[Late results of connection operations on traumatically damaged nerves]. / Spätergebnisse der Verbindungsoperationen an traumatisch beschädigten Nerven.

50 patients with complete interruption of the N. radialis, N. ulnaris or N. medianus who had been treated surgically in the classic manner, i.e. with a suture on the epineurium, were subjected to clinical and electromyographical checkups within 3 to 10 years after the operations. The results of the examinations were correlated with specific indicators of the lesion and the operation. The most important and statistically significant correlation was confirmed to exist between the injury/operation interval and the extension of the nerve defect, with the extension of the defect being more significant. Depending on the extension of the defect, the following critical time intervals were found: with a defect of 2.5 cm 24 months, with a defect of 3 cm 18 months, with a defect of 4 cm 9 months and with a defect of 5 cm 6 months. If the defect was longer than 5 cm or the time interval longer than 24 months, the final result had to be assessed as bad in all cases.

Somatosensory evoked potentials in deep hypothermia.

Treatment with general anesthesia (neuroleptanalgesia) and deep hypothermia was performed on 8 patients suffering from epilepsy. The body temperature was decreased to 29 degrees C and the temperature in the brain ventricles to 16 degrees C. Somatosensory evoked potentials were recorded. Increase in latency of all waves was observed, and it was noted that the more distant the wave, the higher the increase in latency. Statistical values are given for N1, N2 and N3. A parallel decrease in the amplitudes of all components of the somatosensory evoked potential was also present.

Somatosensory cerebral evoked potentials in diagnosing brachial plexus injuries.

Seven patients, 5 months up to 7 years after closed injury of the brachial plexus, were stimulated in the wrist, elbow and axilla of the extremity affected in order to invistigate average somatosensory cerebral evoked potentials (SCEP). Avulsion of most of the roots C5-Thl from the spinal cord could be objectively proved. All available clinical, contrast X-ray, and electrophysiological methods were used as well as surgical approach in the supraclavicular region or laminectomy. Sensation was objectivized by the galvanic skin reflex. Sensory nerve action potentials (NAP) were registered from the ulnar, median, radial nerves. Absence of SCEP in normal NAP helped to localize injury at the preganglionic dorsal root level. Absence of both SCEP and NAP, as seen in one case only, was of no use in the localization. Reduced SCEPs were found in most cases (with or without NAP), with prolonged latency. SCEP can be induced by even a small part of the preserved dorsal roots, e.g. part of a single one, as actually found. The presence of reduced SCEP then does not rule out avulsion of other spinal roots. SCEP from the axilla and upper arm medial side can be conducted--not along the plexus root pathway, but along the intercostobrachia nerve (Th2-3), which normally supplies that skin region.