scholarly journals Contralateral C7 nerve transfer in the treatment of upper-extremity paralysis: a review of anatomical basis, surgical approaches, and neurobiological mechanisms

2022 ◽  
Vol 0 (0) ◽  
Author(s):  
Yang Bai ◽  
Song Han ◽  
Jing-Yu Guan ◽  
Jun Lin ◽  
Ming-Guang Zhao ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Peripheral Nerve Regeneration ◽  
Nerve Transfer ◽  
Surgical Approaches ◽  
Clinical Effects ◽  
Subcutaneous Route ◽  
Motor Cortex Stimulation ◽  
Surgical Operation ◽  
Anatomical Basis ◽  
Brain Involvement

Abstract The previous three decades have witnessed a prosperity of contralateral C7 nerve (CC7) transfer in the treatment of upper-extremity paralysis induced by both brachial plexus avulsion injury and central hemiplegia. From the initial subcutaneous route to the pre-spinal route and the newly-established post-spinal route, this surgical operation underwent a series of innovations and refinements, with the aim of shortening the regeneration distance and even achieving direct neurorrhaphy. Apart from surgical efforts for better peripheral nerve regeneration, brain involvement in functional improvements after CC7 transfer also stimulated scientific interest. This review summarizes recent advances of CC7 transfer in the treatment of upper-extremity paralysis of both peripheral and central causes, which covers the neuroanatomical basis, the evolution of surgical approach, and central mechanisms. In addition, motor cortex stimulation is discussed as a viable rehabilitation treatment in boosting functional recovery after CC7 transfer. This knowledge will be beneficial towards improving clinical effects of CC7 transfer.

FREE VASCULARIZED NERVE TRANSFER IN THE UPPER EXTREMITY

Hand Clinics ◽  
1999 ◽  
Vol 15 (4) ◽  
pp. 673-695
Author(s):  
G. Ian Taylor
Keyword(s):  
Upper Extremity ◽  
Nerve Transfer

BILATERAL MACRODYSTROPHIA LIPOMATOSA WITH SYNDACTYLY: A CASE REPORT AND LITERATURE REVIEW

Hand Surgery ◽  
2013 ◽  
Vol 18 (02) ◽  
pp. 267-272 ◽  
Author(s):  
Steven B. Albright ◽  
Erik M. Wolfswinkel ◽  
Kevin J. Caceres ◽  
William M. Weathers ◽  
Larry H. Hollier
Keyword(s):  
Adipose Tissue ◽  
Case Report ◽  
Literature Review ◽  
Upper Extremity ◽  
Surgical Approaches ◽  
Macrodystrophia Lipomatosa ◽  
Mesenchymal Tissue ◽  
Difficult Condition

Macrodystrophia lipomatosa is a rare, non-hereditary form of congenital local gigantism characterised by enlargement and hypertrophy of all mesenchymal tissue components with a disproportionate increase in adipose tissue. This form of macrodactyly has been reported in association with other anomalies including polydactyly, brachydactyly, syndactyly, and symphalangism. We describe a previously unreported case of bilateral upper extremity macrodystrophia lipomatosa with syndactyly in a 23-month-old boy. In this report, we emphasise the importance of establishing a diagnosis with imaging and review the described surgical approaches to treating this difficult condition.

scholarly journals Management of anterior inferior cerebellar artery aneurysms: an illustrative case and review of literature

2009 ◽  
Vol 26 (5) ◽  
pp. E6 ◽  
Author(s):  
Nicholas C. Bambakidis ◽  
Sunil Manjila ◽  
Shervin Dashti ◽  
Robert Tarr ◽  
Cliff A. Megerian
Keyword(s):  
Surgical Techniques ◽  
Surgical Approaches ◽  
Anterior Inferior Cerebellar Artery ◽  
Parent Artery ◽  
Illustrative Case ◽  
Detailed Knowledge ◽  
Clinical Effects ◽  
Advantages And Disadvantages ◽  
Parent Artery Occlusion ◽  
Cerebellar Artery

Aneurysms of the anterior inferior cerebellar artery (AICA) are relatively rare among intracranial aneurysms. They can occur in 1 of 3 regions of the AICA: 1) craniocaudal (high or low riding), 2) mediolateral-premeatal (proximal), and 3) meatal-postmeatal (distal). The management strategies for treatment differ according to the location and configuration of the aneurysm. The existing body of neurosurgical literature contains articles published on aneurysms arising from the AICA near the basilar artery (BA), intracanalicular/meatal aneurysms, and distal AICA. Several therapeutic options exist, encompassing microsurgical and endovascular techniques. The authors describe a case of treatment involving a large BA-AICA aneurysm approached via exposure of the presigmoid dura using a retromastoid suboccipital craniectomy and partial petrosectomy. Treatment of these lesions requires detailed knowledge of the anatomy, and an anatomical overview of the AICA with its arterial loops and significant branches is presented, including a discussion of the internal auditory (labyrinthine) artery, recurrent perforating arteries, subarcuate artery, and cerebellosubarcuate artery. The authors discuss the various surgical approaches (retromastoid, far lateral, subtemporal, and transclival) with appropriate illustrations, citing the advantages and disadvantages in accessing these AICA lesions in relation to these approaches. The complications of these different surgical techniques and possible clinical effects of parent artery occlusion during AICA surgery are highlighted.

Cortical Plasticity Following Nerve Transfer in the Upper Extremity

Hand Clinics ◽  
2008 ◽  
Vol 24 (4) ◽  
pp. 425-444 ◽  
Author(s):  
Dimitri J. Anastakis ◽  
Martijn J.A. Malessy ◽  
Robert Chen ◽  
Karen D. Davis ◽  
David Mikulis
Keyword(s):  
Upper Extremity ◽  
Cortical Plasticity ◽  
Nerve Transfer

scholarly journals Upper brachial plexus injury in adults: comparative effectiveness of different repair techniques

2015 ◽  
Vol 122 (1) ◽  
pp. 195-201 ◽  
Author(s):  
Zarina S. Ali ◽  
Gregory G. Heuer ◽  
Ryan W. F. Faught ◽  
Shriya H. Kaneriya ◽  
Umar A. Sheikh ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Controlled Trial ◽  
Treatment Strategies ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Surgical Approaches ◽  
Shoulder Abduction ◽  
Nerve Grafting ◽  
Nerve Transfers ◽  
Repair Techniques

OBJECT Adult upper trunk brachial plexus injuries result in significant disability. Several surgical treatment strategies exist, including nerve grafting, nerve transfers, and a combination of both approaches. However, no existing data clearly indicate the most successful strategy for restoring elbow flexion and shoulder abduction in these patients. The authors reviewed the literature to compare outcomes of the three surgical repair techniques listed above to determine the optimal approach to traumatic injury to the upper brachial plexus in adults. METHODS Both PubMed and EMBASE databases were searched for English-language articles containing the MeSH topic “brachial plexus” in conjunction with the word “injury” or “trauma” in the title and “surgery” or “repair” as a MeSH subheading or in the title, excluding pediatric articles and those articles limited to avulsions. The search was also limited to articles published after 1990 and containing at least 10 operated cases involving upper brachial plexus injuries. The search was supplemented with articles obtained through the “Related Articles” feature on PubMed and the bibliographies of selected publications. From the articles was collected information on the operation performed, number of operated cases, mean subject ages, sex distribution, interval between injury and surgery, source of nerve transfers, mean duration of follow-up, year of publication, and percentage of operative success in terms of elbow flexion and shoulder abduction of the injured limb. The recovery of elbow flexion and shoulder abduction was separately analyzed. A subanalysis was also performed to assess the recovery of elbow flexion following various neurotization techniques. RESULTS As regards the restoration of elbow flexion, nerve grafting led to significantly better outcomes than either nerve transfer or the combined techniques (F = 4.71, p = 0.0097). However, separating the Oberlin procedure from other neurotization techniques revealed that the former was significantly more successful (F = 82.82, p < 0.001). Moreover, in comparing the Oberlin procedure to nerve grafting or combined procedures, again the former was significantly more successful than either of the latter two approaches (F = 53.14; p < 0.001). In the restoration of shoulder abduction, nerve transfer was significantly more successful than the combined procedure (p = 0.046), which in turn was significantly better than nerve grafting procedures (F = 5.53, p = 0.0044). CONCLUSIONS According to data in this study, in upper trunk brachial plexus injuries in adults, the Oberlin procedure and nerve transfers are the more successful approaches to restore elbow flexion and shoulder abduction, respectively, compared with nerve grafting or combined techniques. A prospective, randomized controlled trial would be necessary to fully elucidate differences in outcome among the various surgical approaches.

Decussation of hind-limb and fore-limb fibers in the monkey corticospinal tract: relevance to cruciate paralysis

1991 ◽  
Vol 75 (6) ◽  
pp. 935-940 ◽  
Author(s):  
Conrad T. E. Pappas ◽  
Alan R. Gibson ◽  
Volker K. H. Sonntag
Keyword(s):  
Upper Extremity ◽  
Hind Limb ◽  
Corticospinal Tract ◽  
Underlying Mechanism ◽  
Nerve Fibers ◽  
Content Type ◽  
Gray Area ◽  
Anatomical Basis ◽  
Central Gray ◽  
Fine Print

✓ Cruciate paralysis is a clinical entity in which patients with trauma to the anterior cervicomedullary junction present with weakness of the upper extremity greater than that of the lower extremity. The underlying mechanism of this paralysis is commonly thought to be selective damage affecting the upper-extremity nerve fibers in the pyramidal decussation. The authors examined the anatomical basis of cruciate paralysis in six New World squirrel monkeys and two Old World cynomolgus monkeys. No evidence for a differential decussation of fore-limb and hind-limb fibers was found. Thus, there is no obvious anatomical explanation for cruciate palsy. The results do suggest two alternative explanations for cruciate paralysis: 1) selective damage to neural areas involving the internuncial cells, the central gray area, and the cuneate nucleus, or 2) injury to the ventral corticospinal tract.

Anatomic study of the intercostal nerve transfer to the suprascapular nerve and a case report

2013 ◽  
Vol 39 (2) ◽  
pp. 194-198 ◽  
Author(s):  
S. Hu ◽  
B. Chu ◽  
J. Song ◽  
L. Chen
Keyword(s):  
Case Report ◽  
Brachial Plexus ◽  
External Rotation ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
Intercostal Nerve ◽  
Accessory Nerve ◽  
Shoulder Abduction ◽  
Anatomical Basis ◽  
Intercostal Nerves

The purpose of this study was to investigate the anatomical basis of intercostal nerve transfer to the suprascapular nerve and provide a case report. Thoracic walls of 30 embalmed human cadavers were used to investigate the anatomical feasibility for neurotization of the suprascapular nerve with intercostal nerves in brachial plexus root avulsions. We found that the 3rd and 4th intercostal nerves could be transferred to the suprascapular nerve without a nerve graft. Based on the anatomical study, the 3rd and 4th intercostal nerves were transferred to the suprascapular nerve via the deltopectoral approach in a 42-year-old man who had had C5-7 root avulsions and partial injury of C8, T1 of the right brachial plexus. Thirty-two months postoperatively, the patient gained 30° of shoulder abduction and 45° of external rotation. This procedure provided us with a reliable and convenient method for shoulder function reconstruction after brachial plexus root avulsion accompanied with spinal accessory nerve injury. It can also be used when the accessory nerve is intact but needs to be preserved for better shoulder stability or possible future trapezius transfer.

Contralateral Peripheral Neurotization for Hemiplegic Upper Extremity After Central Neurologic Injury

Neurosurgery ◽  
2014 ◽  
Vol 76 (2) ◽  
pp. 187-195 ◽  
Author(s):  
Xu-Yun Hua ◽  
Yan-Qun Qiu ◽  
Tie Li ◽  
Mou-Xiong Zheng ◽  
Yun-Dong Shen ◽  
...  
Keyword(s):  
Motor Control ◽  
Muscle Strength ◽  
Upper Extremity ◽  
Clinical Investigation ◽  
Nerve Transfer ◽  
Neurological Injury ◽  
Control Group ◽  
Modified Ashworth Scale ◽  
Permanent Loss ◽  
Adults And Children

ABSTRACT BACKGROUND: Central neurological injury (CNI) is a major contributor to physical disability that affects both adults and children all over the world. The main sequelae of chronic stage CNI are spasticity, paresis of specific muscles, and poor selective motor control. Here, we apply the concept of contralateral peripheral neurotization in spasticity releasing and motor function restoration of the affected upper extremity. OBJECTIVE: A clinical investigation was performed to verify the clinical efficacy of contralateral C7 neurotization for rescuing the affected upper extremity after CNI. METHODS: In the present study, 6 adult hemiplegia patients received the nerve transfer surgery of contralateral C7 to C7 of the affected side. Another 6 patients with matched pathological and demographic status were assigned to the control group that received rehabilitation only. During the 2-year follow-up, muscle strength of bilateral upper extremities was assessed. The Modified Ashworth Scale and Fugl-Meyer Assessment Scale were used for evaluating spasticity and functional use of the affected upper extremity, respectively. RESULTS: Both flexor spasticity release and motor functional improvements were observed in the affected upper extremity in all 6 patients who had surgery. The muscle strength of the extensor muscles and the motor control of the affected upper extremity improved significantly. There was no permanent loss of sensorimotor function of the unaffected upper extremity. CONCLUSION: This contralateral C7 neurotization approach may open a door to promote functional recovery of upper extremity paralysis after CNI.

scholarly journals Effects of epidural motor cortex stimulation on recovery from upper extremity paresis in patients with chronic stroke

Nosotchu ◽  
2008 ◽  
Vol 30 (5) ◽  
pp. 689-696 ◽  
Author(s):  
Koichiro Ogura ◽  
Tomoharu Koike ◽  
Kiyosi Sugiyama ◽  
Eiji Tachibana ◽  
Chiharu Aoshima ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Upper Extremity ◽  
Chronic Stroke ◽  
Motor Cortex Stimulation

scholarly journals Proof of concept for multiple nerve transfers to a single target muscle

eLife ◽  
2021 ◽  
Vol 10 ◽  
Author(s):  
Matthias Luft ◽  
Johanna Klepetko ◽  
Silvia Muceli ◽  
Jaime Ibáñez ◽  
Vlad Tereshenko ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Nerve Transfer ◽  
Entry Point ◽  
Transfer Model ◽  
Prosthetic Control ◽  
Tension Free ◽  
Nerve Transfers ◽  
Single Target ◽  
Motor Entry Point ◽  
Long Head

Surgical nerve transfers are used to efficiently treat peripheral nerve injuries, neuromas, phantom limb pain or improve bionic prosthetic control. Commonly, one donor nerve is transferred to one target muscle. However, the transfer of multiple nerves onto a single target muscle may increase the number of muscle signals for myoelectric prosthetic control and facilitate the treatment of multiple neuromas. Currently, no experimental models are available for multiple nerve transfers to a common target muscle in the upper extremity. This study describes a novel experimental model to investigate the neurophysiological effects of peripheral double nerve transfers. For this purpose, we developed a forelimb model to enable tension-free transfer of one or two donor nerves in the upper extremity. Anatomic dissections were performed to design the double nerve transfer model (n=8). In 62 male Sprague-Dawley rats the ulnar nerve of the antebrachium alone (n=30) or together with the anterior interosseus nerve (n=32) was transferred to reinnervate the long head of the biceps brachii. Before neurotization, the motor branch to the biceps’ long head was transected at the motor entry point and resected up to its original branch to prevent auto-reinnervation. In all animals, coaptation of both nerves to the motor entry point could be performed tension-free. Mean duration of the procedure was 49 ± 13 min for the single nerve transfer and 78 ± 20 min for the double nerve transfer. Twelve weeks after surgery, muscle response to neurotomy, behavioral testing, retrograde labeling and structural analyses were performed to assess reinnervation. These analyses indicated that all nerves successfully reinnervated the target muscle. No aberrant reinnervation was observed by the originally innervating nerve. Our observations suggest a minimal burden for the animal with no signs of functional deficit in daily activities or auto-mutilation in both procedures. Furthermore, standard neurophysiological analyses for nerve and muscle regeneration were applicable. This newly developed nerve transfer model allows for the reliable and standardized investigation of neural and functional changes following the transfer of multiple donor nerves to one target muscle.

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