Adipose Tissue Uses in Peripheral 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.

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

Operative Neurosurgery ◽

10.1227/neu.0b013e3181f9b0c8 ◽

2010 ◽

Vol 67 (suppl_2) ◽

pp. ons368-ons376 ◽

Cited By ~ 3

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.

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AN ECLECTIC REVIEW OF THE HISTORY OF PERIPHERAL NERVE SURGERY

Neurosurgery ◽

10.1227/01.neu.0000346252.53722.d3 ◽

2009 ◽

Vol 65 (suppl_4) ◽

pp. A3-A8 ◽

Cited By ~ 11

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?

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Intraoperative ultrasound-assisted peripheral nerve surgery

Neurosurgical FOCUS ◽

10.3171/2015.6.focus15232 ◽

2015 ◽

Vol 39 (3) ◽

pp. E4 ◽

Cited By ~ 5

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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Peripheral Nerve Surgery - View through Multidiciplinary Approch Window

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0034-1382203 ◽

2014 ◽

Vol 75 (S 01) ◽

Author(s):

L. Rasulic ◽

M. Samardzic ◽

V. Bascarevic ◽

M. Micovic ◽

I. Cvrkota ◽

...

Keyword(s):

Peripheral Nerve ◽

Peripheral Nerve Surgery ◽

Nerve Surgery

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Preoperative Localization of Spinal and Peripheral Pathologies for Surgery by Computed Tomography–Guided Placement of a Specialized Needle System

Neurosurgery ◽

10.1227/01.neu.0000367450.79418.5b ◽

2010 ◽

Vol 66 (4) ◽

pp. 784-787 ◽

Cited By ~ 8

Author(s):

Philipp Slotty ◽

Patrick Kröpil ◽

Mark Klingenhöfer ◽

Hans-Jakob Steiger ◽

Daniel Hänggi ◽

...

Keyword(s):

Computed Tomography ◽

Peripheral Nerve ◽

Radiation Exposure ◽

Operating Room ◽

Operating Room Personnel ◽

Peripheral Nerve Surgery ◽

Preoperative Marking ◽

Intraoperative Fluoroscopy ◽

Nerve Surgery ◽

Intraoperative Localization

Abstract OBJECTIVE Exact intraoperative localization of pathologies in spinal and peripheral nerve surgery is not easily achieved. In spinal surgery, intraoperative fluoroscopy is the common method for identification of the level affected. It seldom visualizes the pathology itself and is prone to error in identifying anatomic disorders and superimposing structures. In peripheral nerve surgery, intraoperative fluoroscopy is of little value. The present technical study was conducted to evaluate the feasibility of using a preoperative computed tomography–guided needle marking system, which was previously developed for use in gynecology. The goal was to reduce intraoperative localization error and radiation exposure to patients and operating room personnel. METHODS We used a flexible hooked-wire needle marking system, which has previously been used for preoperative marking of breast lesions, to localize and tag spinal and peripheral nerve pathologies. Marking was carried out under computed tomographic control before surgery. Seven illustrative cases were chosen for this report: 6 patients with disorders of the spine and 1 patient with a peripheral nerve schwannoma. RESULTS No adverse reactions, aside from minor discomfort, were observed in this study. In all cases, the needle could be used as a reliable guide for the surgical approach and led directly to the pathology. In no case was additional intraoperative fluoroscopy needed. The level of radiation exposure to the patient as a result of computed tomography–based marking was similar to or less than that encountered in conventional intraoperative x-ray localization. Radiation exposure to the operating room personnel was eliminated by this method. CONCLUSION Preoperative marking of spinal level or peripheral nerve pathologies with a flexible hooked-wire needle marking system is feasible and appears to be safe and useful for neurosurgical spinal and peripheral procedures.

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