ABSTRACT
BACKGROUND: In brachial plexus avulsion, a recent technique connects the ending of the disrupted musculocutaneous nerve to the side of the intact phrenic nerve to regain elbow flexion. This requires the phrenic nerve to perform a new double function: independent control of breathing and elbow flexion. Neuroplastic changes associated with acquisition of double nerve functions have not yet been investigated. OBJECTIVE: To evaluate neuroplastic changes associated with acquisition of double nerve functions in a monofunctional nerve (phrenic nerve). DESIGN: Clinical and functional magnetic resonance imaging investigations during arm movements, forced inspiration, and motor control tasks. SETTING: Investigations at the Medical University of Vienna, Vienna, Austria. PARTICIPANTS: Three healthy control subjects, 2 patients with phrenic nerve end-to-side coaptation, and 1 control patient with C7 end-to-end coaptation (same clinical presentation but phrenic nerve unchanged). RESULTS: Clinical documentation showed that both patients with phrenic nerve end-to-side coaptation were able to control the diaphragm and the biceps independently via the same phrenic nerve. In contrast to all controls, both patients with phrenic nerve end-to-side coaptation activated the cortical diaphragm areas with flexion of the diseased arm. CONCLUSION: Our functional magnetic resonance imaging data indicate that the patient's cortical diaphragm areas reorganize in such a way that independent control of breathing and elbow flexion is possible with the same neuronal population.
Subject(s)
Brachial Plexus/injuries , Brachial Plexus/surgery , Motor Cortex/physiology , Neuronal Plasticity/physiology , Neurosurgical Procedures/methods , Adult , Child , Female , Humans , Male , Nerve Regeneration/physiology , Phrenic Nerve/physiologyABSTRACT
To bring some light into the ongoing controversy concerning end-to-side coaptation in brachial plexus surgery, the authors organized a symposium in 2006 titled How To Improve Peripheral Nerve Surgery. The authors sought the participation of experienced surgeons and researchers who had made personal contributions to the field. This article contains information collected at this symposium and presents the authors' clinical results and ideas illustrating the potential of nerve fiber transfer by end-to-side coaptation.
Subject(s)
Brachial Plexus/injuries , Brachial Plexus/surgery , Nerve Transfer/methods , Neurosurgical Procedures/methods , Action Potentials , Adolescent , Adult , Anastomosis, Surgical , Animals , Electric Stimulation , Female , Hand/innervation , Hand/physiology , Humans , Male , Nerve Fibers , Neural Conduction , Papio , Recovery of FunctionABSTRACT
Over the last 40 years, various factors that influence the outcome of peripheral nerve surgery have been recognized. Some of these factors, such as age of the patient and time interval between injury and surgery, cannot be controlled by the surgeon. On the other hand, other factors related to technical details are the topic of constant debate and improvement. Recently, surgeons have become increasingly aware of issues such as the environment at the site of the nerve repair, compression from an integument that is too tight, or muscle balance.
