Dorsal root entry zone lesioning for brachial plexus avulsion pain: a case series.

STUDY DESIGN: Retrospective case series. OBJECTIVES: Dorsal root entry zone (DREZ) lesioning can be performed in patients with intractable pain following brachial plexus avulsion (BPA). However, post-operative outcomes are variable and it is uncommonly used. We sought to determine the pain outcomes and complication profile of DREZ lesioning for BPA. SETTING: Quaternary neurosurgical centre. METHODS: All patients that had undergone DREZ lesioning for BPA pain over a 13-year period were included. Patients were assessed for outcome with regard to degree of pain relief and presence of complications. RESULTS: Fourteen patients were reviewed, with a median post-operative follow-up duration of 27 months (1-145 months). Of these, ten were contactable for long-term telephone review, with a median post-operative duration of 37 months (11-145 months). At earliest review post-operatively, 12 of 14 patients (86%) had some level of pain relief: complete pain relief in four patients (29%) and partial pain relief in eight patients (57%). At most recent post-operative review, ten of 14 patients (71%) reported lasting significant pain relief: four (29%) had complete pain relief, six (43%) had partial pain relief and four (29%) had insignificant pain relief. Complications were predominantly sensory, including ataxia, hypoaesthesia and dysaesthesia. Four patients (29%) reported persistent motor complications at final follow-up. CONCLUSIONS: DREZ lesioning is uncommonly performed. It remains a reasonable option for relief of refractory BPA pain in selected cases, though there is a significant complication rate. Future prospective studies may enable quantification of pre- and post-lesioning analgesic use, another important determinant of procedure success.

Dorsal Root Entry Zone Lesioning for Brachial Plexus Avulsion: A Comprehensive Literature Review.

Dorsal root entry zone (DREZ) lesioning is a neurosurgical procedure that aims to relieve severe neuropathic pain in patients with brachial plexus avulsion by selectively destroying nociceptive neural structures in the posterior cervical spinal cord. Since the introduction of the procedure over 4 decades ago, the DREZ lesioning technique has undergone numerous modifications, with a variety of center- and surgeon-dependent technical differences and patient outcomes. We have reviewed the literature to discuss reported methods of DREZ lesioning and outcomes.

Profiling biomarkers of traumatic axonal injury: From mouse to man.

Traumatic brain injury (TBI) poses a major public health problem on a global scale. Its burden results from high mortality and significant morbidity in survivors. This stems, in part, from an ongoing inadequacy in diagnostic and prognostic indicators despite significant technological advances. Traumatic axonal injury (TAI) is a key driver of the ongoing pathological process following TBI, causing chronic neurological deficits and disability. The science underpinning biomarkers of TAI has been a subject of many reviews in recent literature. However, in this review we provide a comprehensive account of biomarkers from animal models to clinical studies, bridging the gap between experimental science and clinical medicine. We have discussed pathogenesis, temporal kinetics, relationships to neuro-imaging, and, most importantly, clinical applicability in order to provide a holistic perspective of how this could improve TBI diagnosis and predict clinical outcome in a real-life setting. We conclude that early and reliable identification of axonal injury post-TBI with the help of body fluid biomarkers could enhance current care of TBI patients by (i) increasing speed and accuracy of diagnosis, (ii) providing invaluable prognostic information, (iii) allow efficient allocation of rehabilitation services, and (iv) provide potential therapeutic targets. The optimal model for assessing TAI is likely to involve multiple components, including several blood biomarkers and neuro-imaging modalities, at different time points.

Stem cells for therapy in TBI.

While the pace of traumatic brain injury (TBI) research has accelerated, the treatment options remain limited. Clinical trials are yet to yield successful treatment options, leading to innovative strategies to overcome the severe debilitating consequences of TBI. Stem cells may act as a potential treatment option. They have two key characteristics, the ability of self-renewal and the ability to give rise to daughter cells, which in the case of neural stem cells (NSCs) includes neurons, astrocytes and oligodendrocytes. They respond to the injury environment providing trophic support and have been shown to differentiate and integrate into the host brain. In this review, we introduce the notion of an NSC and describe the two neurogenic niches in the mammalian brain. The literature supporting the activation of an NSC in rodent models of TBI, both in vivo and in vitro, is detailed. This endogenous activation of NSCs may be augmented by exogenous transplantation of NSCs. Delivery of NSCs to assist the host nervous system has become an attractive option, with either fetal or adult NSC. This has resulted in cognitive and functional improvement in rodents, and current animal studies are using human NSCs. While no NSC clinical trials are currently ongoing for TBI, this review touches upon other neurological diseases and discuss how this may move forward into TBI.