Manual of Peripheral Nerve Surgery edited by M. Socolovsky, L. Rasulic, R. Midha, and D. Garozzo [Thieme 2018] This concise and well-focused compendium is the fruit of a very active Peripheral Nerve Surgery Committeewithin the World Federation of Neurosurgical Societies, driven by the book editors who represent clinical and scientific knowledge in this particular field from different continents—a must in an areawith sometimes rare clinical cases and few dedicated specialists in every country. The present book is perfect for beginners or experts and is based on solid ground, starting with current reviews on nerve anatomy of the limbs, the clinical aspect of nerve trauma including war injuries, and diagnostic tools (electrodiagnosis, magnetic resonance, and ultrasound). The different neurosurgical techniques are detailed in this book, starting with neurolysis, direct repair, nerve grafting, and increasing use of tubes. Compressive lesions including the thoracic outlet syndrome are presented; several chapters deal with the traumatic brachial plexus lesions, in adults and the neonate, and lumbosacral plexus. Reconstruction of the facial nerve palsy is exposed by one skilled neurosurgeons’ personal experience and the last two chapters summarize the actual knowledge on benign and malignant peripheral nerve tumors, wherein many authors contributed their knowledge and cases together to help readers better understand the guidelines on diagnosis and surgical strategy. The editors stand for an excellent activity in their committee, aimed to raise interest and performance in the sometimes “neglected” field of the peripheral nerve, also addressed in other surgical specialties such as plastic and hand or orthopaedic surgery. Dedication to the peripheral nerve is a surgical passion, and the book reflects this enthusiasm. Although many textbooks on this topic came up in the last decade, this work is a milestone as it has a clear message as stated in the title “from the basics to complex procedures” in 200 pages, allowing the newcomers to go through it in a reasonable time without being discouraged by a 2,000 page encyclopedia, and still detailed enough on so delicate topics like the malignant peripheral nerve sheath tumors to satisfy surgical experts, facing rare and complex cases. Also, it is not just about “doing”: a lot of emphasis is given to the timing and the outcome of nerve reconstructions, which are not always perfect or predictable and frequently claim an interdisciplinary approach with secondary procedures performed by other specialties. But this is beyond the scope of this book, which clearly fulfils its scope, to address all those, especially neurosurgeons and neurologists, who want to know how surgery on peripheral nerves should be indicated, done, and followed up. This manual fits in the list of existing textbooks as being very well documented, clearly written, and concise, reflecting today’s peripheral nerve surgeon’s activity.
{"title":"Manual of Peripheral Nerve Surgery","authors":"J. Bahm","doi":"10.1055/S-0038-1669393","DOIUrl":"https://doi.org/10.1055/S-0038-1669393","url":null,"abstract":"Manual of Peripheral Nerve Surgery edited by M. Socolovsky, L. Rasulic, R. Midha, and D. Garozzo [Thieme 2018] This concise and well-focused compendium is the fruit of a very active Peripheral Nerve Surgery Committeewithin the World Federation of Neurosurgical Societies, driven by the book editors who represent clinical and scientific knowledge in this particular field from different continents—a must in an areawith sometimes rare clinical cases and few dedicated specialists in every country. The present book is perfect for beginners or experts and is based on solid ground, starting with current reviews on nerve anatomy of the limbs, the clinical aspect of nerve trauma including war injuries, and diagnostic tools (electrodiagnosis, magnetic resonance, and ultrasound). The different neurosurgical techniques are detailed in this book, starting with neurolysis, direct repair, nerve grafting, and increasing use of tubes. Compressive lesions including the thoracic outlet syndrome are presented; several chapters deal with the traumatic brachial plexus lesions, in adults and the neonate, and lumbosacral plexus. Reconstruction of the facial nerve palsy is exposed by one skilled neurosurgeons’ personal experience and the last two chapters summarize the actual knowledge on benign and malignant peripheral nerve tumors, wherein many authors contributed their knowledge and cases together to help readers better understand the guidelines on diagnosis and surgical strategy. The editors stand for an excellent activity in their committee, aimed to raise interest and performance in the sometimes “neglected” field of the peripheral nerve, also addressed in other surgical specialties such as plastic and hand or orthopaedic surgery. Dedication to the peripheral nerve is a surgical passion, and the book reflects this enthusiasm. Although many textbooks on this topic came up in the last decade, this work is a milestone as it has a clear message as stated in the title “from the basics to complex procedures” in 200 pages, allowing the newcomers to go through it in a reasonable time without being discouraged by a 2,000 page encyclopedia, and still detailed enough on so delicate topics like the malignant peripheral nerve sheath tumors to satisfy surgical experts, facing rare and complex cases. Also, it is not just about “doing”: a lot of emphasis is given to the timing and the outcome of nerve reconstructions, which are not always perfect or predictable and frequently claim an interdisciplinary approach with secondary procedures performed by other specialties. But this is beyond the scope of this book, which clearly fulfils its scope, to address all those, especially neurosurgeons and neurologists, who want to know how surgery on peripheral nerves should be indicated, done, and followed up. This manual fits in the list of existing textbooks as being very well documented, clearly written, and concise, reflecting today’s peripheral nerve surgeon’s activity.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/S-0038-1669393","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46262487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diffusion Weighted and Diffusion Tensor Imaging: A Clinical Guide edited by C. da Costa Leite and M. Castillo [Thieme 2016] Imaging of nerve tissue morphology progressed significantly with the development of magnetic resonance imaging (MRI) technology. A step further is done actually with the diffusion tensor imaging (DTI) applied on MRI signals, where one canvisualizenotonlywhitematterbundles, but also starts to get insight in physiologic processes like brain maturation and nerve regeneration) as well as in pathologies like tumors, infectious diseases, demyelination, injury, and hemorrhage. This is a novel up to date book in a new and thrilling clinical and research field, edited and written by neuroradiologic experts. After a comprehensive review of the underlying physics and the anatomy of supratentorial white matter tracts and their organization, the editors present chapters about imaging of the brain during the first 2 years of life (development and aging changes), before addressing the aforementioned main fields of brain pathology—not without dedicating a separate chapter to the spine and spinal cord diseases. The last chapter even goes beyond the future and deals with even newer developments based on non-Gaussian signal distribution, introducing the research on diffusional kurtosis and diffusion spectrum imaging and their potential applications, trying to improve the representation of crossing axonal fibers and tracts, a serious limitation of DTI images. Every chapter is written very clearly and has a welldefined structure, with beautiful illustrations in order to capture the focus of non-radiologic readers within the new field of imaging and research. Of course, a better visualization of organized tracts and their alteration in pathology and aging will stimulate our pathophysiologic curiosity and drive them to investigate further. For neurologists, potentially hypothetic tissue changes such as in earlyAlzheimer’s disease nowbecome obvious. For neurosurgeons who deal with a vascular pathology or a tumor, the alteration of neighboring tracts is precisely represented. The peripheral nerve surgeon starts to follow in the postoperative course regenerating cones through the morphologic highway of a peripheral nerve structure, recognizable by their clear unidirectional fluid and tissue movement, so precisely identifiable on tractography. DTI is not necessarily expensive, but time consuming. Thus far, it is not a routine procedure either in neuroradiology investigation or in medical cost reimbursement considerations. This book provides quick updates to a lot of concerned physicians and technicians.
扩散加权和扩散张量成像：C.da Costa Leite和M.Castillo编辑的《临床指南》[Thieme 2016]随着磁共振成像（MRI）技术的发展，神经组织形态的成像取得了显著进展。实际上，更进一步的是将扩散张量成像（DTI）应用于MRI信号，在那里，人们可以直观地观察白质束，但也开始深入了解生理过程，如大脑成熟和神经再生，以及肿瘤、传染病、脱髓鞘、损伤和出血等病理学。这是一本新的、激动人心的临床和研究领域的最新小说，由神经放射学专家编辑和撰写。在全面回顾了幕上白质束及其组织的基本物理和解剖结构后，编辑们介绍了关于生命前2年大脑成像（发育和衰老变化）的章节，在谈到上述大脑病理学的主要领域之前，我们将专门用一章来讨论脊椎和脊髓疾病。最后一章甚至超越了未来，介绍了基于非高斯信号分布的新发展，介绍了扩散峰度和扩散光谱成像的研究及其潜在应用，试图改善交叉轴突纤维和束的表现，这是DTI图像的一个严重限制。每一章都写得非常清楚，结构清晰，插图精美，以捕捉新的成像和研究领域中非放射学读者的焦点。当然，更好地显示有组织的束及其在病理学和衰老中的变化将激发我们的病理生理好奇心，并驱使他们进一步研究。对于神经学家来说，潜在的假设性组织变化，如早期阿尔茨海默病，现在变得显而易见。对于处理血管病理或肿瘤的神经外科医生来说，相邻束的改变是准确的。外周神经外科医生开始在术后过程中通过外周神经结构的形态学高速公路来追踪再生锥，通过其清晰的单向液体和组织运动可以识别，因此可以在纤维束造影上精确识别。DTI不一定昂贵，但很耗时。到目前为止，无论是在神经放射学调查还是在医疗费用报销方面，这都不是一个常规程序。这本书为许多关心的医生和技术人员提供了快速更新。
{"title":"Diffusion Weighted and Diffusion Tensor Imaging: A Clinical Guide","authors":"J. Bahm","doi":"10.1055/S-0038-1669394","DOIUrl":"https://doi.org/10.1055/S-0038-1669394","url":null,"abstract":"Diffusion Weighted and Diffusion Tensor Imaging: A Clinical Guide edited by C. da Costa Leite and M. Castillo [Thieme 2016] Imaging of nerve tissue morphology progressed significantly with the development of magnetic resonance imaging (MRI) technology. A step further is done actually with the diffusion tensor imaging (DTI) applied on MRI signals, where one canvisualizenotonlywhitematterbundles, but also starts to get insight in physiologic processes like brain maturation and nerve regeneration) as well as in pathologies like tumors, infectious diseases, demyelination, injury, and hemorrhage. This is a novel up to date book in a new and thrilling clinical and research field, edited and written by neuroradiologic experts. After a comprehensive review of the underlying physics and the anatomy of supratentorial white matter tracts and their organization, the editors present chapters about imaging of the brain during the first 2 years of life (development and aging changes), before addressing the aforementioned main fields of brain pathology—not without dedicating a separate chapter to the spine and spinal cord diseases. The last chapter even goes beyond the future and deals with even newer developments based on non-Gaussian signal distribution, introducing the research on diffusional kurtosis and diffusion spectrum imaging and their potential applications, trying to improve the representation of crossing axonal fibers and tracts, a serious limitation of DTI images. Every chapter is written very clearly and has a welldefined structure, with beautiful illustrations in order to capture the focus of non-radiologic readers within the new field of imaging and research. Of course, a better visualization of organized tracts and their alteration in pathology and aging will stimulate our pathophysiologic curiosity and drive them to investigate further. For neurologists, potentially hypothetic tissue changes such as in earlyAlzheimer’s disease nowbecome obvious. For neurosurgeons who deal with a vascular pathology or a tumor, the alteration of neighboring tracts is precisely represented. The peripheral nerve surgeon starts to follow in the postoperative course regenerating cones through the morphologic highway of a peripheral nerve structure, recognizable by their clear unidirectional fluid and tissue movement, so precisely identifiable on tractography. DTI is not necessarily expensive, but time consuming. Thus far, it is not a routine procedure either in neuroradiology investigation or in medical cost reimbursement considerations. This book provides quick updates to a lot of concerned physicians and technicians.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/S-0038-1669394","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47919282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Handbook of Pain Surgery by Kim J. Burchiel [Thieme 2018] Painmight be a terrible experience for the patient and still remains difficult to be treated. Pain surgery thus is of great interest for all therapists encountering pain patients. The present handbook gives a clear overview of common techniques and procedureswith a clearly structured text and a lot of figures. The first chapter on approach to the patient with chronic pain sets the frame: take the time to listen to the patient, his story, and pain characteristics. How demanding this may be! In section II, several authors develop the stimulation techniques addressing the peripheral nerves or spinal cord and intrathecal drug administration before focusing on the surgical options in trigeminal neuralgia. The last section is on destructive procedures addressing the myelon to interfere with pain-transmitting pathways. This concise handbook is a must for everyone who deals with patients experiencing severe, chronic, especially neuropathic pain, either general practitioners, anesthetists, neurologists or neurosurgeons, and upper limb surgeons. Even if we are not performing these procedures ourselves, we need to be aware of all existing techniques and evaluated procedures, to bring these into an inclusive discussion with the patient seeking our advice. This handbook gives a clear and well-documented overview and thus allows a better, more complete, more elaboratedmultidisciplinary approach to chronic pain, which does not respond sufficiently to analgesic regimens. Of course we should always bear in mind that the chronic pain needs to be addressed not only by medication and surgery, but the whole suffering individual should be considered including help for his/her daily living, psychology, emotional coping with pain, and still mandatory life project.
疼痛手术手册，作者:Kim J. Burchiel [Thieme 2018]疼痛对患者来说可能是一种可怕的经历，并且仍然难以治疗。因此，疼痛手术对所有遇到疼痛患者的治疗师来说都是非常感兴趣的。本手册给出了一个清晰的概述常见的技术和程序，结构清晰的文本和大量的数字。第一章关于治疗慢性疼痛患者的方法:花时间倾听患者，他的故事和疼痛特征。这是多么苛刻啊!在第二节中，几位作者在重点讨论三叉神经痛的手术选择之前，发展了针对周围神经或脊髓的刺激技术和鞘内给药。最后一节是关于破坏程序解决mymyon干扰疼痛传递途径。无论是全科医生、麻醉师、神经科医生或神经外科医生，还是上肢外科医生，都必须使用这本简明的手册来处理严重、慢性、特别是神经性疼痛的患者。即使我们自己不做这些手术，我们也需要了解所有现有的技术和评估的手术，以便与寻求我们建议的患者进行全面的讨论。这本手册给出了一个清晰的和充分记录的概述，从而允许一个更好的，更完整的，更详细的多学科方法来治疗慢性疼痛，这对止痛方案没有充分的反应。当然，我们应该始终牢记，慢性疼痛不仅需要通过药物和手术来解决，还应该考虑到整个受苦的个体，包括对他/她的日常生活、心理、情感应对疼痛的帮助，以及仍然是强制性的生活项目。
{"title":"Handbook of Pain Surgery","authors":"J. Bahm","doi":"10.1055/S-0038-1669392","DOIUrl":"https://doi.org/10.1055/S-0038-1669392","url":null,"abstract":"Handbook of Pain Surgery by Kim J. Burchiel [Thieme 2018] Painmight be a terrible experience for the patient and still remains difficult to be treated. Pain surgery thus is of great interest for all therapists encountering pain patients. The present handbook gives a clear overview of common techniques and procedureswith a clearly structured text and a lot of figures. The first chapter on approach to the patient with chronic pain sets the frame: take the time to listen to the patient, his story, and pain characteristics. How demanding this may be! In section II, several authors develop the stimulation techniques addressing the peripheral nerves or spinal cord and intrathecal drug administration before focusing on the surgical options in trigeminal neuralgia. The last section is on destructive procedures addressing the myelon to interfere with pain-transmitting pathways. This concise handbook is a must for everyone who deals with patients experiencing severe, chronic, especially neuropathic pain, either general practitioners, anesthetists, neurologists or neurosurgeons, and upper limb surgeons. Even if we are not performing these procedures ourselves, we need to be aware of all existing techniques and evaluated procedures, to bring these into an inclusive discussion with the patient seeking our advice. This handbook gives a clear and well-documented overview and thus allows a better, more complete, more elaboratedmultidisciplinary approach to chronic pain, which does not respond sufficiently to analgesic regimens. Of course we should always bear in mind that the chronic pain needs to be addressed not only by medication and surgery, but the whole suffering individual should be considered including help for his/her daily living, psychology, emotional coping with pain, and still mandatory life project.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/S-0038-1669392","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47140650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-09eCollection Date: 2017-01-01DOI: 10.1055/s-0037-1608624
J Bahm, A Gkotsi, S Bouslama, W El-Kazzi, F Schuind
Background In rare, selected cases of severe (extended) upper obstetric brachial plexus palsy (OBPP), after supraclavicular exposure and distal mobilization of the traumatized trunks and careful neuroma excision, we decided to perform direct nerve coaptation with tolerable tension and immobilized the affected arm positioned in adduction and 90-degree elbow flexion for three weeks. Objectives We present our surgical technique and preliminary results in a prospective open patient series, including 22 patients (14 right and 8 left side affected) between 2009 and 2016, operated at a mean age of 8.4 months. Methods Analysis of functional results after a minimum of 18 months was conducted using the British Medical Research Council (BMRC) scale. Results All children reached 60-90° of elbow flexion and 75° of shoulder abduction at already six months after surgery. For those patients having already passed one year post surgery, the mean active shoulder abduction reached 92°, and for those who past the 18 months 124°. We discuss the actual knowledge about nerve coaptation under "reasonable" tension including its advantages and drawbacks. Conclusion This technique may be indicated in preoperatively selected cases of (extended) upper OBPP and may give good functional results.
{"title":"Direct Nerve Sutures in (Extended) Upper Obstetric Brachial Plexus Repair.","authors":"J Bahm, A Gkotsi, S Bouslama, W El-Kazzi, F Schuind","doi":"10.1055/s-0037-1608624","DOIUrl":"https://doi.org/10.1055/s-0037-1608624","url":null,"abstract":"<p><p><b>Background</b> In rare, selected cases of severe (extended) upper obstetric brachial plexus palsy (OBPP), after supraclavicular exposure and distal mobilization of the traumatized trunks and careful neuroma excision, we decided to perform direct nerve coaptation with tolerable tension and immobilized the affected arm positioned in adduction and 90-degree elbow flexion for three weeks. <b>Objectives</b> We present our surgical technique and preliminary results in a prospective open patient series, including 22 patients (14 right and 8 left side affected) between 2009 and 2016, operated at a mean age of 8.4 months. <b>Methods</b> Analysis of functional results after a minimum of 18 months was conducted using the British Medical Research Council (BMRC) scale. <b>Results</b> All children reached 60-90° of elbow flexion and 75° of shoulder abduction at already six months after surgery. For those patients having already passed one year post surgery, the mean active shoulder abduction reached 92°, and for those who past the 18 months 124°. We discuss the actual knowledge about nerve coaptation under \"reasonable\" tension including its advantages and drawbacks. <b>Conclusion</b> This technique may be indicated in preoperatively selected cases of (extended) upper OBPP and may give good functional results.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2017-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0037-1608624","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35549697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-30eCollection Date: 2017-01-01DOI: 10.1055/s-0037-1608623
George Georgoulis, Eirini Papagrigoriou, Marc Sindou
Dear Editor, We have recently published a work on the intraoperative identification of fourth cervical (C4) root and phrenic nerve during “difficult” surgery, by changing the ventilator waveforms triggered by electrical stimulation of these anatomic structures.1,2 Reviewing the literature on the domain, we came across the correspondence by Bhakta (October 2008) regarding the article “Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note.”3,4 Having studied the method in a series of 12 patients for C4 root (microsurgical cervical DREZotomy for neuropathic pain after brachial plexus avulsion) and 2 patients for phrenic nerve (transversomegaly of seventh cervical vertebra and brachial plexus tumor), we would like to add our own findings and conclusions in the discussion. In the original article (May 2008), Bhagat et al4 had presentedtheirwork inwhich thechangesoncapnographyelicited byelectrical stimulationof thephrenicnervehadbeen successfully used for the intraoperative identification of the nerve in a series of threepatients. InOctober2008, Bhaktaquestioned the correlation between the changes on capnography and the stimulation, suggesting that various anesthesiologic parameters could have resulted in similar changes. Our own method consists of the combined analysis of capnography and at least one of pressure–time and flow– time curves. In our series, general intravenous anesthesia was used, without neuromuscular blocking agents. As opposed to thepatients in the series ofBhagat et al,where a laryngealmask was used,4 our patients were intubated and ventilated in fully controlledventilationmodeswith tidal volumes of 6mL/kg and frequencies between 11 and 15. No difference of performance was observed between volume control and pressure control modes. No hyperventilation or air leak around the cuff was suspected at any point. No poststimulation hemodynamic variabilitywas observed. The electrical stimulationwas always performed at around 1 mA. Under these fully controlled conditions, capnography showed a sensitivity of 100% in the detection of the stimulation of either C4 root or phrenic nerve. The disadvantages of the capnography curve alone are that it can only be interpreted during expiration, as values during inspiration are zero, and there is normal delay between the occurrence of ventilatory events and their appearance on the curve. The combined analysis of the three curves offered valuable additional information, thus increasing the specificity of the findings. The study of pressure and flow curves, which are real-time curves covering the entire respiratory cycle, allowed us to confirm the on–off effect, that is, the appearance and disappearance of the changes concomitantly with the onset and end of stimulation. The patterns observed on capnography were of greater amplitude but rather nonspecific, whereas those observed on pressure and/or flow curve were generally of smaller amplitude but more specific, o
{"title":"Evolution and Critics on \"Capnography as an Aid in Localizing the Phrenic Nerve in Brachial Plexus Surgery. Technical Note\" by Combined Ventilator Waveforms Analysis.","authors":"George Georgoulis, Eirini Papagrigoriou, Marc Sindou","doi":"10.1055/s-0037-1608623","DOIUrl":"https://doi.org/10.1055/s-0037-1608623","url":null,"abstract":"Dear Editor, We have recently published a work on the intraoperative identification of fourth cervical (C4) root and phrenic nerve during “difficult” surgery, by changing the ventilator waveforms triggered by electrical stimulation of these anatomic structures.1,2 Reviewing the literature on the domain, we came across the correspondence by Bhakta (October 2008) regarding the article “Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note.”3,4 Having studied the method in a series of 12 patients for C4 root (microsurgical cervical DREZotomy for neuropathic pain after brachial plexus avulsion) and 2 patients for phrenic nerve (transversomegaly of seventh cervical vertebra and brachial plexus tumor), we would like to add our own findings and conclusions in the discussion. In the original article (May 2008), Bhagat et al4 had presentedtheirwork inwhich thechangesoncapnographyelicited byelectrical stimulationof thephrenicnervehadbeen successfully used for the intraoperative identification of the nerve in a series of threepatients. InOctober2008, Bhaktaquestioned the correlation between the changes on capnography and the stimulation, suggesting that various anesthesiologic parameters could have resulted in similar changes. Our own method consists of the combined analysis of capnography and at least one of pressure–time and flow– time curves. In our series, general intravenous anesthesia was used, without neuromuscular blocking agents. As opposed to thepatients in the series ofBhagat et al,where a laryngealmask was used,4 our patients were intubated and ventilated in fully controlledventilationmodeswith tidal volumes of 6mL/kg and frequencies between 11 and 15. No difference of performance was observed between volume control and pressure control modes. No hyperventilation or air leak around the cuff was suspected at any point. No poststimulation hemodynamic variabilitywas observed. The electrical stimulationwas always performed at around 1 mA. Under these fully controlled conditions, capnography showed a sensitivity of 100% in the detection of the stimulation of either C4 root or phrenic nerve. The disadvantages of the capnography curve alone are that it can only be interpreted during expiration, as values during inspiration are zero, and there is normal delay between the occurrence of ventilatory events and their appearance on the curve. The combined analysis of the three curves offered valuable additional information, thus increasing the specificity of the findings. The study of pressure and flow curves, which are real-time curves covering the entire respiratory cycle, allowed us to confirm the on–off effect, that is, the appearance and disappearance of the changes concomitantly with the onset and end of stimulation. The patterns observed on capnography were of greater amplitude but rather nonspecific, whereas those observed on pressure and/or flow curve were generally of smaller amplitude but more specific, o","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2017-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0037-1608623","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35213645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-02eCollection Date: 2017-01-01DOI: 10.1055/s-0037-1606841
Lukas Rasulic
Peripheral nerve injuries and brachial plexus injuries are relatively frequent. Significance of these injuries lies in the fact that the majority of patients with these types of injuries constitute working population. Since these injuries may create disability, they present substantial socioeconomic problem nowadays. This article will present current state-of-the-art achievements of minimal invasive brachial plexus and peripheral nerve surgery. It is considered that the age of the patient, the mechanism of the injury, and the associated vascular and soft-tissue injuries are factors that primarily influence the extent of recovery of the injured nerve. The majority of patients are treated using classical open surgical approach. However, new minimally invasive open and endoscopic approaches are being developed in recent years-endoscopic carpal and cubital tunnel release, targeted minimally invasive approaches in brachial plexus surgery, endoscopic single-incision sural nerve harvesting, and there were even attempts to perform endoscopic brachial plexus surgery. The use of the commercially available nerve conduits for bridging short nerve gap has shown promising results. Multidisciplinary approach individually designed for every patient is of the utmost importance for the successful treatment of these injuries. In the future, integration of biology and nanotechnology may fabricate a new generation of nerve conduits that will allow nerve regeneration over longer nerve gaps and start new chapter in peripheral nerve surgery.
{"title":"Current Concept in Adult Peripheral Nerve and Brachial Plexus Surgery.","authors":"Lukas Rasulic","doi":"10.1055/s-0037-1606841","DOIUrl":"https://doi.org/10.1055/s-0037-1606841","url":null,"abstract":"<p><p>Peripheral nerve injuries and brachial plexus injuries are relatively frequent. Significance of these injuries lies in the fact that the majority of patients with these types of injuries constitute working population. Since these injuries may create disability, they present substantial socioeconomic problem nowadays. This article will present current state-of-the-art achievements of minimal invasive brachial plexus and peripheral nerve surgery. It is considered that the age of the patient, the mechanism of the injury, and the associated vascular and soft-tissue injuries are factors that primarily influence the extent of recovery of the injured nerve. The majority of patients are treated using classical open surgical approach. However, new minimally invasive open and endoscopic approaches are being developed in recent years-endoscopic carpal and cubital tunnel release, targeted minimally invasive approaches in brachial plexus surgery, endoscopic single-incision sural nerve harvesting, and there were even attempts to perform endoscopic brachial plexus surgery. The use of the commercially available nerve conduits for bridging short nerve gap has shown promising results. Multidisciplinary approach individually designed for every patient is of the utmost importance for the successful treatment of these injuries. In the future, integration of biology and nanotechnology may fabricate a new generation of nerve conduits that will allow nerve regeneration over longer nerve gaps and start new chapter in peripheral nerve surgery.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2017-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0037-1606841","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35466734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-16eCollection Date: 2017-01-01DOI: 10.1055/s-0036-1597838
Yigit Uyanikgil, Turker Cavusoglu, Kubilay Dogan Kılıc, Gurkan Yigitturk, Servet Celik, Richard Shane Tubbs, Mehmet Turgut
Abstract This review summarizes the role of melatonin (MLT) in defense against toxic-free radicals and its novel effects in the development of the nervous system, and the effect of endogenously produced and exogenously administered MLT in reducing the degree of tissue and nerve injuries. MLT was recently reported to be an effective free radical scavenger and antioxidant. Since endogenous MLT levels fall significantly in senility, these findings imply that the loss of this antioxidant could contribute to the incidence or severity of some age-related neurodegenerative diseases. Considering the high efficacy of MLT in overcoming much of the injury not only to the peripheral nerve but also to other organs, clinical trials for this purpose should be seriously considered.
{"title":"Useful Effects of Melatonin in Peripheral Nerve Injury and Development of the Nervous System.","authors":"Yigit Uyanikgil, Turker Cavusoglu, Kubilay Dogan Kılıc, Gurkan Yigitturk, Servet Celik, Richard Shane Tubbs, Mehmet Turgut","doi":"10.1055/s-0036-1597838","DOIUrl":"https://doi.org/10.1055/s-0036-1597838","url":null,"abstract":"Abstract This review summarizes the role of melatonin (MLT) in defense against toxic-free radicals and its novel effects in the development of the nervous system, and the effect of endogenously produced and exogenously administered MLT in reducing the degree of tissue and nerve injuries. MLT was recently reported to be an effective free radical scavenger and antioxidant. Since endogenous MLT levels fall significantly in senility, these findings imply that the loss of this antioxidant could contribute to the incidence or severity of some age-related neurodegenerative diseases. Considering the high efficacy of MLT in overcoming much of the injury not only to the peripheral nerve but also to other organs, clinical trials for this purpose should be seriously considered.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2017-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0036-1597838","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35078744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anne-Marie A Verenna, D. Alexandru, A. Karimi, Justin M. Brown, G. Bove, F. Daly, A. Pastore, Helen E. Pearson, M. Barbe
Abstract Rationale Knowledge of the relationship of the dorsal scapular artery (DSA) with the brachial plexus is limited. Objective We report a case of a variant DSA path, and revisit DSA origins and under-investigated relationship with the plexus in cadavers. Methods The DSA was examined in a male patient and 106 cadavers. Results In the case, we observed an unusual DSA compressing the lower plexus trunk, that resulted in intermittent radiating pain and paresthesia. In the cadavers, the DSA originated most commonly from the subclavian artery (71%), with 35% from the thyrocervical trunk. Nine sides of eight cadavers (seven females) had two DSA branches per side, with one branch from each origin. The most typical DSA path was a subclavian artery origin before passing between upper and middle brachial plexus trunks (40% of DSAs), versus between middle and lower trunks (23%), or inferior (4%) or superior to the plexus (1%). Following a thyrocervical trunk origin, the DSA passed most frequently superior to the plexus (23%), versus between middle and lower trunks (6%) or upper and middle trunks (4%). Bilateral symmetry in origin and path through the brachial plexus was observed in 13 of 35 females (37%) and 6 of 17 males (35%), with the most common bilateral finding of a subclavian artery origin and a path between upper and middle trunks (17%). Conclusion Variability in the relationship between DSA and trunks of the brachial plexus has surgical and clinical implications, such as diagnosis of thoracic outlet syndrome.
{"title":"Dorsal Scapular Artery Variations and Relationship to the Brachial Plexus, and a Related Thoracic Outlet Syndrome Case","authors":"Anne-Marie A Verenna, D. Alexandru, A. Karimi, Justin M. Brown, G. Bove, F. Daly, A. Pastore, Helen E. Pearson, M. Barbe","doi":"10.1055/s-0036-1583756","DOIUrl":"https://doi.org/10.1055/s-0036-1583756","url":null,"abstract":"Abstract Rationale Knowledge of the relationship of the dorsal scapular artery (DSA) with the brachial plexus is limited. Objective We report a case of a variant DSA path, and revisit DSA origins and under-investigated relationship with the plexus in cadavers. Methods The DSA was examined in a male patient and 106 cadavers. Results In the case, we observed an unusual DSA compressing the lower plexus trunk, that resulted in intermittent radiating pain and paresthesia. In the cadavers, the DSA originated most commonly from the subclavian artery (71%), with 35% from the thyrocervical trunk. Nine sides of eight cadavers (seven females) had two DSA branches per side, with one branch from each origin. The most typical DSA path was a subclavian artery origin before passing between upper and middle brachial plexus trunks (40% of DSAs), versus between middle and lower trunks (23%), or inferior (4%) or superior to the plexus (1%). Following a thyrocervical trunk origin, the DSA passed most frequently superior to the plexus (23%), versus between middle and lower trunks (6%) or upper and middle trunks (4%). Bilateral symmetry in origin and path through the brachial plexus was observed in 13 of 35 females (37%) and 6 of 17 males (35%), with the most common bilateral finding of a subclavian artery origin and a path between upper and middle trunks (17%). Conclusion Variability in the relationship between DSA and trunks of the brachial plexus has surgical and clinical implications, such as diagnosis of thoracic outlet syndrome.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2016-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0036-1583756","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58154181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peripheral nerve research as well as nerve repair simulation has relied heavily on the rat animal model, more specifically on the rat sciatic nerve.1 As the use of animals in experiments and training has received much criticism from animal rights activists and society at large, the field of surgical simulation is currently emerging. In microsurgery, high-fidelity Silastic models, animal parts such as chicken thighs or wings, and cadaveric specimens have been used. Based on the available experience with Thiel embalmed cadaveric tissue in simulation,2–4 we experimented with Thiel embalmed peripheral nerves for the purpose of microsurgical skill training. We used median, ulnar, and tibial nerves from cadavers that had been used for anatomic and surgical training and had not touched the peripheral nerve tissue. The donors had previously consented to tissue utilization in postmortem research. The tissues originated from cadavers prepared with the embalming method described by Thiel.5 This technique preserves texture, volume, color, and shape of the body as perfect as possible, with the advantage of avoiding decay observed with fresh cadaveric specimens. There is no shrinking or soaking of the soft tissues. Thirteen nerve sections measuring 5 cm eachwere prepared on a foam board. Needles (25 G) are used to fix the nerves to the foam board. A blue background was used for the exercise, as it improves contrast. An operating microscope (Opmi Pico, Carl Zeiss, Oberkochen, German) at 10 magnification was used for all microneurorrhaphies. Under magnification, the nerves were crushed in the midsection to simulate an injured nerve. The participants transected the nerve using a 15-blade scalpel, and trimmed the damagednerve tissue. The two endswere inspected for the fascicular architecture and oriented appropriately for the repair. The epineurium was then gently reflected back and the proud fascicles trimmed. Nylon 8–0 sutures were used to perform a simple epineural repair, starting with the 0and 180-degree orientation sutures and then filling in the required sutures to obtain a well-oriented microneurorrhaphy. Under magnification of the operative microscope, we found the Thiel nerve tissue to show a slight gray-brown discoloration with an epineural layer that was hydrophilic, giving the impression of edematous tissue (►Fig. 1). This thicker-than-normal epineural layer, however, offers adequate support for manipulation. Unfortunately, the cadaveric nature of themodel precludes the use of the vasa nervorum,which are not visible, for adequate orientation of the nerve. Upon transection of the nerve, it can be observed that the fascicles arewell preserved and bound byfirm endoneurium and perineurium which have not undergone the same edema as the epineurium (►Fig. 1). Despite therebeing no immediate herniation of nerve fascicles upon transection, the fascicles have a tendency to bemorehygroscopic, and by the end of the neurorrhaphy, one can observe some protrusion of
周围神经的研究以及神经修复模拟在很大程度上依赖于大鼠动物模型，特别是大鼠坐骨神经由于在实验和训练中使用动物受到了动物权利活动家和整个社会的许多批评，手术模拟领域目前正在兴起。在显微外科手术中，高保真的硅胶模型，动物部位，如鸡腿或翅膀，和尸体标本被使用。基于已有的Thiel尸体组织防腐的模拟经验，2-4我们对Thiel尸体组织防腐的周围神经进行了显微外科技能训练。我们使用了来自尸体的正中神经、尺神经和胫骨神经，这些神经曾用于解剖和外科训练，并且没有接触周围神经组织。捐赠者先前已经同意将组织用于死后研究。这些组织来自用thiel描述的防腐方法制备的尸体。这种技术尽可能完美地保留了尸体的质地、体积、颜色和形状，其优点是避免了用新鲜尸体标本观察到的腐烂。软组织无萎缩、浸泡现象。在泡沫板上制备了13个神经切片，每个5厘米。针头(25g)用于将神经固定在泡沫板上。练习中使用了蓝色背景，因为它可以提高对比度。手术显微镜(Opmi Pico, Carl Zeiss, Oberkochen，德国)10倍放大用于所有显微缝合。在放大镜下，神经在中段被压碎，以模拟受伤的神经。参与者使用15刃手术刀横切神经，并修整受损的神经组织。检查了两端的束状结构，并适当地定位修复。然后将神经外膜轻轻向后反射，并修剪骄傲的神经束。使用尼龙8-0缝线进行简单的神经外修复，从0度和180度方向缝线开始，然后填充所需缝线，以获得定向良好的微神经缝合。在手术显微镜下，我们发现Thiel神经组织显示轻微的灰褐色变色，神经外层亲水，给人水肿组织的印象(图1)。然而，这层比正常的神经外膜厚，为操作提供了足够的支持。不幸的是，该模型的尸体性质排除了使用不可见的神经血管来充分定位神经。横断神经时，可以观察到神经束保存完好，并被坚固的神经内膜和神经周围膜结合，它们没有像神经外膜那样经历水肿(图1)。1).尽管在横断时神经束没有立即突出，但神经束有吸湿的倾向，在神经缝合结束时，可以观察到缝合线之间有一些神经束突出。束状图很容易识别，在缝合前可以使神经很好地对准。13名整形外科、耳鼻喉科和骨科住院医生志愿者分别使用了该模型一次，并填写了模拟后的调查问卷。调查结果以李克特五分制进行评分(非常同意、不同意、既不同意也不反对、同意、非常同意)。一个关于参与者使用实验室的频率的问题，答案分为五类。模拟后调查的内容见表1。对调查问题的结果进行了描述性统计。所有参与者(100.0%)同意他们每年至少使用该模块两次，53.9%(7名居民)表示他们每月使用一次以上，38.5%(5名居民)每月使用一次，7.7%(1名居民)每年使用两次。在过去的三十年中，显微外科手术的快速发展与一些用于显微外科手术技能教学和磨练的模拟模型的发展相呼应。在大多数整形外科中心，免费皮瓣是常规手术，住院医生有充分的机会参与和执行这些手术。作为一个
{"title":"Thiel Cadaveric Nerve Tissue: A Model for Microsurgical Simulation","authors":"A. Odobescu, Sami P Moubayed, M. Danino","doi":"10.1055/s-0036-1580626","DOIUrl":"https://doi.org/10.1055/s-0036-1580626","url":null,"abstract":"Peripheral nerve research as well as nerve repair simulation has relied heavily on the rat animal model, more specifically on the rat sciatic nerve.1 As the use of animals in experiments and training has received much criticism from animal rights activists and society at large, the field of surgical simulation is currently emerging. In microsurgery, high-fidelity Silastic models, animal parts such as chicken thighs or wings, and cadaveric specimens have been used. Based on the available experience with Thiel embalmed cadaveric tissue in simulation,2–4 we experimented with Thiel embalmed peripheral nerves for the purpose of microsurgical skill training. We used median, ulnar, and tibial nerves from cadavers that had been used for anatomic and surgical training and had not touched the peripheral nerve tissue. The donors had previously consented to tissue utilization in postmortem research. The tissues originated from cadavers prepared with the embalming method described by Thiel.5 This technique preserves texture, volume, color, and shape of the body as perfect as possible, with the advantage of avoiding decay observed with fresh cadaveric specimens. There is no shrinking or soaking of the soft tissues. Thirteen nerve sections measuring 5 cm eachwere prepared on a foam board. Needles (25 G) are used to fix the nerves to the foam board. A blue background was used for the exercise, as it improves contrast. An operating microscope (Opmi Pico, Carl Zeiss, Oberkochen, German) at 10 magnification was used for all microneurorrhaphies. Under magnification, the nerves were crushed in the midsection to simulate an injured nerve. The participants transected the nerve using a 15-blade scalpel, and trimmed the damagednerve tissue. The two endswere inspected for the fascicular architecture and oriented appropriately for the repair. The epineurium was then gently reflected back and the proud fascicles trimmed. Nylon 8–0 sutures were used to perform a simple epineural repair, starting with the 0and 180-degree orientation sutures and then filling in the required sutures to obtain a well-oriented microneurorrhaphy. Under magnification of the operative microscope, we found the Thiel nerve tissue to show a slight gray-brown discoloration with an epineural layer that was hydrophilic, giving the impression of edematous tissue (►Fig. 1). This thicker-than-normal epineural layer, however, offers adequate support for manipulation. Unfortunately, the cadaveric nature of themodel precludes the use of the vasa nervorum,which are not visible, for adequate orientation of the nerve. Upon transection of the nerve, it can be observed that the fascicles arewell preserved and bound byfirm endoneurium and perineurium which have not undergone the same edema as the epineurium (►Fig. 1). Despite therebeing no immediate herniation of nerve fascicles upon transection, the fascicles have a tendency to bemorehygroscopic, and by the end of the neurorrhaphy, one can observe some protrusion of","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2016-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0036-1580626","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58134417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Multifactorial motion analysis was first established for gait and then developed in the upper extremity. Recordings of infrared light reflecting sensitive passive markers in space, combined with surface eletromyographic recordings and/or transmitted forces, allow eclectic study of muscular coordination in the upper limb. Brachial plexus birth injury is responsible for various patterns of muscle weakness, imbalance, and/or simultaneous activation, soft tissue contractures, and bone-joint deformities, leading to individual motion patterns and adaptations, which we studied by means of motion analysis tools. We describe the technical development and examination setup to evaluate motion impairment and present first clinical results. Motion analysis is a reliable objective assessment tool allowing precise pre- and postoperative multimodal evaluation of upper limb function. Level of evidence: II.
{"title":"Upper Limb Multifactorial Movement Analysis in Brachial Plexus Birth Injury","authors":"J. Bahm","doi":"10.1055/s-0036-1579762","DOIUrl":"https://doi.org/10.1055/s-0036-1579762","url":null,"abstract":"Abstract Multifactorial motion analysis was first established for gait and then developed in the upper extremity. Recordings of infrared light reflecting sensitive passive markers in space, combined with surface eletromyographic recordings and/or transmitted forces, allow eclectic study of muscular coordination in the upper limb. Brachial plexus birth injury is responsible for various patterns of muscle weakness, imbalance, and/or simultaneous activation, soft tissue contractures, and bone-joint deformities, leading to individual motion patterns and adaptations, which we studied by means of motion analysis tools. We describe the technical development and examination setup to evaluate motion impairment and present first clinical results. Motion analysis is a reliable objective assessment tool allowing precise pre- and postoperative multimodal evaluation of upper limb function. Level of evidence: II.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2016-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0036-1579762","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58132370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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