ, Amrami KK, Wenger DE, Dyck PJ, Scheithauer BW, Spinner RJ Lipomatosis of the sciatic nerve: typical and atypical MRI features. Skeletal Radiol. 2006;35(3):180\u2013184."},{"issue":"1","key":"b10","series-title":"Microsurgery","first-page":"66","article-title":"Lipomatosis of the sciatic nerve: report of a case and review of the literature","volume":"29","author":"Fandridis EM","year":"2009","unstructured":"Fandridis EM, Kiriako AS, Spyridonos SG, Delibasis GE, Bourlos DN, Gerostathopoulos NE Lipomatosis of the sciatic nerve: report of a case and review of the literature. Microsurgery. 2009;29(1):66\u201371."},{"issue":"7","key":"b11","series-title":"Skeletal Radiol","first-page":"963","article-title":"Occult radiological effects of lipomatosis of the lumbosacral plexus","volume":"43","author":"Mahan MA","year":"2014","unstructured":"Mahan MA, Howe BM, Amrami KK, Spinner RJ Occult radiological effects of lipomatosis of the lumbosacral plexus. Skeletal Radiol. 2014;43(7):963\u2013968."},{"issue":"2","key":"b12","series-title":"J Neurosurg","first-page":"418","article-title":"Adipose lesions of nerve: the need for a modified classification","volume":"116","author":"Spinner RJ","year":"2012","unstructured":"Spinner RJ, Scheithauer BW, Amrami KK, Wenger DE, H\u00e9bert-Blouin MN Adipose lesions of nerve: the need for a modified classification. J Neurosurg. 2012;116(2):418\u2013431."},{"key":"b13","series-title":"Ann Med Surg (Lond)","first-page":"104542","article-title":"Lipofibromatous hamartoma of sciatic nerve: a case report","volume":"81","author":"Khadka S","year":"2022","unstructured":"Khadka S, Adhikari P, Regmi PR, et\u00a0al. Lipofibromatous hamartoma of sciatic nerve: a case report. Ann Med Surg (Lond). 2022;81:104542."},{"issue":"2","key":"b14","series-title":"J Neurosurg Case Lessons","first-page":"CASE22463","article-title":"Occult lipomatosis of the nerve as part of macrodystrophia lipomatosa: illustrative case","volume":"5","author":"Marek T","year":"2023","unstructured":"Marek T, Amrami KK, Spinner RJ Occult lipomatosis of the nerve as part of macrodystrophia lipomatosa: illustrative case. J Neurosurg Case Lessons. 2023;5(2):CASE22463."},{"issue":"8","key":"b15","series-title":"Clin Anat","first-page":"1210","article-title":"Unrecognized lipomatosis of the femoral nerve and nerve-territory overgrowth","volume":"31","author":"Marek T","year":"2018","unstructured":"Marek T, Howe BM, Amrami KK, Taunton MJ, Spinner RJ Unrecognized lipomatosis of the femoral nerve and nerve-territory overgrowth. Clin Anat. 2018;31(8):1210\u20131214."},{"issue":"2","key":"b16","series-title":"Invest Radiol","first-page":"133","article-title":"Satisfaction of search in diagnostic radiology","volume":"25","author":"Berbaum KS","year":"1990","unstructured":"Berbaum KS, Franken EA Jr, Dorfman DD, et\u00a0al. Satisfaction of search in diagnostic radiology. Invest Radiol. 1990;25(2):133\u2013140."},{"issue":"1","key":"b17","series-title":"NEJM Catalyst","article-title":"What is telehealth?","volume":"4","year":"2018","unstructured":"What is telehealth? 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