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.

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.

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.

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.

scholarly journals Nerve transfer in brachial plexus traction injuries

1992 ◽  
Vol 76 (2) ◽  
pp. 191-197 ◽  
Author(s):  
Miroslav Samardzic ◽  
Danica Grujicic ◽  
Vaso Antunovic
Keyword(s):  
Brachial Plexus ◽  
Nerve Root ◽  
Nerve Transfer ◽  
Spinal Nerve ◽  
Spinal Nerve Root ◽  
Root Avulsion ◽  
Brachial Plexus Palsy ◽  
Content Type ◽  
Spinal Accessory ◽  
Nerve Root Avulsion

✓ Brachial plexus palsy due to traction injury, especially spinal nerve-root avulsion, represents a severe handicap for the patient. Despite recent progress in diagnosis and microsurgical repair, the prognosis in such cases remains unfavorable. Nerve transfer is the only possibility for repair in cases of spinal nerve-root avulsion. This technique was analyzed in 37 patients with 64 reinnervation procedures of the musculocutaneous and/or axillary nerve using upper intercostal, spinal accessory, and regional nerves as donors. The most favorable results, with an 83.8% overall rate of useful functional recovery, were obtained in patients with upper brachial plexus palsy in which regional donor nerves, such as the medial pectoral, thoracodorsal, long thoracic, and subscapular nerves, had been used. The overall rates of recovery for the spinal accessory and upper intercostal nerves were 64.3% and 55.5%, respectively, which are significantly lower. The authors evaluate the results of nerve transfer and analyze different donor nerves as factors influencing the prognosis of surgical repair.

scholarly journals Additive value of magnetic resonance neurography in diagnosis of brachial plexopathy: a cross-section descriptive study

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Sara Mohamed Mahmoud Mabrouk ◽  
Hossam Abd El Hafiz Zaytoon ◽  
Ashraf Mohamed Farid ◽  
Rania Sobhy Abou Khadrah
Keyword(s):  
Magnetic Resonance ◽  
Brachial Plexus ◽  
Nerve Injury ◽  
Clinical Examination ◽  
Nerve Root ◽  
Nerve Conduction ◽  
Brachial Plexopathy ◽  
Root Avulsion ◽  
Magnetic Resonance Neurography ◽  
Nerve Root Avulsion

Abstract Background Management of brachial plexopathy requires proper localization of the site and nature of nerve injury. Nerve conduction studies and electrophysiological studies (ED) are crucial when diagnosing brachial neuropathy but these do not determine the actual site of the lesion. Conventional MRI has been used to evaluate the brachial plexus. Still, it carried the disadvantage of the inability to provide multi-planar images that depict the entire length of the neural plexus .It might be difficult to differentiate the brachial plexus nerves from adjacent vascular structures. Magnetic resonance neurography (MRN) is an innovative imaging technique for direct imaging of the spinal nerves. Our study aims to detect the additive role of MRN in the diagnosis of brachial plexopathy over ED. Forty cases of clinically suspected and proved by clinical examination and ED—traumatic (N = 30) and non-traumatic (N = 10)—were included in our study. We compared MRN finding with results of clinical examination and ED. Results MRN findings showed that the root was involved in 80% of cases, trunks in 70% of cases affecting the middle trunk in 40% of cases, the middle and posterior cord in 25%, lateral cord in 50%, and terminal branches on 10% of cases. Ten percent of cases were normal according to MRN, and 90% had abnormal findings in the form of preganglionic nerve root avulsion in 30% of cases, mild perineural edema surrounding C6/7 nerve roots in 20%, lower brachial trunk high signal in 10%, complicated with pseudo meningocele in 20%, and with increased shoulder muscle T2 signal intensity with muscle atrophy in 10%. There were minimal differences between clinical examination finding and MRN findings, with very good agreement between electromyography and nerve conduction (p value < 0.05, with sensitivity and specificity values of 94.44% and 100%, respectively). Conclusion MRN is important in differentiating different types of nerve injuries, nerve root avulsion, and nerve edema, playing an important role in differentiating the site of nerve injury, both preganglionic or postganglionic and planning for treatment of the cause of nerve injury, either medical or surgical.

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