Our experience with surgical treatment of lesions of nervus facialis.

OBJECTIVE: The study presents the results of reconstruction surgery of lesions on n. facialis with n. hypoglossus and n. accessorius performed in our clinic. PATIENT GROUP AND METHODS: 10 patients were treated by anastomosis of n. facialis with n. hypoglossus (HFA), 1 patient by anastomosis of n. facialis with n. accessorius (AFA). All operations were performed under the microscope; HFA and AFA anastomoses were sewed without tension at perineurium. The techique of suturation of facial nerves did not differ from the suturation of peripheral nerves in extremities. For the connection of n. VII-XII was not used plasma pasting. We did not use end to side anastomosis or reconstruction of n. VIIVII in pontocerebellar angle, in pyramid, or symetrical anastomoses of n. VII-VII, in any case. The results were objectivized by a VI grade Brudny's modification of House-Brackman classification introduced originally for scaling of the outcome of HFA anastomosis. In this study, this classification has been used for the objectivization of AFA anastomosis results. RESULTS: Reconstruction surgery by HFA and AFA resulted in all cases in grade III of the scale. Glossal hemiatrophy or atrophy of m. sternocleidomastoideus and m. trapesius were observed in patients treated by cross anastomosis with n. hypoglossus or n. accessorius. In patients treated by HFA and even more pronounced in patient with AFA anastomosis, minute synkineses in the region of labial angle, chin, also in the region of lower eyelid, occurred in the excited emotional state or during a long-lasting speech. Major diskincses were not observed in any of reported treatments. Recovery in older patients up to 60 years was coming more slowly, in one case after 6 months. CONCLUSION: Compared to AFA anastomosis, HFA anastomoses resulted in improved mimics and synkineses present here were finer. We prefer HFA anastomosis also because the discomfort caused by atrophy of ni. trapesius and ni. sternocleidomastoideus was apparently more perceived by patient treated by AFA than the negative effects of hemiatrophy reported by patients treated by FIFA.

Our experience with surgical treatment of lesions of nervus facialis

Objetivo. Este trabajo presenta los resultados de cirugía reparativa de lesiones del nervio facial con anastomosis con el nervio hipogloso y con el accesorio en nuestra clínica. Grupo de pacientes y métodos. Se trataron 10 pacientes con anastomosis del nervio facial con hipogloso(AFH) y un paciente con anastomosis con el nervio accesorio, (AFA). Todas las operaciones se realizaron con microscopio. Todas las anastomosis se hicieron sin tensión en el perineuro. La técnica de sutura no difería de la habitual en otros nervios periféricos. Para la unión del VII-XII no se utilizó pegamento de plasma. No utilizamos anastomosis latero-terminal ni anastomosis de los extremos del VII lesionado en el ángulo pontocerebeloso, en la pirámide ni tampoco del VII-VII simétricos. Los resultados se objetivaron con el grado VI de Brudny, modificación de la escala de House-Brackman, clasificación propuesta para medir el pronóstico de las lesiones del facial. En este estudio se ha utilizado para objetivar el resultado de la anastomosis. Resultados. La reconstrucción quirúrgica por anastomosis dio como resultado un grado III de la escala. Se observó hemiatrofia de la lengua y del trapecio esternocleidomastoideo. Se apreciaron mínimas discinesias en la comisura labial, mejilla y párpado inferior en situaciones de alteración emocional o después de hablar largamente. No hubo discinesias importantes en ningún caso. La recuperación fue lenta en pacientes de más de 60 años; en un caso después de seis meses. Conclusión. Si se compara la AFH con la AFA el mejor resultado se obtuvo con la anastomosis del hipogloso, tanto en la mímica como en las sincinesias. Preferimosla AFH porque la atrofia del esternocleidomastoideo y trapecio eran más molestas para el paciente que las producidas por la hemiatrofia lingual

Objective. The study presents the results of reconstruction surgery of lesions on n. facialis with n. hypoglossus and n. accessorius performed in our clinic. Patient group and methods. 10 patients were treatedby anastomosis of n. facialis with n. hypoglossus (HFA),1 patient by anastomosis of n. facialis with n. accessorius (AFA). All operations were performed under the microscope; HFA and AFA anastomoses were sewed without tension at perineurium. The techique of suturation of facial nerves did not differ from the suturation of peripheral nerves in extremities. For the connection of n. VII-XII was not used plasma pasting. We did not use end to side anastomosis or reconstruction of n. VIIVII in pontocerebellar angle, in pyramid, or symetrical anastomoses of n. VII-VII, in any case. The results were objectivized by a VI grade Brudny's modification of House-Brackman classification introduced originally for scaling of the outcome of HFA anastomosis. In this study, this classification has been used for the objectivization of AFA anastomosis results. Results. Reconstruction surgery by HFA and AFA resulted in all cases in grade III of the scale. Glossal hemiatrophy or atrophy of m. sternocleidomastoide us and m. trapesius were observed in patients treated by cross anastomosis with n. hypoglossus or n. accessorius. In patients treated by HFA and even more pronounced in patient with AFA anastomosis, minute synkineses in the region of labial angle, chin, also in the region of lower eyelid, occurred in the excited emotional state or during a long-lasting speech. Major diskincses were not observed in any of reported treatments. Recovery in older patients up to 60 years was coming more slowly, in one case after 6 months. Conclusion. Compared to AFA anastomosis, HFA anastomoses resulted in improved mimics and synkineses present here were finer. We prefer HFA anastomosis also because the discomfort caused by atrophy of ni. trapesius and ni. sternocleidomastoideus was apparently more perceived by patient treated by AFA than the negative effects of hemiatrophy reported by patient streated by FIFA

Surgery of the peripheral nerves.

OUTCOME: In contrast to the CNS, peripheral nerves have the ability to regenerate. This ability has been utilized for a long time in the therapy of injuries of peripheral nerves. The aim of the present research was to assess the achievements in reconstructive surgery including nerve grafting and peripheral nerve suture repair in our clinic. MATERIAL AND METHODS: During the 16-year period from 1986 to 2001 we surgically treated 116 patients with peripheral nerve lesions. The cases of lesions of the brachial plexus, partial peripheral nerve lesions and postoperative revision, as well as the attempts of reconstruction of cervical nerves and neurolysis are not included in this work. We analysed the results of surgery in our patients who where subjected to treatment of peripheral nerves in the arms (95 patients) and legs (21 patients). In 53 patients reconstructive surgery was performed by suture repair of peripheral nerve, which included treatment of 65 nerves, 10 patients were treated by suture repair of 2 nerves and repair of 3 nerves in one patient. In 42 patients we reconstructed 45 peripheral nerves of the hand by autograft. The total number of 42 patients compromised 37 males and five females. The average age was 36 years. Double nerve reconstruction (ulnar and median) was accomplished in three patients. In the remaining 21 patients (14 males and seven females) we performed 21 reconstruction operations of 24 injured nerves in the lower extremities, of which 8 operations of 9 nerves involved suture repair of peripheral nerves and 13 operations of 15 nerves were performed using a nerve graft. Their average age was 39.7 years. The average period between primary treatment and operation was 6.7 months. In five cases the interval exceeded 12 months. Operations were performed by microtechnique. All patients were subject to several postoperational tests aimed at the estimation of the degree of recovery in sensory and motor adaptation. The evaluation was performed according the Seddon classification (1975). Motor recovery was evaluated according to a five-point scale and the degree of sensory recovery according to a four-point scale. Recovery of grade M4 and S3 (or higher) was considered an excellent or very good result and grades M3 and S2 were considered a good result. Results corresponding to grades M0-M2 and S0-S1 were considered to be insufficient. RESULTS AND CONCLUSION: The results of reconstruction operations of peripheral nerves injuries were dependent on the patient's age, the period between the injury and operation, the length of the autograft, the location of the injury, the type of injured nerve and the character of the injury (Fig. 2, Tab. 7, Ref: 15).

[Rare compression syndromes of the peripheral nerves of the forearm and distal leg]. / Zriedkavé uzinové syndrómy periférnych nervov na predlaktí a predkolení.

OBJECTIVES: The study presents results of rare operations of the peripheral nerves compartment syndromes of the forearm and distal leg, completed in our clinic during a 14-year period (1990-2004). SUBJECTS AND METHODS: We completed 25 procedures for 25 compartment syndromes in 25 patients. All patients sufferred from unilateral compartment syndromes. The patients were operated for the first time in our clinic. None of them needed to be re-operated. The clinical pictures of the compartment syndromes were classified (three degrees) according to the Dellon's intensity classification: None of the patients sufferred from the Ist degree compression. The IInd degree occured in 4 patients (16%). The IIIrd degree occured in 21 patients (84%). The surgical procedure's effectiveness was analyzed, taking into consideration the degree of the compression, its duration and the symptoms duration. RESULTS: Excellent and good results were observed in all cases of the IInd degree compression and the symptoms duration up to 12 months. Worse results were recorded in the IIIrd degree compression cases, where excellent and good results were observed in 19 cases (76%). In cases, where the symptoms lasted for over 12 months, no excellent or good results were recorded. CONCLUSION: The decisive factor affecting the procedure's outcome, is the degree of the compression and its duration. The main factors improving the outcome of the procedure are the following: the patient's age up to 30 years of age and the duration of the symptoms up to 1 year, when the defect is not irreversible.

[Our experience with surgical management of injuries to peripheral nerves of the upper extremities]. / Nase skúsenosti s chirurgickým liecením poranení periférnych nervov horných koncatín.

OBJECTIVES: The authors present their results of 44 microsurgical procedures of 47 nerves in 44 patients subjects over a period of 19 years, from 1985 to 2003. STUDY GROUP SUBJECTS AND METHODS: 44 patients with injuries to peripheral nerves of the upper extremities underwent reconstructions of 47 nerves using autotransplants. The procedures effectivity results were analysed using the following indicators: the injury to the procedure time, the patient's age, the autotransplant length, the injury type, the injury site, the injured nerve type. RESULTS: The best results were reached: in young patients up to the age of 20, in cases of early operations up to 3 months, in cases when grafts up to 5 cm were used. Clean, for instance incision injury, has much better prospects for successful nerve graft autotransplantation than others, more complicated injuries (e.g. lacerated injury or contusion).

Diagnosis and treatment of brachial plexus injuries.

In the reconstruction of the nerves in traction injuries of brachial plexus, the main role is the correction of the function of upper extremity. This article is aimed at establishing a diagnosis, indications for intervention and surgical treatment. Operation results are influenced by a degree of injury, type of surgical therapy, patient's age, and by the time delay between the injury and the intervention (Ref. 6).

Follow-up evaluation of neurolysis of brachial plexus and peripheral nerves of upper extremities.

BACKGROUND: The work presents the results of neurolysis of brachial plexus and peripheral nerves of upper extremities performed in the Neurosurgical clinic of the Faculty Hospital Bratislava during the 18-year period from 1985 to 2003. PATIENTS AND METHODS: 59 patients were subject to surgical therapy by neurolysis, including 10 treatments of brachial plexus and 49 treatments of the upper limb nerves. The average age in the patient group was 35 years. The average period between the injury and surgical treatment was 6.9 months. Extremely long period over 12 months occurred in 3 cases. The treatment was performed in patients with complete or persisting neurological deficit. The external neurolysis was performed in 59 patients and this treatment was supplemented also by internal neurolysis in two cases. Cases requiring resection of fascicles and reconstruction with autotransplants and cases where reconstruction surgery has been already performed in the past have not been included into the study. The analysis of results was performed with respect to the period between the injury and operation, patient age, the type of injured nerve and the degree of fibrotic changes that have been identified peroperationally. RESULTS: The evaluation of results has been performed according to Seddon classification (1975). The complete recovery of mobility, strength and BMG findings (classification grade M5) was observed in 25 patients. The functional grade M3 and more was present in 52 patients. The best results were observed in the youngest patient group aged below 20 years, in cases of early therapy onset, in patients with distal traumatic lesions and for neurolyses of n. radialis. CONCLUSION: Based on our experience we believe that the early surgical revision is the critical factor determining the outcome of the operations in indicated cases. (Tab. 6, Ref. 3.)