Pub Date : 2020-02-13DOI: 10.5772/intechopen.90234
S. Ferris
Nerve transfers have revolutionized outcomes in brachial plexus and peripheral nerve surgery. The ability to plan and execute effective and safe nerve transfers is now integral to providing contemporary reconstructive nerve surgery. This chapter provides an academic and philosophical approach to patient care. It includes details of preoperative planning and intraoperative techniques in sufficient practical detail to help surgeons both minimize risk and maximize results. This includes thorough discussion of techniques for interfasicular dissection, management of nerve branching, intraoperative nerve mapping, optimizing purity and quality of selected donor nerves and decision-making about donor neurotomy and preferred level of secondary nerve coaptation. These concepts and techniques provide the opportunity to improve results in known and familiar nerve transfers, as well as provide the opportunity to undertake new procedures with the best chance of success and the lowest risk of harm.
{"title":"Risk and Reward: Avoiding Donor Morbidity and Maximizing Results in Nerve Transfer Surgery","authors":"S. Ferris","doi":"10.5772/intechopen.90234","DOIUrl":"https://doi.org/10.5772/intechopen.90234","url":null,"abstract":"Nerve transfers have revolutionized outcomes in brachial plexus and peripheral nerve surgery. The ability to plan and execute effective and safe nerve transfers is now integral to providing contemporary reconstructive nerve surgery. This chapter provides an academic and philosophical approach to patient care. It includes details of preoperative planning and intraoperative techniques in sufficient practical detail to help surgeons both minimize risk and maximize results. This includes thorough discussion of techniques for interfasicular dissection, management of nerve branching, intraoperative nerve mapping, optimizing purity and quality of selected donor nerves and decision-making about donor neurotomy and preferred level of secondary nerve coaptation. These concepts and techniques provide the opportunity to improve results in known and familiar nerve transfers, as well as provide the opportunity to undertake new procedures with the best chance of success and the lowest risk of harm.","PeriodicalId":286292,"journal":{"name":"Peripheral Nerve Disorders and Treatment","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130400674","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 : 2020-01-20DOI: 10.5772/intechopen.87043
R. Alvites, M. Branquinho, A. Caseiro, S. S. Pedrosa, A. Luís, S. Geuna, A. Varejão, A. Maurício
Peripheral nerve injuries remain a common clinical complication, and currently available therapies present significant limitations, often resulting in poor and suboptimal outcomes. Despite significant developments in microsurgical approaches in the last decades, no effective treatment options have been disclosed. Current research focuses on the optimization of such microsurgical techniques and on their combination with other pro-regenerative factors, such as mesenchymal stem cells or biomaterials. Mesenchymal stem cells present a remarkable capacity for bioactive molecule production that modulates inflammatory and regenerative processes, stimulating peripheral nerve regeneration. In parallel, efforts have been directed towards the development of biomaterial nerve guidance channels and nerve conduits. These biomaterials have been optimized in terms of biodegradability, ability to release bioactive factors, incorporation of cellular agents, and internal matrix architecture (to enable cellular migration and mimic native tissue morphology and to generate and bear specific electrical activity). The current literature review presents relevant advances in the development of mesenchymal stem cell and biomaterial-based therapeutic approaches aiming at the peripheral nerve tissue regeneration in diverse lesion scenarios, also exploring the advances achieved by our research group in this field in recent years.
{"title":"Biomaterials and Cellular Systems at the Forefront of Peripheral Nerve Regeneration","authors":"R. Alvites, M. Branquinho, A. Caseiro, S. S. Pedrosa, A. Luís, S. Geuna, A. Varejão, A. Maurício","doi":"10.5772/intechopen.87043","DOIUrl":"https://doi.org/10.5772/intechopen.87043","url":null,"abstract":"Peripheral nerve injuries remain a common clinical complication, and currently available therapies present significant limitations, often resulting in poor and suboptimal outcomes. Despite significant developments in microsurgical approaches in the last decades, no effective treatment options have been disclosed. Current research focuses on the optimization of such microsurgical techniques and on their combination with other pro-regenerative factors, such as mesenchymal stem cells or biomaterials. Mesenchymal stem cells present a remarkable capacity for bioactive molecule production that modulates inflammatory and regenerative processes, stimulating peripheral nerve regeneration. In parallel, efforts have been directed towards the development of biomaterial nerve guidance channels and nerve conduits. These biomaterials have been optimized in terms of biodegradability, ability to release bioactive factors, incorporation of cellular agents, and internal matrix architecture (to enable cellular migration and mimic native tissue morphology and to generate and bear specific electrical activity). The current literature review presents relevant advances in the development of mesenchymal stem cell and biomaterial-based therapeutic approaches aiming at the peripheral nerve tissue regeneration in diverse lesion scenarios, also exploring the advances achieved by our research group in this field in recent years.","PeriodicalId":286292,"journal":{"name":"Peripheral Nerve Disorders and Treatment","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130259511","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 : 2019-11-04DOI: 10.5772/intechopen.89091
Y. Eshraghi, Sarah Vitug, M. Guirguis
Trigeminal neuralgia is characterized by sudden and severe shock-like episodes of transient unilateral pain in the trigeminal nerve distribution. Most cases are idiopathic and are known to respond favorably to anticonvulsants. For patients who fail at least three drug trials or experience intolerable side effects, surgery may be warranted. First, a diagnostic block at the trigeminal nerve or Gasserian ganglion to confirm clinical diagnosis is performed. Surgical intervention can be either ablative or nonablative, each with its respective indications, contraindications, and risk-benefit profile. Most common are the percutaneous rhizotomies: conventional and pulsed radiofrequency ablation (RFA), chemical glycerol injections, and mechanical balloon compression. Stereotactic or gamma knife radiosurgery (GKRS) is the least invasive with only a moderate duration of pain relief, whereas microvascular decompression (VMD) is the most invasive, but associated with greatest long-term benefit. RFA has consistently shown favorable results and is the only modality with evidence of pain relief in ≥50% of patients treated 20 years postoperatively. Auxiliary interventional options such as peripheral neurectomy, botulinum toxin type-A (BTX-A) injections, and cryotherapy are available for those with contraindications to rhizotomies, radiosurgery, or neurosurgery. Ultimately, physicians must tailor their management of trigeminal neuralgia to the needs of the patient.
{"title":"Interventional Treatment Options for Trigeminal Neuralgia","authors":"Y. Eshraghi, Sarah Vitug, M. Guirguis","doi":"10.5772/intechopen.89091","DOIUrl":"https://doi.org/10.5772/intechopen.89091","url":null,"abstract":"Trigeminal neuralgia is characterized by sudden and severe shock-like episodes of transient unilateral pain in the trigeminal nerve distribution. Most cases are idiopathic and are known to respond favorably to anticonvulsants. For patients who fail at least three drug trials or experience intolerable side effects, surgery may be warranted. First, a diagnostic block at the trigeminal nerve or Gasserian ganglion to confirm clinical diagnosis is performed. Surgical intervention can be either ablative or nonablative, each with its respective indications, contraindications, and risk-benefit profile. Most common are the percutaneous rhizotomies: conventional and pulsed radiofrequency ablation (RFA), chemical glycerol injections, and mechanical balloon compression. Stereotactic or gamma knife radiosurgery (GKRS) is the least invasive with only a moderate duration of pain relief, whereas microvascular decompression (VMD) is the most invasive, but associated with greatest long-term benefit. RFA has consistently shown favorable results and is the only modality with evidence of pain relief in ≥50% of patients treated 20 years postoperatively. Auxiliary interventional options such as peripheral neurectomy, botulinum toxin type-A (BTX-A) injections, and cryotherapy are available for those with contraindications to rhizotomies, radiosurgery, or neurosurgery. Ultimately, physicians must tailor their management of trigeminal neuralgia to the needs of the patient.","PeriodicalId":286292,"journal":{"name":"Peripheral Nerve Disorders and Treatment","volume":"80 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134636671","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 : 2019-10-11DOI: 10.5772/intechopen.89742
M. Bedewi, D. Coraci, S. Swify
The diagnosis of different peripheral nerve disorders is basically established by electrodiagnostic tests; the assessment of the function of peripheral nerve disorders is estimated by nerve conduction tests (NCT) and electromyography (EMG). The need for more information about nerve morphology mandated the usage of more diagnostic tools. This role is now achieved by means of peripheral nerve imaging consisting mainly of magnetic resonance imaging (MRI) and ultrasonography. In this chapter we will clarify the role of imaging in the diagnosis of peripheral nerve disorders, concentrating more on the role of modern high-resolution ultrasound, considering its advantages like cheap price, dynamic ability, and possibility of comparison with the contralateral side at the same setting.
{"title":"Peripheral Nerve Imaging: Focus on Sonography","authors":"M. Bedewi, D. Coraci, S. Swify","doi":"10.5772/intechopen.89742","DOIUrl":"https://doi.org/10.5772/intechopen.89742","url":null,"abstract":"The diagnosis of different peripheral nerve disorders is basically established by electrodiagnostic tests; the assessment of the function of peripheral nerve disorders is estimated by nerve conduction tests (NCT) and electromyography (EMG). The need for more information about nerve morphology mandated the usage of more diagnostic tools. This role is now achieved by means of peripheral nerve imaging consisting mainly of magnetic resonance imaging (MRI) and ultrasonography. In this chapter we will clarify the role of imaging in the diagnosis of peripheral nerve disorders, concentrating more on the role of modern high-resolution ultrasound, considering its advantages like cheap price, dynamic ability, and possibility of comparison with the contralateral side at the same setting.","PeriodicalId":286292,"journal":{"name":"Peripheral Nerve Disorders and Treatment","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131798803","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 : 2019-03-08DOI: 10.5772/INTECHOPEN.84839
Tayir Alon, V. Bril
In this chapter, we describe the prevalence, diagnostic methods, and treatment efficacy of compressive neuropathies of the median and the ulnar nerves in patients with diabetes mellitus (DM). Median neuropathy at the wrist is found in up to one-third of patients with DM, when demonstrated electrophysiologically, but is symptomatic as carpal tunnel syndrome (CTS) in a smaller proportion of these patients. It is clear that diabetes increases the risk of having clinical CTS. Diagnosis of CTS using nerve conduction studies is difficult in patients with DM and diabetic sensorimotor polyneuropathy (DSP) as median nerve conduction studies are affected predominantly by the diabetes state. We will discuss different electrodiagnostic and ultrasonography techniques for diagnosis and the outcomes of carpal tunnel release decompressive surgery in this special patient population. It is controversial whether DM is a risk factor for cubital tunnel syndrome or ulnar neuropathy at the elbow (UNE) or at the wrist (UNW). In this chapter, we will review the ultrasonographic and electrophysiological diagnostic techniques used in UNE and UNW and the efficacy of cubital tunnel release in DM patients.
{"title":"Focal Upper Limb Mononeuropathies in Patients with Diabetes Mellitus","authors":"Tayir Alon, V. Bril","doi":"10.5772/INTECHOPEN.84839","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.84839","url":null,"abstract":"In this chapter, we describe the prevalence, diagnostic methods, and treatment efficacy of compressive neuropathies of the median and the ulnar nerves in patients with diabetes mellitus (DM). Median neuropathy at the wrist is found in up to one-third of patients with DM, when demonstrated electrophysiologically, but is symptomatic as carpal tunnel syndrome (CTS) in a smaller proportion of these patients. It is clear that diabetes increases the risk of having clinical CTS. Diagnosis of CTS using nerve conduction studies is difficult in patients with DM and diabetic sensorimotor polyneuropathy (DSP) as median nerve conduction studies are affected predominantly by the diabetes state. We will discuss different electrodiagnostic and ultrasonography techniques for diagnosis and the outcomes of carpal tunnel release decompressive surgery in this special patient population. It is controversial whether DM is a risk factor for cubital tunnel syndrome or ulnar neuropathy at the elbow (UNE) or at the wrist (UNW). In this chapter, we will review the ultrasonographic and electrophysiological diagnostic techniques used in UNE and UNW and the efficacy of cubital tunnel release in DM patients.","PeriodicalId":286292,"journal":{"name":"Peripheral Nerve Disorders and Treatment","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116602623","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 : 2018-12-13DOI: 10.5772/INTECHOPEN.82523
Ching-Cheng Huang, M. Chiang
A novel technique and product applied to carpal tunnel microscopic surgical procedures through the designed medical devices were prepared and studied. The novel design of the medical device could be developed and applied for new carpal tunnel microscopic surgical procedures instead of the traditional carpal tunnel surgical procedures. Also, a new medical device with optical LLLT module was designed for wound healing in carpal tunnel syndrome treatments. Furthermore, assistive surgical healing dressings for carpal tunnel syndrome treatments via minimally invasive surgery (MIS) such as air-foam soft cleaning sponges and hydrogel surgical dressings with polymeric films were designed for more comfortable treatments. Biological and clinical evaluations of carpal tunnel surgical procedure using the new designed medical devices are studied. For commercialized reasons, guidance such as ISO 10993-1:2009(E) for biological evaluation of medical devices must be considered. Furthermore, the clinical evaluation of modified medical devices would be carried out.
{"title":"Biological and Preclinical Evaluations of Designed Optically Guided Medical Devices with Light Scattering Modules for Carpal Tunnel Syndrome Treatment and Surgical Procedure","authors":"Ching-Cheng Huang, M. Chiang","doi":"10.5772/INTECHOPEN.82523","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.82523","url":null,"abstract":"A novel technique and product applied to carpal tunnel microscopic surgical procedures through the designed medical devices were prepared and studied. The novel design of the medical device could be developed and applied for new carpal tunnel microscopic surgical procedures instead of the traditional carpal tunnel surgical procedures. Also, a new medical device with optical LLLT module was designed for wound healing in carpal tunnel syndrome treatments. Furthermore, assistive surgical healing dressings for carpal tunnel syndrome treatments via minimally invasive surgery (MIS) such as air-foam soft cleaning sponges and hydrogel surgical dressings with polymeric films were designed for more comfortable treatments. Biological and clinical evaluations of carpal tunnel surgical procedure using the new designed medical devices are studied. For commercialized reasons, guidance such as ISO 10993-1:2009(E) for biological evaluation of medical devices must be considered. Furthermore, the clinical evaluation of modified medical devices would be carried out.","PeriodicalId":286292,"journal":{"name":"Peripheral Nerve Disorders and Treatment","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132744005","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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