AN ECLECTIC REVIEW OF THE HISTORY OF PERIPHERAL NERVE SURGERY

Neurosurgery ◽  
2009 ◽  
Vol 65 (suppl_4) ◽  
pp. A3-A8 ◽  
Author(s):  
Allan H. Friedman
Keyword(s):  
Peripheral Nerve ◽  
Peripheral Nerves ◽  
Nerve Repair ◽  
Lessons Learned ◽  
Injured Nerve ◽  
Peripheral Nerve Surgery ◽  
Distinguished Career ◽  
History Of ◽  
Nerve Surgery

Abstract WE TAKE OUR present concepts of nerve repair for granted. In fact, the pioneers who established these principles traveled a road filled with erroneous dogma, bad advice, and misleading data. The lessons learned from a review of the history of peripheral nerve surgery are applicable to all neurosurgical disciplines. In honor of Dr. David Kline's distinguished career, we will review 3 aspects of the history of peripheral nerve surgery: Can an injured nerve regain function? How do peripheral nerves regenerate? When should a neuroma in continuity be resected?

Waterjet Dissection of Peripheral Nerves: An Experimental Study of the Sciatic Nerve of Rats

2010 ◽  
Vol 67 (suppl_2) ◽  
pp. ons368-ons376 ◽  
Author(s):  
Christoph A. Tschan ◽  
Doerthe Keiner ◽  
Harald D. Müller ◽  
Kerstin Schwabe ◽  
Michael R. Gaab ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Peripheral Nerve ◽  
Nerve Regeneration ◽  
Peripheral Nerves ◽  
Scar Tissue ◽  
Small Water ◽  
Peripheral Nerve Surgery ◽  
Sciatic Nerves ◽  
Nerve Surgery ◽  
Waterjet Dissection

ABSTRACT BACKGROUND: Although waterjet dissection has been well evaluated in intracranial pathologies, little is known of its qualities in peripheral nerve surgery. Theoretically, the precise dissection qualities could support the separation of nerves from adjacent tissues and improve the preservation of nerve integrity in peripheral nerve surgery. OBJECTIVE: To evaluate the potential of the new waterjet dissector in peripheral nerve surgery. METHODS: Waterjet dissection with pressures of 20 to 80 bar was applied on the sciatic nerves of 101 rats. The effect of waterjet dissection on the sciatic nerve was evaluated by clinical tests, neurophysiological examinations, and histopathological studies up to 12 weeks after surgery. RESULTS: With waterjet pressures up to 30 bar, the sciatic nerve was preserved in its integrity in all cases. Functional damaging was observed at pressures of 40 bar and higher. However, all but 1 rat in the 80 bar subgroup showed complete functional regeneration at 12 weeks after surgery. Histopathologically, small water bubbles were observed around the nerves. At 40 bar and higher, the sciatic nerves showed signs of direct nerve injury. However, all these animals showed nerve regeneration after 12 weeks, as demonstrated by histological studies. CONCLUSION: Sciatic nerves were preserved functionally and morphologically at pressures up to 30 bar. Between 40 and 80 bar, reliable functional and morphological nerve regeneration occurred. Waterjet pressures up to 30 bar might be applied safely under clinical conditions. This technique might be well suited to separate intact peripheral nerves from adjacent tumor or scar tissue. Further studies will have to show the clinical relevance of these dissection qualities.

scholarly journals Practical considerations concerning the use of stem cells for peripheral nerve repair

2009 ◽  
Vol 26 (2) ◽  
pp. E2 ◽  
Author(s):  
Sarah Walsh ◽  
_ _ ◽  
Rajiv Midha
Keyword(s):  
Stem Cells ◽  
Peripheral Nerve ◽  
Schwann Cells ◽  
Nerve Injury ◽  
Cell Fate ◽  
Peripheral Nerves ◽  
Nerve Repair ◽  
Precursor Cells ◽  
Host Cells ◽  
Injured Nerve

In this review the authors intend to demonstrate the need for supplementing conventional repair of the injured nerve with alternative therapies, namely transplantation of stem or progenitor cells. Although peripheral nerves do exhibit the potential to regenerate axons and reinnervate the end organ, outcome following severe nerve injury, even after repair, remains relatively poor. This is likely because of the extensive injury zone that prevents axon outgrowth. Even if outgrowth does occur, a relatively slow growth rate of regeneration results in prolonged denervation of the distal nerve. Whereas denervated Schwann cells (SCs) are key players in the early regenerative success of peripheral nerves, protracted loss of axonal contact renders Schwann cells unreceptive for axonal regeneration. Given that denervated Schwann cells appear to become effete, one logical approach is to support the distal denervated nerve environment by replacing host cells with those derived exogenously. A number of different sources of stem/precursor cells are being explored for their potential application in the scenario of peripheral nerve injury. The most promising candidate, transplant cells are derived from easily accessible sources such as the skin, bone marrow, or adipose tissue, all of which have demonstrated the capacity to differentiate into Schwann cell–like cells. Although recent studies have shown that stem cells can act as promising and beneficial adjuncts to nerve repair, considerable optimization of these therapies will be required for their potential to be realized in a clinical setting. The authors investigate the relevance of the delivery method (both the number and differentiation state of cells) on experimental outcomes, and seek to clarify whether stem cells must survive and differentiate in the injured nerve to convey a therapeutic effect. As our laboratory uses skin-derived precursor cells (SKPCs) in various nerve injury paradigms, we relate our findings on cell fate to other published studies to demonstrate the need to quantify stem cell survival and differentiation for future studies.

An eclectic history of peripheral nerve surgery

2004 ◽  
Vol 15 (2) ◽  
pp. 109-123 ◽  
Author(s):  
Kenneth M Little ◽  
Ali R Zomorodi ◽  
Lee A Selznick ◽  
Allan H Friedman
Keyword(s):  
Peripheral Nerve ◽  
Peripheral Nerve Surgery ◽  
History Of ◽  
Nerve Surgery

Reflections on the contributions of Harvey Cushing to the surgery of peripheral nerves

2011 ◽  
Vol 114 (5) ◽  
pp. 1442-1448 ◽  
Author(s):  
R. Shane Tubbs ◽  
Neal Patel ◽  
Brian Vala Nahed ◽  
Aaron A. Cohen-Gadol ◽  
Robert J. Spinner
Keyword(s):  
Peripheral Nerve ◽  
Nerve Repair ◽  
Johns Hopkins Hospital ◽  
Nerve Reconstruction ◽  
Surgical Resident ◽  
Nerve Blocks ◽  
Peripheral Nerve Surgery ◽  
Harvey Cushing ◽  
Operative Notes ◽  
Nerve Surgery

By the time Harvey Cushing entered medical school, nerve reconstruction techniques had been developed, but peripheral nerve surgery was still in its infancy. As an assistant surgical resident influenced by Dr. William Halsted, Cushing wrote a series of reports on the use of cocaine for nerve blocks. Following his residency training and a hiatus to further his clinical interests and intellectual curiosity, he traveled to Europe and met with a variety of surgeons, physiologists, and scientists, who likely laid the groundwork for Cushing's increased interest in peripheral nerve surgery. Returning to The Johns Hopkins Hospital in 1901, he began documenting these surgeries. Patient records preserved at Yale's Cushing Brain Tumor Registry describe Cushing's repair of ulnar and radial nerves, as well as his exploration of the brachial plexus for nerve repair or reconstruction. The authors reviewed Harvey Cushing's cases and provide 3 case illustrations not previously reported by Cushing involving neurolysis, nerve repair, and neurotization. Additionally, Cushing's experience with facial nerve neurotization is reviewed. The history, physical examination, and operative notes shed light on Cushing's diagnosis, strategy, technique, and hence, his surgery on peripheral nerve injury. These contributions complement others he made to surgery of the peripheral nervous system dealing with nerve pain, entrapment, and tumor.

scholarly journals Introduction: Peripheral Nerve Surgery—Biology, Entrapment, and Injuries

2009 ◽  
Vol 26 (2) ◽  
pp. E1 ◽  
Author(s):  
Allan H. Friedman ◽  
W. Jeffrey Elias ◽  
Rajiv Midha
Keyword(s):  
Peripheral Nerve ◽  
Peripheral Nerves ◽  
Nerve Repair ◽  
Peripheral Nerve Injuries ◽  
Significant Progress ◽  
Vital Function ◽  
Harvey Cushing ◽  
Nerve Transfers ◽  
Electrophysiological Technique ◽  
Nerve Surgery

Surgery aimed at repairing damaged peripheral nerves has a long history. Refuting the timehonored nihilism of Hippocrates and Galen that an injured nerve cannot regain function, a few adventurous medieval surgeons attempted to repair severed nerves.6,8 However, the ability of a peripheral nerve repair to restore function was not generally accepted until 1800.1,4 Neurosurgeons, beginning with Harvey Cushing, have had an interest in repairing damaged peripheral nerves.2 Significant progress in the treatment of peripheral nerve injuries resulted from experience with the numerous injuries that occurred during World Wars I and II.3,7,12 Surgeons steadily defined the anatomy of peripheral nerves and developed techniques for decompressing and repairing peripheral nerves.9,11 Kline and Dejonge5 developed an intraoperative electrophysiological technique for detecting axons regenerating across a damaged segment of nerve. In the second 2 decades of the 20th century, distal nerve transfers were rediscovered whereby the proximal end of a less essential nerve is used to reinnervate the distal end of a nerve, providing a more vital function.10

Peripheral Nerve Injuries- An Analysis of 75 Cases

JMS SKIMS ◽  
2010 ◽  
Vol 13 (1) ◽  
pp. 7-10
Author(s):  
Owais Habib ◽  
Adil Hafeez ◽  
Abdul Rashid Bhat
Keyword(s):  
Peripheral Nerve ◽  
Peripheral Nerves ◽  
Primary Repair ◽  
Nerve Repair ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries ◽  
Microsurgical Technique ◽  
Injured Nerve ◽  
Neural Damage ◽  
Civilian Practice

Background: Peripheral neural trauma is a common injury seen both in civilian practice and warfare.Majority of such neural damage is caused by glass cut. The agent causes extnesive damage to te underlying structures from an apparantly looking small incised wound.Material and Method: We explored the wonds of 75 patients under anaesthesia to look for injury to the underlying peripheral nerves. Upon identifying the injured nerve, primary repair using epineural microsurgical technique was carried out using very fine sutures and micro- instruments. The patients were followed sequentailly in the post operative period.Conclusion:When such a protocol was adhered to, the results of nerve repair were excellent in majority of the patients. J Med Sci 2010;13(1):7-10

scholarly journals Adipose Tissue Uses in Peripheral Nerve Surgery

2022 ◽  
Vol 23 (2) ◽  
pp. 644
Author(s):  
Allison Podsednik ◽  
Raysa Cabrejo ◽  
Joseph Rosen
Keyword(s):  
Peripheral Nerve ◽  
Peripheral Nerves ◽  
Animal Studies ◽  
Surgical Repair ◽  
Fat Grafting ◽  
Adipose Derived Stem Cells ◽  
Injury Site ◽  
Peripheral Nerve Surgery ◽  
Improved Outcomes ◽  
Nerve Surgery

Currently, many different techniques exist for the surgical repair of peripheral nerves. The degree of injury dictates the repair and, depending on the defect or injury of the peripheral nerve, plastic surgeons can perform nerve repairs, grafts, and transfers. All the previously listed techniques are routinely performed in human patients, but a novel addition to these peripheral nerve surgeries involves concomitant fat grafting to the repair site at the time of surgery. Fat grafting provides adipose-derived stem cells to the injury site. Though fat grafting is performed as an adjunct to some peripheral nerve surgeries, there is no clear evidence as to which procedures have improved outcomes resultant from concomitant fat grafting. This review explores the evidence presented in various animal studies regarding outcomes of fat grafting at the time of various types of peripheral nerve surgery.

scholarly journals Intraoperative ultrasound-assisted peripheral nerve surgery

2015 ◽  
Vol 39 (3) ◽  
pp. E4 ◽  
Author(s):  
Clayton L. Haldeman ◽  
Christopher D. Baggott ◽  
Amgad S. Hanna
Keyword(s):  
Peripheral Nerve ◽  
Peripheral Nerves ◽  
Imaging Modality ◽  
Intraoperative Ultrasound ◽  
Pathological Anatomy ◽  
Peripheral Nerve Surgery ◽  
Surgical Adjunct ◽  
High Resolution Ultrasonography ◽  
Nerve Surgery ◽  
Deep Location

Historically, peripheral nerve surgery has relied on landmarks and fairly extensive dissection for localization of both normal and pathological anatomy. High-resolution ultrasonography is a radiation-free imaging modality that can be used to directly visualize peripheral nerves and their associated pathologies prior to making an incision. It therefore helps in localization of normal and pathological anatomy, which can minimize the need for extensive exposures. The authors found intraoperative ultrasound (US) to be most useful in the management of peripheral nerve tumors and neuromas of nerve branches that are particularly small or have a deep location. This study presents the use of intraoperative US in 5 cases in an effort to illustrate some of the applications of this useful surgical adjunct.

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