Our previous investigation suggested that faster seventh cervical nerve (C7) regeneration occurs in patients with cerebral injury undergoing contralateral C7 transfer. This finding needed further verification, and the mechanism remained largely unknown. Here, Tinel's test revealed faster C7 regeneration in patients with cerebral injury, which was further confirmed in mice by electrophysiological recordings and histological analysis. Furthermore, we identified an altered systemic inflammatory response that led to the transformation of macrophage polarization as a mechanism underlying the increased nerve regeneration in patients with cerebral injury. In mice, we showed that, as a contributing factor, serum amyloid protein A1 (SAA1) promoted C7 regeneration and interfered with macrophage polarization in vivo. Our results indicate that altered inflammation promotes the regenerative capacity of the C7 nerve by altering macrophage behavior. SAA1 may be a therapeutic target to improve the recovery of injured peripheral nerves.
Animals ; Brachial Plexus ; Brachial Plexus Neuropathies/surgery* ; Humans ; Mice ; Nerve Transfer ; Peripheral Nerves ; Spinal Nerves

Accessory Nerve ; transplantation ; Birth Injuries ; complications ; surgery ; Brachial Plexus Neuropathies ; etiology ; surgery ; Child, Preschool ; Early Medical Intervention ; Elbow ; Humans ; Infant ; Intercostal Nerves ; transplantation ; Nerve Transfer ; methods ; Radial Nerve ; surgery ; Sural Nerve ; transplantation ; Time Factors ; Treatment Outcome ; Ulnar Nerve ; transplantation

Adult ; Brachial Plexus ; injuries ; Brachial Plexus Neuropathies ; rehabilitation ; surgery ; Female ; Humans ; Male ; Middle Aged ; Young Adult

A 27-year-old man underwent excision of a mediastinal mass using video-assisted thoracoscopic surgery (VATS) performed in the right lateral position. Postoperatively, he complained of pain in the left upper arm and chest wall, limitation of the left shoulder joint, allodynia, hyperalgesia, spontaneous pain in left finger, edema, hypohidrosis, and change of skin color of the left hand. We diagnosed the patient with complex regional pain syndrome (CRPS) by using the proposed modified International Association of the Study of Pain (IASP) research diagnostic criteria, and initiated treatment through medication and interventional management. After 3 months of treatment, the pain intensity reduced to below 2 cm on the VAS. In this study, we describe a case of postoperative CRPS, which is believed to have been caused by excessive stretching of the brachial plexus. Careful positioning of patients on the operating table with proper padding will reduce injuries to the peripheral nerves.
Adult ; Arm ; Brachial Plexus ; Brachial Plexus Neuropathies ; Edema ; Fingers ; Hand ; Humans ; Hyperalgesia ; Hypohidrosis ; Operating Tables ; Peripheral Nerves ; Shoulder Joint ; Skin ; Thoracic Surgery, Video-Assisted ; Thoracic Wall

BACKGROUND: Mediastinal neurogenic tumors are generally benign lesions and they are ideal candidates for performing resection via video-assisted thoracoscopic surgery (VATS). However, benign neurogenic tumors at the thoracic apex present technical problems for the surgeon because of the limited exposure of the neurovascular structures, and the optimal way to surgically access these tumors is still a matter of debate. This study aims to clarify the feasibility and safety of the VATS approach for performing surgical resection of benign apical neurogenic tumors (ANT). MATERIAL AND METHOD: From January 1996 to September 2008, 31 patients with benign ANT (15 males/16 females, mean age: 45 years, range: 8~73), were operated on by various surgical methods: 14 VATS, 10 lateral thoracotomies, 6 cervical or cervicothoracic incisions and 1 median sternotomy. 3 patients had associated von Recklinhausen's disease. The perioperative variables and complications were retrospectively reviewed according to the surgical approaches, and the surgical results of VATS were compared with those of the other invasive surgeries. RESULT: In the VATS group, the histologic diagnosis was schwannoma in 9 cases, neurofibroma in 4 cases and ganglioneuroma in 1 case, and the median tumor size was 4.3 cm (range: 1.2~7.0 cm). The operation time, amount of chest tube drainage and the postoperative stay in the VATS group were significantly less than that in the other invasive surgical group (p<0.05). No conversion thoracotomy was required. There were 2 cases of Hornor's syndrome and 2 brachial plexus neuropathies in the VATS group; there was 1 case of Honor's syndrome, 1 brachial plexus neuropathy, 1 vocal cord palsy and 2 non-neurologic complications in the invasive surgical group, and all the complications developed postoperatively. The operative method was an independent predictor for postoperative neuropathies in the VATS group (that is, non-enucleation of the tumor) (p=0.029). CONCLUSION: The VATS approach for treating benign ANT is a less invasive, safe and feasible method. Enucleation of the tumor during the VATS procedure may be an important technique to decrease the postoperative neurological complications.
Ants ; Brachial Plexus Neuropathies ; Chest Tubes ; Drainage ; Female ; Ganglioneuroma ; Humans ; Mediastinum ; Neurilemmoma ; Neurofibroma ; Retrospective Studies ; Sternotomy ; Thoracic Surgery, Video-Assisted ; Thoracoscopy ; Thoracotomy ; Vocal Cord Paralysis

BACKGROUNDThere are few effective methods for treating injuries to the lower trunk of brachial plexus, and the curative effect is usually poor. The purpose of this study was to provide anatomic references for transferring the brachialis muscle branch of musculocutaneous nerve (BMBMCN) for selective neurotization of finger flexion in brachial plexus lower trunk injury, and to evaluate its clinical curative effects.

METHODSMicroanatomy and measurement were done on 50 limbs from 25 adult human cadavers to observe the origin, branch, type of the BMBMCN and median nerve, as well as their adjacent structures. Internal topographic features of the fascicular groups of the median nerve at the level of the BMBMCN were observed. In addition, the technique of BMBMCN transfer for selective neurotization of finger flexion of the median nerve was designed and tested in 6 fresh adult human cadavers. Acetylcholinesterase (AchE) staining of the BMBMCN and median nerve was done to observe the features of the nerve fibers. This technique was clinically tried to restore digital flexion in 6 cases of adult brachial plexus lower trunk injury. These cases were followed up for 3, 6, 9 and 12 months postoperatively. Recovery of function, grip strength, nerve electrophysiology and muscle power of the affected limbs were observed and measured.

RESULTSThe brachialis muscle was totally innervated by the musculocutaneous nerve (MCN). Based on the Hunter's line, the level of the origin of the BMBMCN was (13.18 +/- 2.77) cm. AchE histochemical staining indicated that the BMBMCN were totally made up of medullated nerve fibers. At the level of the BMBMCN, the median nerve consistently collected into three fascicular groups as shown by microanatomy in combination with AchE stain. The posterior fascicular group was mainly composed of anterior interosseous nerves and branches to the palmaris longus. The technique was tested in six fresh cadavers successfully, except that stoma split occurred in one case. Five of the six cases recovered digital flexion 12 months after operation, and at the same time grip strength, muscle power, and nerve electrophysiology also recovered markedly.

CONCLUSIONSThe technique of transferring the BMBMCN for selective neurotization of finger flexion is anatomically safe and effective, with satisfactory clinical outcomes.

Acetylcholinesterase ; analysis ; Adult ; Brachial Plexus ; anatomy & histology ; injuries ; Brachial Plexus Neuropathies ; surgery ; Clinical Trials as Topic ; Female ; Humans ; Male ; Middle Aged ; Musculocutaneous Nerve ; transplantation ; Nerve Transfer ; methods ; Retrospective Studies

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

OBJECTIVETo explore the effective treatment for chronic ulcer following radiotherapy for breast cancer and reveal the universality and severity of radiation-induced brachial plexus neuropathy.

METHODSThe TRAM flap, the local expanded flap or the delayed skin flap were applied to repair the ulcer wounds in 16 patients. Electromyogram examinations were used to evaluate the radiation lesions of the brachial plexus.

RESULTSAll the flaps survived successfully with satisfactory results except one, which sustained partial necrosis due to infection. Ten patients underwent regular electromyogram examinations, seven of them were found to have radiation-induced brachial plexus neuropathy.

CONCLUSIONSRadiation ulcer following radiotherapy for breast cancer is often concomitant with brachial plexus neuropathy. These injuries presented a chronically progressive and irreversible course. Application of the flaps that have adequate blood supply can reconstruct the wounds effectively.

Adult ; Aged ; Brachial Plexus Neuropathies ; etiology ; Breast Neoplasms ; radiotherapy ; Female ; Humans ; Middle Aged ; Radiation Injuries ; etiology ; surgery ; Radiotherapy ; adverse effects ; Surgical Flaps ; Treatment Outcome ; Ulcer ; etiology ; surgery

OBJECTIVETo explore the diagnosis and operative treatment of radiation-induced brachial plexopathy.

METHODSNine cases of radiation-induced brachial plexopathy were divided into two groups, 4 cases undergoing neurolysis of brachial plexus as Group A and 5 cases undergoing transfer of myocutaneous flaps after neurolysis as Group B. In Group B, 4 cases were treated with latissimus dorsi myocutaneous flaps (about 20 cm x 20 cm) and 1 case with pectoralis major myocutaneous flap (about 8 cm x 6 cm).

RESULTSAll the 9 cases of radiation-induced brachial plexopathy were followed up for a period of 2 to 5 years, with an average of 2.3 years. As far as pain relief and function recovery were concerned, the results of Group B were better than those of Group A.

CONCLUSIONSBased on the results of Group B in the series, we suggest that the procedure of covering the wounds with transferred myocutaneous flaps after neurolysis of the brachial plexus should be performed to those advanced patients. The procedure may improve the blood supply of the fibrotic brachial plexus by reestablishing a good nerve bed.

Adult ; Brachial Plexus Neuropathies ; diagnosis ; etiology ; surgery ; Breast Neoplasms ; diagnosis ; radiotherapy ; surgery ; Breast Neoplasms, Male ; diagnosis ; radiotherapy ; surgery ; Female ; Graft Survival ; Humans ; Male ; Mastectomy ; methods ; Middle Aged ; Nerve Regeneration ; physiology ; Prognosis ; Prospective Studies ; Radiation Dosage ; Radiation Injuries ; diagnosis ; surgery ; Radiotherapy, Adjuvant ; adverse effects ; Risk Assessment ; Sampling Studies ; Surgical Flaps ; Transplantation, Autologous

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