Functional and electrophysiological aspects of the neuritization procedure in brachial plexus injury
| Authors | |
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| Year of publication | 2006 |
| Type | Article in Proceedings |
| Conference | Proceedings of the 4th Intern. Mt. Bandai Symposium for Neuroscience |
| MU Faculty or unit | |
| Citation | |
| Field | Neurology, neurosurgery, neurosciences |
| Keywords | nerve recostruction; end-to-side anastomosis |
| Description | Introduction. Despite the improvement over the last decade in surgical techniques for the brachial plexus, surgical outcome and functional restoration of the affected arm are still very limited. Nerve avulsions and proximal lesions are still considered to be directly irreparable and nerve transfer (neurotization) is the method of choice in the treatment of those lesions. Methods. End-to-end nerve transfer was performed by the first author in 86 patients and total of 179 nerves were neurotized. Besides the standard techniques of neurotization, the perineurial suture after creation of epineurial window has been used for end-to-side neurorrhaphy in 23 selected cases. Results. Overall functional recovery was accomplished in 54% of patients following end-to-end neurotization. We achieved the best results using regional (intraplexal) nerves as donors for nerve transfer. The difference was significant especially for the musculocutaneus nerve as recipient: 93% of functional recovery when regional nerves were used, 48% when extraplexal nerves were used (p=0,005). Functional recovery of the recipient peripheral nerves strongly depended on the choice of donor. Use of the medial pectoral nerve as a donor led to the most favorable functional recovery in 88% of cases. According to the electrophysiological data, even use of clearly partially denervated intraplexal donor nerves resulted to the more favorable recovery than use of extraplexal nerves. End-to-side neurorrhaphy was performed predominantly for the neurotization of axillary nerve and functional recovery (62%) was similar to the use intraplexal (67%) and extraplexal (60%) nerves as donors for the axillary nerve. Conclusions. Better functional recovery was achieved using regional (intraplexal) donors of motor fibres. End-to-side anastomosis is an alternative method with results similar to the other donors of motor fibres. The advantage of end-to-side neurorrhaphy is in no need to sacrifice any other healthy nerve. |
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