OBJECTIVETo determine the optimal position of hypoglossal nerve in hypoglossal-facial nerve anastomosis and the eligibility of hypoglossal-facial nerve anastomosis with the cervical loop.

METHODSThe cervical course and adjacent structures of the hypoglossal nerve were observed on 21 adult cadavers. The hypoglossal nerve and facial nerve were taken from 3 fresh specimens, and the number of the fasciculus and the cross-sectional area of the nerve were measured.

RESULTSThe facial nerve trunk were monofascicular with a cross-sectional area of 5.1-/+0.2 (range 4.6-5.7) mm(2). The number of the fasciculus and the cross-sectional areas of the nerve trunk and the fasciculus were 1.6-/+0.8 (range 1-4) mm(2) , 7.5-/+0.7 mm(2) (range 6.8-8.0) mm(2), and 4.7-/+0.6 (4.1-5.5) mm(2), respectively, at the proximal segment of the hypoglossal nerve, 3.6-/+0.5 (1-5) mm(2) , 5.6-/+0.5 (4.9-6.1) mm(2) , and 1.6-/+0.4 (0.9-2.2) mm(2) at the distal segment, and 2.4-/+0.8 (1-3) mm(2), 1.1-/+0.7 (0.6-2.2) mm(2), and 0.5-/+0.3 (0.3-1.2) mm(2) at the cervical loop.

CONCLUSIONThe cervical loop is inadequate for facial nerve anastomosis and the proximal segment is large enough to allow partial harvesting of the hypoglossal nerve for neurotisation of the facial nerve.

Anastomosis, Surgical ; methods ; Cadaver ; Facial Nerve ; anatomy & histology ; surgery ; Humans ; Hypoglossal Nerve ; anatomy & histology ; surgery ; Nerve Transfer ; methods

Brachial Plexus ; surgery ; Brachial Plexus Neuropathies ; Humans ; Nerve Transfer ; methods ; Spinal Nerve Roots ; surgery

OBJECTIVETo experimentally compare the treatment outcome of the injured upper limb of the root avulsion of C5 and C6 of the brachial plexus repaired by ipsilateral C7 nerve root transfer and other three multiple nerve transfers.

METHODSOne hundred and twenty SD rats of simulated C5 and C6 root avulsion randomly divided into 4 groups, and 30 each underwent various combined nerve transfers. Group A: the ipsilateral C7 root transferred to the upper trunk of brachial plexus and the spinal accessory nerve to the suprascapular nerve; Group B: partial fascicles of the ulnar nerve transferred to the biceps branch (Oberlin's procedure), the spinal accessory to the suprascapular and branches to the triceps long head to the axillary nerve; Group C: the phrenic transferred to the musculocutaneous, cervical plexus motor branches to the lower trunk (axillary nerve) of brachial plexus and the spinal accessory nerve to the suprascapular nerve; Group D: the phrenic transferred to the musculocutaneous and the spinal accessory nerve to the suprascapular nerve. Neurotization outcomes were evaluated at 3, 6 and 12 weeks postoperatively by comparing changes of behavioral tests (Ochiai clinical scores, Barth Foot-fault test and Terzis grooming test), neurophysiological investigations and muscular histology.

RESULTSAt 3 weeks after operation, no significant difference was found between Group A and other three control groups in the three behavioral evaluations. Neurophysiologic investigations of the axillary nerve showed that Group A was superior to the other three groups. Muscular histological outcome of the axillary nerve and deltoid muscle showed that Group A was superior to the Group C and D, while no significant difference was found between Group A and B. Except that the thruput of regenerating medullated musculocutaneous nerve fibers of Group A was superior to Group C, neurophysiological and histological outcome of the musculocutaneous nerve and biceps showed that no significant difference was found between Group A and other three groups. At 12 weeks postoperatively, nearly all the behavioral, neurophysiological and histological determination showed that Group A was superior to the other three groups.

CONCLUSIONSIpsilateral C7 transfer to the upper trunk of brachial plexus combined with the spinal accessory nerve to the suprascapular nerve is found to be significantly effective on treatment of the root avulsion of C5 and C6 of the brachial plexus.

Animals ; Brachial Plexus ; injuries ; Disease Models, Animal ; Nerve Transfer ; methods ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Spinal Nerve Roots ; surgery

BACKGROUNDIn recent years, transfer of the spinal accessory nerve to suprascapular nerve has become a routine procedure for restoration of shoulder abduction. However, the operation via the traditional supraclavicular anterior approach often leads to partial denervation of the trapezius muscle. The purpose of the study was to introduce transfer of the spinal accessory nerve through dorsal approach, using distal branch of the spinal accessory nerve, to repair the suprascapular nerve for restoration of shoulder abduction, and to observe its therapeutic effect.

METHODSFrom January to October 2003, a total of 11 patients with a brachial plexus injury and an intact or nearly intact spinal accessory nerve were treated by transferring the spinal accessory nerve to the suprascapular nerve through dorsal approach. The patients were followed up for 18 to 26 months [mean (23.5 +/- 5.2) months] to evaluate their shoulder abduction and function of the trapezius muscle. The outcomes were compared with those of 26 patients treated with traditional anterior approach. And the data were analyzed by Student's t test using SPSS 10.5.

RESULTSIn the 11 patients, the spinal accessory nerves were transferred to the suprascapular nerve through the dorsal approach successfully. Intact function of the upper trapezius was achieved in all of them. In the patients, the location of the two nerves was relatively stable at the level of superior margin of the scapula, the mean distance between them was (4.2 +/- 1.4) cm, both the nerves could be easily dissected and end-to-end anastomosed without any tension. During the follow-up, the first electrophysiological sign of recovery of the infraspinatus appeared at (6.8 +/- 2.7) months and the first sign of restoration of the shoulder abduction at (7.6 +/- 2.9) months after the operation, which were earlier than that after the traditional operation [(8.7 +/- 2.4) months and (9.9 +/- 2.8) months, respectively; P < 0.05]. The postoperative shoulder abduction was 62.8 degrees +/- 12.6 degrees after transfer of the spinal accessory nerve, better than that after the traditional (51.6 degrees +/- 15.7 degrees). All the 11 patients could extend and externally rotate the shoulder almost normally.

CONCLUSIONSThe accessory nerve transfer through dorsal approach is a safe and reliable procedure for the treatment of brachial plexus injury. Its postoperative effect is confirmed, which is better than that of the traditional operation.

Accessory Nerve ; surgery ; Adolescent ; Adult ; Brachial Plexus ; injuries ; Humans ; Male ; Nerve Transfer ; methods ; Shoulder Joint ; innervation ; physiology

In the whole arm type of brachial plexus injury, the nerve grafting method give the best result. As it is impossible, however to operate the preganglionic whole arm type by interfascicular nerve graft, the treatment of this type of injury is difficult. In this lesion, neurotization may be the only useful method. To evaluate it's efficacy, 38 cases of multiple neurotization have been reviewed. The follow up period was on average 45 months(24 months to 76 months). The results are as follows: 1. Motor or sensory improvement of good or better results was observed in 27 nerves(29%) and that of better-than-fair results in 54 nerves(57%). 2. The best results were obtained in patients less than thirty year old and in the patients where the operation was performed within the first six months after injury(19 cases, 42%). 3. The use of spinal accessory, phrenic, intercostal and supraclavicular nerves, as a source of neurotization produced similar results. Phrenic nerve neurotization was performed without any significant respiratory difficulty. 4. The results of neurotization were analysed by Kim's method. Functional recovery of the upper extremity showed relatively poor results. 5. Out of the 25 patients who had developed a painful syndrome before neurotization, 19 cases(60%) showed improvement of the symptom. Multiple neurotization in preganglionic whole arm type of brachial plexus injury is of a little value in improving upper extremity function. Nerve neurotization can not always make a paralysed upper limb useful, because it is impossible to control the digits and intrinsic muscles in the hand and to restorate fine sensation by it. Nevertheless, functional recovery of the paralyzed upper limb, compared with no previous muscle contraction, encourages patients who have suffered serious brachial plexus injuries to start an active their life again.
Arm ; Brachial Plexus ; Follow-Up Studies ; Hand ; Humans ; Methods ; Muscle Contraction ; Muscles ; Nerve Transfer ; Phrenic Nerve ; Sensation ; Transplants ; Upper Extremity

OBJECTIVETo anatomically reconstruct the oculomotor nerve, trochlear nerve, and abducent nerve by skull base surgery.

METHODSSeventeen cranial nerves (three oculomotor nerves, eight trochlear nerves and six abducent nerves) were injured and anatomically reconstructed in thirteen skull base operations during a period from 1994 to 2000. Repair techniques included end-to-end neurosuture or fibrin glue adhesion, graft neurosuture or fibrin glue adhesion. The relationships between repair techniques and functional recovery and the related factors were analyzed.

RESULTSFunctional recovery began from 3 to 8 months after surgery. During a follow-up period of 4 months to 6 years, complete recovery of function was observed in 6 trochlear nerves (75%) and 4 abducent nerves (67%), while partial functional recovery was observed in the other cranial nerves including 2 trochlear nerves, 2 abducent nerves, and 3 oculomotor nerves.

CONCLUSIONSComplete or partial functional recovery could be expected after anatomical neurotization of an injured oculomotor, trochlear or abducent nerve. Our study demonstrated that, in terms of functional recovery, trochlear and abducent nerves are more responsive than oculomotor nerves, and that end-to-end reconstruction is more efficient than graft reconstruction. These results encourage us to perform reconstruction for a separated cranial nerve as often as possible during skull base surgery.

Abducens Nerve ; surgery ; Adolescent ; Adult ; Female ; Humans ; Male ; Middle Aged ; Nerve Regeneration ; Nerve Transfer ; methods ; Oculomotor Nerve ; surgery ; Oculomotor Nerve Injuries ; Skull Base Neoplasms ; surgery ; Trochlear Nerve ; surgery ; Trochlear Nerve Injuries

OBJECTIVETo compare the effect of using partial median and ulnar nerves for treatment of C(5-6) or C(5-7) avulsion of the brachial plexus with that of using phrenic and spinal accessary nerves.

METHODSThe patients were divided into 2 groups randomly according to different surgical procedures. Twelve cases were involved in the first group. The phrenic nerve was transferred to the musculocutaneous nerve or through a sural nerve graft, and the spinal accessary nerve was to the suprascapular nerve. Eleven cases were classified into the second group. A part of the fascicles of median nerve was transferred to be coapted with the motor fascicle of musculocutaneous nerve and a part of fascicles of ulnar nerve was transferred to the axillary nerve. The cases were followed up from 1 to 3 years and the clinical outcome was compared between the two groups.

RESULTSThere were 2 cases (16.6%) who got the recovery of M4 strength of biceps muscle in the first group but 7 cases (63.6%) in the second group, and the difference was statistically significant (P<0.025). However, it was not statistically different in the recovery of shoulder function between the two groups.

CONCLUSIONSPartial median and ulnar nerve transfer, phrenic and spinal accessary nerve transfer were all effective for the reconstruction of elbow or shoulder function in brachial plexus injury, but the neurotization using a part of median nerve could obtain more powerful biceps muscle strength than that of phrenic nerve transfer procedure.

Adolescent ; Adult ; Brachial Plexus Neuropathies ; surgery ; Humans ; Male ; Median Nerve ; transplantation ; Middle Aged ; Nerve Transfer ; methods ; Treatment Outcome ; Ulnar Nerve ; transplantation

OBJECTIVETo observe long-term functional recovery after contralateral C7 transfer.

METHODSFrom August 1986 to July 2000, 224 patients with brachial plexus avulsion injuries were treated with contralateral C7 transfer in our department. Thirty-two patients were followed up for over 2 years for evaluation of the following items: 1 influence on healthy limb function; 2 sensory and motor recovery of the recipient nerves in the affected limb; and 3 coordination between the healthy and affected limbs.

RESULTSThere was no impairment of healthy limb function. Functional recovery of the recipient area reached > or =M3 in 8 patients (8/10, 80%) after musculocutaneous nerve neurotization, > or =M3 in 4 patients (4/6, 66%) after radial nerve neurotization, > or = M3 in 7 patients (7/14, 50%) and > or = M3 in 12 patients (85.7%) after median nerve neurotization, and > or = M3 in 1 patients (1/2, 50%) after thoracodorsal nerve neurotization. Synchronic contraction of the affected limb with the healthy limb occurred within 2-3 years in 12 patients, within 5 years in 13 patients, and over 5 years in 7 patients.

CONCLUSIONContralateral C7 transfer is an ideal procedure for the treatment of brachial plexus root avulsion injury. Selection of the whole root or the posterior division as neurotizer and a staged operation are the major factors influencing treatment outcome.

Adolescent ; Adult ; Brachial Plexus ; injuries ; surgery ; Child ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Motor Activity ; Nerve Transfer ; methods

Paralytic hand is the ultimate result of permsnent damage of the central nervous system, failure of the functional repair of peripheral nerve injuries and extensive muscular or tendinous defect resulting in the impairment of hand function. There are a lot of controversies in the side of treatment methods in the paralytic hand, and it is very difficult to formulate the most adequate surgical reconstruction for a given pstient. At Depsrtment of Orthopedic Surgery, Seoul National University Hospital, 66 cases oi paralytic hands in 62 patients have been treated surgically with tendon transfers for 7 years from Jan, 1980 to Dec, 1986. 49 case in 46 patients were followed up for more than one year, and surgical method and its results were anslysed. They consist of CNS lesion (17), peripheral nerve lesion(23) and musulotenidinous defect(9). The methods of surgical reconstruction were opponenesplasty(12), standard set extensor reconstruction(9), Green and Bsnks FCU transfer(11), intrinsic reconstruction(7), pronator rerouting(7), adductorplasty (5) and so on. The mean follow-up was 2.2 years, and in 38 cases good or excellent results were obtained.
Central Nervous System ; Follow-Up Studies ; Hand ; Humans ; Methods ; Orthopedics ; Peripheral Nerve Injuries ; Peripheral Nerves ; Seoul ; Tendon Transfer

Loss of radial nerve function in the hand results in a significant disability and so cannot extend the wrist, thumb & fingers according to the injury levels. Therefore the patient has great difficulty in grasping objects, especially power grip. Tendon transfers to restore function of extension of wrist and fingers are among the the best − most predictable transfers in the upper extremity. We performed 13 cases of tendon transfers for radial nerve palsy and extensive extensor ruptures from 1987 to 1993. The results were evaluated according to Arbitrary Value Method. Among 13 cases 30% of excellent, 46% of good, 24% of fair and no poor result were obtained and the better results were obtatined in low radial nerve lesion.
Fingers ; Hand ; Hand Strength ; Humans ; Methods ; Paralysis ; Radial Nerve ; Radial Neuropathy ; Rupture ; Tendon Transfer ; Tendons ; Thumb ; Upper Extremity ; Wrist