scholarly journals Complications of contralateral C-7 transfer through the modified prespinal route for repairing brachial plexus root avulsion injury: a retrospective study of 425 patients

2015 ◽  
Vol 122 (6) ◽  
pp. 1421-1428 ◽  
Author(s):  
Wenjun Li ◽  
Shufeng Wang ◽  
Jianyong Zhao ◽  
M. Fazlur Rahman ◽  
Yucheng Li ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Vertebral Artery ◽  
Upper Extremity ◽  
Nerve Root ◽  
Severe Bleeding ◽  
Root Avulsion ◽  
Avulsion Injury ◽  
Lower Trunk ◽  
Study Population ◽  
Posterior Division

OBJECT In this report, the authors review complications related to the modified prespinal route in contralateral C-7 transfer for repairing brachial plexus nerve root avulsion injury and suggest a prevention strategy. METHODS A retrospective, nonselected amalgamation of every case of modified contralateral C-7 transfer through the prespinal route was undertaken. The study population comprised 425 patients treated between February 2002 and August 2009. The patients were managed according to a standardized protocol by one senior professor. The surgical complications were grouped into one of the following categories: those associated with tunnel making through the prespinal route, those related to the dissection and transection of the contralateral C-7 nerve root, and those that occurred in the postoperative period. RESULTS The study population included 379 male and 46 female patients whose average age was 21 years (range 3 months to 56 years). A total of 401 patients were diagnosed with traumatic brachial plexus injury, the leading cause of which was motor vehicle accident, and 24 patients were diagnosed with obstetrical brachial plexus palsy. The contralateral C-7 nerve root was cut at the proximal side of the division portion of the middle trunk in 15 cases and sectioned at the distal end of the anterior and posterior divisions in 410 cases. The overall incidence of complications was 5.4% (23 of 425). Complications associated with making a prespinal tunnel occurred in 12 cases, including severe bleeding due to vertebral artery injury during the procedure in 2 cases (0.47%), temporary recurrent laryngeal nerve palsy in 5 cases (1.18%), pain and numbness in the donor upper extremity during swallowing in 4 cases (0.94%), and dyspnea caused by thrombosis of the brainstem 42 hours postoperatively in 1 case (0.24%); this last patient died 38 days after the operation. Complications related to exploration and transection of the contralateral C-7 nerve root occurred in 11 cases, including deficiency in extensor strength of the fingers and thumb in 4 cases (0.94%) due to injury to the posterior division of the lower trunk, unbearable pain on the donor upper extremity in 3 cases (0.71%), Horner's syndrome in 2 children (0.47%) who suffered birth palsy, a section of C-6 nerve root mistaken as C-7 in l case (0.24%), and atrophy of the sternocostal part of the pectoralis major in 1 case (0.24%). CONCLUSIONS The most serious complications of using the modified prespinal route in contralateral C-7 transfer were vertebral artery laceration and injury to the posterior division of the lower trunk. The prevention of such complications is necessary to popularize this surgical procedure and attain good long-term clinical results.

scholarly journals PLGA-PEG-PLGA hydrogel with NEP1-40 promotes the functional recovery of brachial plexus root avulsion in adult rats

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e12269
Author(s):  
Wenlai Guo ◽  
Bingbing Pei ◽  
Zehui Li ◽  
Xiao Lan Ou ◽  
Tianwen Sun ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Functional Recovery ◽  
Rat Model ◽  
Nerve Root ◽  
Axonal Regeneration ◽  
Biceps Brachii ◽  
Nerve Tissue ◽  
Root Avulsion ◽  
Avulsion Injury ◽  
Nerve Root Avulsion

Adult brachial plexus root avulsion can cause serious damage to nerve tissue and impair axonal regeneration, making the recovery of nerve function difficult. Nogo-A extracellular peptide residues 1-40 (NEP1-40) promote axonal regeneration by inhibiting the Nogo-66 receptor (NgR1), and poly (D, L-lactide-co-glycolide)-poly (ethylene glycol)-poly (D, L-lactide-co-glycolide) (PLGA-PEG-PLGA) hydrogel can be used to fill in tissue defects and concurrently function to sustain the release of NEP1-40. In this study, we established an adult rat model of brachial plexus nerve root avulsion injury and conducted nerve root replantation. PLGA-PEG-PLGA hydrogel combined with NEP1-40 was used to promote nerve regeneration and functional recovery in this rat model. Our results demonstrated that functional recovery was enhanced, and the survival rate of spinal anterior horn motoneurons was higher in rats that received a combination of PLGA-PEG-PLGA hydrogel and NEP1-40 than in those receiving other treatments. The combined therapy also significantly increased the number of fluorescent retrogradely labeled neurons, muscle fiber diameter, and motor endplate area of the biceps brachii. In conclusion, this study demonstrates that the effects of PLGA-PEG-PLGA hydrogel combined with NEP1-40 are superior to those of other therapies used to treat brachial plexus nerve root avulsion injury. Therefore, future studies should investigate the potential of PLGA-PEG-PLGA hydrogel as a primary treatment for brachial plexus root avulsion.

Upper trunk block for shoulder analgesia with potential phrenic nerve sparing: a preliminary anatomical report

2019 ◽  
Vol 44 (9) ◽  
pp. 872-874 ◽  
Author(s):  
José Cros Campoy ◽  
Oscar Domingo Bosch ◽  
Jaume Pomés ◽  
Jing Lee ◽  
Ben Fox ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Suprascapular Nerve ◽  
Nerve Sparing ◽  
Phrenic Nerve Palsy ◽  
Scalene Muscle ◽  
Lower Trunk ◽  
Anatomical Basis ◽  
Dye Staining ◽  
Posterior Division

Background and objectivesIpsilateral phrenic nerve palsy (PNP) is an undesirable side of conventional approaches to interscalene brachial plexus blocks. The purpose of this study was to demonstrate whether or not the phrenic nerve can be spared by dye when injected at the division of the upper trunk of the brachial plexus.MethodsUnder ultrasound guidance, 5 mL of radiolabeled dye was injected between the anterior and posterior division of the upper trunk in two fresh, cryopreserved cadavers. CT scan analysis, cadaveric dissection, and cryosectioning were performed to examine the spread of the injectate.ResultsWe found staining of the injectate over the entire upper trunk with its anterior and posterior divisions, the suprascapular nerve under the omohyoid muscle and the lateral pectoralis nerve, and the C5 and C6 roots. The middle trunk was partially stained. There was no evidence of dye staining of the lower trunk, anterior aspect of the anterior scalene muscle, or the phrenic nerve.ConclusionsOur study offers an anatomical basis for the possibility of providing shoulder analgesia and avoiding a PNP.

Pretreatment of nerve grafts with resveratrol improves axonal regeneration following replantation surgery for nerve root avulsion injury in rats

2018 ◽  
Vol 36 (5) ◽  
pp. 647-658 ◽  
Author(s):  
Hiroki Oda ◽  
Souichi Ohta ◽  
Ryosuke Ikeguchi ◽  
Takashi Noguchi ◽  
Yukitoshi Kaizawa ◽  
...  
Keyword(s):  
Nerve Root ◽  
Axonal Regeneration ◽  
Root Avulsion ◽  
Avulsion Injury ◽  
Nerve Grafts ◽  
Nerve Root Avulsion

scholarly journals Pseudomeningocele after Traumatic Nerve Root Avulsion

2013 ◽  
Vol 19 (4) ◽  
pp. 496-499 ◽  
Author(s):  
Maria Pascual-Gallego ◽  
Horacio Zimman ◽  
Alberto Gil ◽  
Luis López-Ibor
Keyword(s):  
Brachial Plexus ◽  
Nerve Root ◽  
Soft Tissues ◽  
The Novel ◽  
Root Avulsion ◽  
Endovascular Technique ◽  
Subsequent Formation ◽  
Nerve Root Avulsion

Traumatic brachial plexus complete avulsions and the subsequent formation of pseudomeningoceles are a well-known entity that usually remains asymptomatic. Pseudomeningocele is due to the dural sleeve encasing the damaged roots and the spinal liquid that may accumulate locally or in the supraclavicular soft tissues. The pseudomeningocele, added to the associated lesion of the plexus and usually the surrounding vessels, may become difficult to manage. We describe the novel management of a traumatic pseudomeningocele using an endovascular technique.

Intradural neurotropic spread of malignant mesothelioma

1998 ◽  
Vol 88 (1) ◽  
pp. 122-125 ◽  
Author(s):  
Timothy R. Steel ◽  
James Allibone ◽  
Tamas Revesz ◽  
Corrado D'Arrigo ◽  
H. Alan Crockard
Keyword(s):  
Spinal Cord ◽  
Brachial Plexus ◽  
Malignant Mesothelioma ◽  
Nerve Root ◽  
Spinal Canal ◽  
Content Type ◽  
Lower Trunk ◽  
Local Spread ◽  
History Of ◽  
Fine Print

✓ This 54-year-old man with a history of right-sided malignant mesothelioma presented with signs of a partial spinal cord syndrome. The tumor had invaded the lower trunk of the brachial plexus and spread along the T-1 nerve root beneath the arachnoid onto the spinal cord itself. Mesothelioma, despite its known predilection for local spread, is rarely encountered within the spinal canal. Neurotropism is commonly encountered in facial malignancies; however, it has never been reported to affect the brachial plexus and spinal cord.

Coaptation of the anterior rami of C-3 and C-4 to the upper trunk of the brachial plexus for cervical nerve root avulsion

1991 ◽  
Vol 74 (2) ◽  
pp. 171-177 ◽  
Author(s):  
Shokei Yamada ◽  
Gordon W. Peterson ◽  
Donald S. Soloniuk ◽  
A. Douglas Will
Keyword(s):  
Brachial Plexus ◽  
Nerve Root ◽  
Shoulder Girdle ◽  
Brachial Plexopathy ◽  
Root Avulsion ◽  
Cervical Nerve Root ◽  
Cervical Nerve ◽  
Content Type ◽  
Nerve Root Avulsion ◽  
Shoulder Girdle Muscles

✓ No surgical procedure has been available to repair cervical nerve root avulsion inside the spinal canal. Results with peripheral neurotization of denervated muscles have been discouraging. The authors have performed bridge-graft coaptation in three patients with C-5 and C-6 nerve root avulsion. The components of the coaptation included the anterior primary rami of C-3 and C-4 as the donor material, the entire upper trunk as the recipient, and the sural nerve graft as the bridge. This procedure resulted in restoration of motor function in the biceps and shoulder-girdle muscles and produced improved sensation. Stimulation of the C-3 and C-4 nerve roots elicited electrical responses in the biceps and deltoid muscles that indicated nerve growth through the graft and the brachial plexus into these muscles. This reconstructive procedure is effective and should stimulate development of new approaches to treatment of cervical nerve root avulsion and proximal brachial plexopathy.

Sign in / Sign up

Export Citation Format

Share Document