Ultrasound of the elbow with emphasis on detailed assessment of ligaments, tendons, and nerves

International Nuclear Information System (INIS)

De Maeseneer, Michel; Brigido, Monica Kalume; Antic, Marijana; Lenchik, Leon; Milants, Annemieke; Vereecke, Evie; Jager, Tjeerd; Shahabpour, Maryam

2015-01-01

. Slightly more distally the ulnar nerve courses between the two heads of the flexor carpi ulnaris. An accessory muscle, the anconeus epitrochlearis can cover the ulnar nerve at the cubital tunnel, and is easily identified on ultrasound. The radial nerve divides in a superficial sensory branch and a deep motor branch. The motor branch, the posterior interosseous nerve, courses under the arcade of Frohse where it enters the supinator muscle. At the level of the dorsal wrist the posterior interosseous nerve is located at the deep aspect of the extensor tendons. The median nerve may be compressed at various sites, including the lacertus fibrosis, between the pronator teres heads, and the sublimis bridge. These compression sites can be identified with ultrasound

Ultrasound of the elbow with emphasis on detailed assessment of ligaments, tendons, and nerves

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De Maeseneer, Michel, E-mail: Michel.demaeseneer@uzbrussel.be [Department of Radiology, Universitair Ziekenhuis Brussel, Brussels (Belgium); Brigido, Monica Kalume, E-mail: Mbrigido@med.umich.edu [Department of Radiology, University of Michigan, Ann Arbor, MI (United States); Antic, Marijana, E-mail: Misscroa@gmail.com [Department of Radiology, Universitair Ziekenhuis Brussel, Brussels (Belgium); Lenchik, Leon, E-mail: Llenchik@wakehealth.edu [Department of Radiology, Wake Forest University, Winston-Salem, NC (United States); Milants, Annemieke, E-mail: Annemieke.Milants@gmail.com [Department of Radiology, Universitair Ziekenhuis Brussel, Brussels (Belgium); Vereecke, Evie, E-mail: Evie.Vereecke@kuleuven-kulak.be [Department of Anatomy, KULAK, Katholieke Universiteit Leuven, Campus Kortrijk, Kortrijk (Belgium); Jager, Tjeerd [Aalsters Stedelijk Ziekenhuis, Aalst (Belgium); Shahabpour, Maryam, E-mail: Maryam.Shahabpour@uzbrussel.be [Department of Radiology, Universitair Ziekenhuis Brussel, Brussels (Belgium)

2015-04-15

. Slightly more distally the ulnar nerve courses between the two heads of the flexor carpi ulnaris. An accessory muscle, the anconeus epitrochlearis can cover the ulnar nerve at the cubital tunnel, and is easily identified on ultrasound. The radial nerve divides in a superficial sensory branch and a deep motor branch. The motor branch, the posterior interosseous nerve, courses under the arcade of Frohse where it enters the supinator muscle. At the level of the dorsal wrist the posterior interosseous nerve is located at the deep aspect of the extensor tendons. The median nerve may be compressed at various sites, including the lacertus fibrosis, between the pronator teres heads, and the sublimis bridge. These compression sites can be identified with ultrasound.

Unilateral abducens and bilateral facial nerve palsies associated with posterior fossa exploration surgery.

Science.gov (United States)

Khalil, Ayman; Clerkin, James; Mandiwanza, Tafadzwa; Green, Sandra; Javadpour, Mohsen

2016-03-06

Multiple cranial nerves palsies following a posterior fossa exploration confined to an extradural compartment is a rare clinical presentation. This case report describes a young man who developed a unilateral abducens and bilateral facial nerve palsies following a posterior fossa exploration confined to an extradural compartment. There are different theories to explain this presentation, but the exact mechanism remains unclear. We propose that this patient cranial nerve palsies developed following cerebrospinal fluid (CSF) leak, potentially as a consequence of rapid change in CSF dynamics. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2016.

Major Peripheral Nerve Injuries After Elbow Arthroscopy.

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Desai, Mihir J; Mithani, Suhail K; Lodha, Sameer J; Richard, Marc J; Leversedge, Fraser J; Ruch, David S

2016-06-01

To survey the American Society for Surgery of the Hand membership to determine the nature and distribution of nerve injuries treated after elbow arthroscopy. An online survey was sent to all members of the American Society for Surgery of the Hand under an institutional review board-approved protocol. Collected data included the number of nerve injuries observed over a 5-year period, the nature of treatment required for the injuries, and the outcomes observed after any intervention. Responses were anonymous, and results were securely compiled. We obtained 372 responses. A total of 222 nerve injuries were reported. The most injured nerves reported were ulnar, radial, and posterior interosseous (38%, 22%, and 19%, respectively). Nearly half of all patients with injuries required operative intervention, including nerve graft, tendon transfer, nerve repair, or nerve transfer. Of the patients who sustained major injuries, those requiring intervention, 77% had partial or no motor recovery. All minor injuries resolved completely. Our results suggest that major nerve injuries after elbow arthroscopy are not rare occurrences and the risk of these injuries is likely under-reported in the literature. Furthermore, patients should be counseled on this risk because most nerve injuries show only partial or no functional recovery. With the more widespread practice of elbow arthroscopy, understanding the nature and sequelae of significant complications is critically important in ensuring patient safety and improving outcomes. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

MRI-guided cryoablation of the posterior femoral cutaneous nerve for the treatment of neuropathy-mediated sitting pain

International Nuclear Information System (INIS)

Joshi, Dharmdev H.; Thawait, Gaurav K.; Fritz, Jan; Del Grande, Filippo

2017-01-01

Neuropathy of the posterior femoral cutaneous nerve may manifest as pain and paresthesia in the skin over the inferior buttocks, posterior thigh, and popliteal region. Current treatment options include physical and oral pain therapy, perineural injections, and surgical neurectomy. Perineural steroid injections may provide short-term pain relief; however, to our knowledge, there is currently no minimally invasive denervation procedure for sustained pain relief that could serve as an alternative to surgical neurectomy. Percutaneous cryoablation of nerves is a minimally invasive technique that induces a sustained nerve conduction block through temporary freezing of the neural layers. It can result in long-lasting pain relief, but has not been described for the treatment of neuropathy-mediated PFCN pain. We report a technique of MR-guided cryoablation of the posterior femoral cutaneous nerve resulting in successful treatment of PFCN-mediated sitting pain. Cryoablation of the posterior femoral cutaneous nerve seems a promising, minimally invasive treatment option that deserves further investigation. (orig.)

MRI-guided cryoablation of the posterior femoral cutaneous nerve for the treatment of neuropathy-mediated sitting pain

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Joshi, Dharmdev H.; Thawait, Gaurav K.; Fritz, Jan [Johns Hopkins University School of Medicine, Section of Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Del Grande, Filippo [Johns Hopkins University School of Medicine, Section of Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Ospedale Regionale di Lugano, Servizio di Radiologia, Lugano, Ticino (Switzerland)

2017-07-15

Neuropathy of the posterior femoral cutaneous nerve may manifest as pain and paresthesia in the skin over the inferior buttocks, posterior thigh, and popliteal region. Current treatment options include physical and oral pain therapy, perineural injections, and surgical neurectomy. Perineural steroid injections may provide short-term pain relief; however, to our knowledge, there is currently no minimally invasive denervation procedure for sustained pain relief that could serve as an alternative to surgical neurectomy. Percutaneous cryoablation of nerves is a minimally invasive technique that induces a sustained nerve conduction block through temporary freezing of the neural layers. It can result in long-lasting pain relief, but has not been described for the treatment of neuropathy-mediated PFCN pain. We report a technique of MR-guided cryoablation of the posterior femoral cutaneous nerve resulting in successful treatment of PFCN-mediated sitting pain. Cryoablation of the posterior femoral cutaneous nerve seems a promising, minimally invasive treatment option that deserves further investigation. (orig.)

Chronic Localized Back Pain Due to Posterior Cutaneous Nerve Entrapment Syndrome (POCNES): A New Diagnosis.

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Boelens, Oliver B; Maatman, Robert C; Scheltinga, Marc R; van Laarhoven, Kees; Roumen, Rudi M

2017-03-01

Most patients with chronic back pain suffer from degenerative thoracolumbovertebral disease. However, the following case illustrates that a localized peripheral nerve entrapment must be considered in the differential diagnosis of chronic back pain. We report the case of a 26-year-old woman with continuous excruciating pain in the lower back area. Previous treatment for nephroptosis was to no avail. On physical examination the pain was present in a 2 x 2 cm area overlying the twelfth rib some 4 cm lateral to the spinal process. Somatosensory testing using swab and alcohol gauze demonstrated the presence of skin hypo- and dysesthesia over the painful area. Local pressure on this painful spot elicited an extreme pain response that did not irradiate towards the periphery. These findings were highly suggestive of a posterior version of the anterior cutaneous nerve entrapment syndrome (ACNES), a condition leading to a severe localized neuropathic pain in anterior portions of the abdominal wall. She demonstrated a beneficial albeit temporary response after lidocaine infiltration as dictated by an established diagnostic and treatment protocol for ACNES. She subsequently underwent a local neurectomy of the involved superficial branch of the intercostal nerve. This limited operation had a favorable outcome resulting in a pain-free return to normal activities up to this very day (follow-up of 24 months).We propose to name this novel syndrome "posterior cutaneous nerve entrapment syndrome" (POCNES). Each patient with chronic localized back pain should undergo simple somatosensory testing to detect the presence of overlying skin hypo- and dysesthesia possibly reflecting an entrapped posterior cutaneous nerve.Key words: Chronic pain, back pain, posterior cutaneous nerve entrapment, peripheral nerve entrapment, surgical treatment for pain, anterior cutaneous nerve entrapment.

Radial nerve measurements in nonsymptomatic upper extremities of Filipinos: A cross-sectional study.

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Gonzalez-Suarez, Consuelo B; Dones, Valentin C; Grimmer, Karen; Thoirs, Kerry; Milanese, Steven; Atlas, Alvin

2015-10-01

Despite reports on the association of radial nerve (RN) size and lateral epicondylalgia (LE), Filipino normative values on RN size in healthy elbows are not established. An association with upper extremity anthropometric measurements is likewise not reported. Musculoskeletal ultrasound measurements of the RN at the level of the lateral epicondyle (RN-LE), posterior interosseous nerve at the level of the radial head and supinator (PIN-RH and PIN-sup), and superficial RN (SRN) in the elbows of healthy Filipinos were made in Manila from January-September 2011. A total of 198 elbows of 99 healthy participants aged 43 years (range, 33-48 years) [median(IQR)] were investigated. Men have larger PIN-RH, PIN-sup, and SRN compared with women. Arm length was associated with PIN-RH, PIN-sup, and SRN (P values can now be used for comparison in elbows with LE. © 2015 Wiley Periodicals, Inc.

Surgical Anatomy of the Radial Nerve at the Elbow and in the Forearm: Anatomical Basis for Intraplexus Nerve Transfer to Reconstruct Thumb and Finger Extension in C7 - T1 Brachial Plexus Palsy.

Science.gov (United States)

Zhang, Lei; Dong, Zhen; Zhang, Chun-Lin; Gu, Yu-Dong

2016-11-01

Background  C7 - T1 palsy results in complete loss of finger motion and poses a surgical challenge. This study investigated the anatomy of the radial nerve in the elbow and forearm and the feasibility of intraplexus nerve transfer to restore thumb and finger extension. Methods  The radial nerves were dissected in 28 formalin-fixed upper extremities. Branching pattern, length, diameter, and number of myelinated fibers were recorded. Results  Commonly, the branching pattern (from proximal to distal) was to the brachioradialis, extensor carpi radialis longus, superficial sensory proximal to the lateral epicondyle, extensor carpi radialis brevis, supinator, extensor digitorum communis, extensor digiti minimi, extensor carpi ulnaris, abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, and extensor indicis distal to the lateral epicondyle. Conclusions  Branches to the brachioradialis, extensor carpi radialis longus, and supinator can be transferred to the posterior interosseous nerve to restore hand movement in patients with C7 - T1 brachial plexus palsies; the supinator branch is probably the best choice in this regard. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Clinical Outcomes following median to radial nerve transfers

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Ray, Wilson Z.; Mackinnon, Susan E.

2010-01-01

Purpose In this study the authors evaluate the clinical outcomes in patients with radial nerve palsy who underwent nerve transfers utilizing redundant fascicles of median nerve (innervating the flexor digitorum superficialis and flexor carpi radialis muscles) to the posterior interosseous nerve and the nerve to the extensor carpi radialis brevis. Methods A retrospective review of the clinical records of 19 patients with radial nerve injuries who underwent nerve transfer procedures using the median nerve as a donor nerve were included. All patients were evaluated using the Medical Research Council (MRC) grading system. Results The mean age of patients was 41 years (range 17 – 78 years). All patients received at least 12 months of follow-up (20.3 ± 5.8 months). Surgery was performed at a mean of 5.7 ± 1.9 months post-injury. Post-operative functional evaluation was graded according to the following scale: grades MRC 0/5 - MRC 2/5 were considered poor outcomes, while MRC of 3/5 was a fair result, MRC grade 4/5 was a good result, and grade 4+/5 was considered an excellent outcome. Seventeen patients (89%) had a complete radial nerve palsy while two patients (11%) had intact wrist extension but no finger or thumb extension. Post-operatively all patients except one had good to excellent recovery of wrist extension. Twelve patients recovered good to excellent finger and thumb extension, two patients had fair recovery, five patients had a poor recovery. Conclusions The radial nerve is a commonly injured nerve, causing significant morbidity in affected patients. The median nerve provides a reliable source of donor nerve fascicles for radial nerve reinnervation. This transfer was first performed in 1999 and evolved over the subsequent decade. The important nuances of both surgical technique and motor re-education critical for to the success of this transfer have been identified and are discussed. PMID:21168979

The prevalence of tenosynovitis of the interosseous tendons of the hand in patients with rheumatoid arthritis

International Nuclear Information System (INIS)

Rowbotham, Emma L.; Freeston, Jane E.; Emery, Paul; Grainger, Andrew J.

2016-01-01

The aim of this study was to establish the prevalence of tenosynovitis affecting the interosseous tendons of the hand in a rheumatoid arthritis (RA) population and to assess for association with metacarpophalangeal (MCP) joint synovitis, flexor tendon tenosynovitis or ulnar drift. Forty-four patients with RA underwent hand MRI along with 20 normal controls. Coronal 3D T1 VIBE sequences pre- and post-contrast were performed and reconstructed. The presence of interosseous tendon tenosynovitis was recorded alongside MCP joint synovitis, flexor tendon tenosynovitis and ulnar drift. Twenty-one (47.7 %) patients with RA showed interosseous tendon tenosynovitis. Fifty-two (14.8 %) interosseous tendons showed tenosynovitis amongst the RA patients. Interosseous tendon tenosynovitis was more commonly seen in association with adjacent MCP joint synovitis (p < 0.001), but nine MCP joints (5.1 %) showed adjacent interosseous tenosynovitis in the absence of joint synovitis. Interosseous tendon tenosynovitis was more frequently seen in fingers which also showed flexor tendon tenosynovitis (p < 0.001) and in patients with ulnar drift of the fingers (p = 0.01). Tenosynovitis of the hand interosseous tendons was found in 47.7 % of patients with RA. In the majority of cases this was adjacent to MCP joint synovitis; however, interosseous tendon tenosynovitis was also seen in isolation. (orig.)

The prevalence of tenosynovitis of the interosseous tendons of the hand in patients with rheumatoid arthritis

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Rowbotham, Emma L. [Leeds Teaching Hospitals NHS Trust, Musculoskeletal Radiology Department, Leeds (United Kingdom); Freeston, Jane E. [Department of Rheumatology, Leeds Teaching Hospitals NHS Trust, Leeds (United Kingdom); Emery, Paul [University of Leeds, Arthritis Research UK, Leeds Musculoskeletal Biomedical Research Unit, LTHT Leeds Institute of Rheumatic Musculoskeletal Medicine, Leeds (United Kingdom); Grainger, Andrew J. [Leeds Teaching Hospitals NHS Trust, Musculoskeletal Radiology Department, Leeds (United Kingdom); Chapel Allerton Hospital, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds (United Kingdom)

2016-02-15

The aim of this study was to establish the prevalence of tenosynovitis affecting the interosseous tendons of the hand in a rheumatoid arthritis (RA) population and to assess for association with metacarpophalangeal (MCP) joint synovitis, flexor tendon tenosynovitis or ulnar drift. Forty-four patients with RA underwent hand MRI along with 20 normal controls. Coronal 3D T1 VIBE sequences pre- and post-contrast were performed and reconstructed. The presence of interosseous tendon tenosynovitis was recorded alongside MCP joint synovitis, flexor tendon tenosynovitis and ulnar drift. Twenty-one (47.7 %) patients with RA showed interosseous tendon tenosynovitis. Fifty-two (14.8 %) interosseous tendons showed tenosynovitis amongst the RA patients. Interosseous tendon tenosynovitis was more commonly seen in association with adjacent MCP joint synovitis (p < 0.001), but nine MCP joints (5.1 %) showed adjacent interosseous tenosynovitis in the absence of joint synovitis. Interosseous tendon tenosynovitis was more frequently seen in fingers which also showed flexor tendon tenosynovitis (p < 0.001) and in patients with ulnar drift of the fingers (p = 0.01). Tenosynovitis of the hand interosseous tendons was found in 47.7 % of patients with RA. In the majority of cases this was adjacent to MCP joint synovitis; however, interosseous tendon tenosynovitis was also seen in isolation. (orig.)

Communication between radial nerve and medial cutaneous nerve of forearm

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R R Marathe

2010-01-01

Full Text Available Radial nerve is usually a branch of the posterior cord of the brachial plexus. It innervates triceps, anconeous, brachialis, brachioradialis, extensor carpi radialis longus muscles and gives the posterior cutaneous nerve of the arm, lower lateral cutaneous nerve of arm, posterior cutaneous nerve of forearm; without exhibiting any communication with the medial cutaneous nerve of forearm or any other nerve. We report communication between the radial nerve and medial cutaneous nerve of forearm on the left side in a 58-year-old male cadaver. The right sided structures were found to be normal. Neurosurgeons should keep such variations in mind while performing the surgeries of axilla and upper arm.

Interosseous Ligament and Transverse Forearm Stability: A Biomechanical Cadaver Study.

Science.gov (United States)

Gutowski, Christina J; Darvish, Kurosh; Ilyas, Asif M; Jones, Christopher M

2017-02-01

The interosseous ligament (IOL) is known to be an important longitudinal stabilizer of the forearm. We hypothesize that it may also contribute to transverse stability, with pronosupination tensioning of the radius relative to the ulna. Therefore, when injured, we predict the interosseous space should widen in the transverse plane, enough to be appreciable on plain radiographs. A measurable difference in interosseous space, comparing an injured with an uninjured forearm, can potentially be of diagnostic and clinical value. Ten fresh-frozen cadaver arms (from 5 individuals) were radiographed in 6 different positions of forearm supination, first in an uninjured state and then with the IOL sectioned, both partially (central band only) and completely. The transverse interosseous distance was measured on radiographs using edge detection software and compared using analysis of variance and contrast analysis. The maximum range of pronosupination was also compared before and after injury, using a paired t test. Average maximum supination increased from 84° to 106°, and pronation from 69° to 84°, after the IOL was sectioned completely. Sectioning of the IOL led to a statistically significant increase in the interosseous distance, a minimum of 2 mm, in all but one forearm position. The IOL of the forearm plays an important role in providing transverse stability to the radius and ulna. When the IOL is sectioned, the forearm exhibits increased pronosupination range of motion. Radiographs of bilateral forearms taken in identical rotational position can reliably differentiate between an intact and torn IOL in cadavers. The IOL's stabilizing role during forearm rotation suggests a novel strategy for diagnosing forearm IOL injury using comparative radiographic measurements. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Strain Distribution in the Anterior Inferior Tibiofibular Ligament, Posterior Inferior Tibiofibular Ligament, and Interosseous Membrane Using Digital Image Correlation.

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Xu, Daorong; Wang, Yibei; Jiang, Chunyu; Fu, Maoqing; Li, Shiqi; Qian, Lei; Sun, Peidong; Ouyang, Jun

2018-05-01

Ligament repair and augmentation techniques can stabilize syndesmosis injuries. However, little is known about the mechanical behavior of syndesmotic ligaments. The aim of this study was to analyze full-field strain, strain trend under foot rotation, and subregional strain differences of the anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), and interosseous membrane (IOM). Eleven fresh-frozen lower limbs were dissected to expose the AITFL, PITFL, and IOM. The foot underwent rotation from 0° to 25° internal and 35° external, with 3 ankle positions (neutral, 15° dorsiflexion, and 25° plantarflexion) and a vertical load of 430 N. Ligament strain was recorded using digital image correlation. The mean strain on the AITFL with 35° external rotation was greater in the proximal portion compared with distal portion in the neutral position ( P = .009) and dorsiflexion ( P = .003). The mean strain in the tibial insertion and midsubstance near tibial insertion were greater when compared with other regions ( P = .018 and P = .009). The subregions of mean strain in the PITFL and IOM groups were not significantly different. The strain trend of AITFL, PITFL, and IOM showed common transformation, just when the foot was externally rotated. The findings of this study show that a significantly high strain was observed on the proximal part and the midsubstance near the Chaput tubercle of the AITFL when the ankle was externally rotated. All 3 ligaments resisted the torque in the syndesmosis by external rotation of the foot. This study allows for better understanding of the mechanical behavior of the syndesmosis ligaments, which could influence the repair technique and AITFL augmentation techniques.

A randomised controlled trial of ultrasound-guided blockade of the saphenous nerve and the posterior branch of the obturator nerve for postoperative analgesia after day-case knee arthroscopy

DEFF Research Database (Denmark)

Westergaard, B; Jensen, K; Lenz, K

2014-01-01

The purpose of this study was to investigate the effects of blockade of the saphenous nerve and the posterior branch of the obturator nerve in addition to a standard analgesic regimen for patients discharged the same day after knee arthroscopy. The primary outcome was knee pain on flexion during...

High-resolution MRI of cranial nerves in posterior fossa at 3.0 T

Institute of Scientific and Technical Information of China (English)

Zi-Yi Guo; Jing Chen; Qi-Zhou Liang; Hai-Yan Liao; Qiong-Yue Cheng; Shui-Xi Fu; Cai-Xiang Chen; Dan Yu

2013-01-01

Objective:To evaluate the influence of high-resolution imaging obtainable with the higher field strength of3.0T on the visualization of the brain nerves in the posterior fossa.Methods:In total,20 nerves were investigated onMRI of12 volunteers each and selected for comparison, respectively, with theFSE sequences with5 mm and2 mm section thicknesses and gradient recalled echo(GRE) sequences acquired with a3.0-T scanner.TheMR images were evaluated by three independent readers who rated image quality according to depiction of anatomic detail and contrast with use of a rating scale.Results:In general, decrease of the slice thickness showed a significant increase in the detection of nerves as well as in the image quality characteristics. ComparingFSE andGRE imaging, the course of brain nerves and brainstem vessels was visualized best with use of the three-dimensional(3D) pulse sequence.Conclusions:The comparison revealed the clear advantage of a thin section.The increased resolution enabled immediate identification of all brainstem nerves.GRE sequence most distinctly and confidently depicted pertinent structures and enables3D reconstruction to illustrate complex relations of the brainstem.

High-resolution MRI of cranial nerves in posterior fossa at 3.0 T.

Science.gov (United States)

Guo, Zi-Yi; Chen, Jing; Liang, Qi-Zhou; Liao, Hai-Yan; Cheng, Qiong-Yue; Fu, Shui-Xi; Chen, Cai-Xiang; Yu, Dan

2013-02-01

To evaluate the influence of high-resolution imaging obtainable with the higher field strength of 3.0 T on the visualization of the brain nerves in the posterior fossa. In total, 20 nerves were investigated on MRI of 12 volunteers each and selected for comparison, respectively, with the FSE sequences with 5 mm and 2 mm section thicknesses and gradient recalled echo (GRE) sequences acquired with a 3.0-T scanner. The MR images were evaluated by three independent readers who rated image quality according to depiction of anatomic detail and contrast with use of a rating scale. In general, decrease of the slice thickness showed a significant increase in the detection of nerves as well as in the image quality characteristics. Comparing FSE and GRE imaging, the course of brain nerves and brainstem vessels was visualized best with use of the three-dimensional (3D) pulse sequence. The comparison revealed the clear advantage of a thin section. The increased resolution enabled immediate identification of all brainstem nerves. GRE sequence most distinctly and confidently depicted pertinent structures and enables 3D reconstruction to illustrate complex relations of the brainstem. Copyright © 2013 Hainan Medical College. Published by Elsevier B.V. All rights reserved.

Vascularized nerve grafts for lower extremity nerve reconstruction.

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Terzis, Julia K; Kostopoulos, Vasileios K

2010-02-01

Vascularized nerve grafts (VNG) were introduced in 1976 but since then, there have been no reports of their usage in lower extremity reconstruction systematically. The factors influencing outcomes as well as a comparison with conventional nerve grafts will be presented.Since 1981, 14 lower extremity nerve injuries in 12 patients have been reconstructed with VNG. Common peroneal nerve was injured in 12 and posterior tibial nerve in 5 patients. The level of the injury was at the knee or thigh. Twelve sural nerves were used as VNG with or without concomitant vascularized posterior calf fascia.All patients regained improved sensibility and adequate posterior tibial nerve function. For common peroneal nerve reconstructions, all patients with denervation time less than 6 months regained muscle strength of grade at least 4, even when long grafts were used for defects of 20 cm or more. Late cases, yielded inadequate muscle function even with the use of VNG.Denervation time of 6 months or less was critical for reconstruction with vascularized nerve graft. Not only the results were statistically significant compared with late cases, but also all early operated patients achieved excellent results. VNG are strongly recommended in traction avulsion injuries of the lower extremity with lengthy nerve damage.

Occasional head of flexor pollicis longus muscle: a study of its morphology and clinical significance.

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Hemmady M

1993-01-01

Full Text Available A cadaveric dissection study of 54 upper extremities to determine the incidence of occurrence, morphology and relations of the occasional head of the flexor pollicis longus muscle is presented. The occasional head of the flexor pollicis longus muscle was found to be present more frequently (66.66% than absent. It mainly arose from the medical epicondyle of the humerus (55.55% and the medial border of the coronoid process of the ulna (16.66%. It was found to be in close association with the median nerve (anteriorly and the anterior interosseous nerve (posteriorly. The clinical implications of these findings are discussed viz. entrapment neuropathies of the median and anterior interosseous nerves, cicatricial contraction of the occasional head leading to flexion deformity of the thumb and the likely necessity to lengthen/release the occasional head in spastic paralysis of the flexor pollicis longus muscle.

Extensive molecular differences between anterior- and posterior-half-sclerotomes underlie somite polarity and spinal nerve segmentation

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Keynes Roger J

2009-05-01

Full Text Available Abstract Background The polarization of somite-derived sclerotomes into anterior and posterior halves underlies vertebral morphogenesis and spinal nerve segmentation. To characterize the full extent of molecular differences that underlie this polarity, we have undertaken a systematic comparison of gene expression between the two sclerotome halves in the mouse embryo. Results Several hundred genes are differentially-expressed between the two sclerotome halves, showing that a marked degree of molecular heterogeneity underpins the development of somite polarity. Conclusion We have identified a set of genes that warrant further investigation as regulators of somite polarity and vertebral morphogenesis, as well as repellents of spinal axon growth. Moreover the results indicate that, unlike the posterior half-sclerotome, the central region of the anterior-half-sclerotome does not contribute bone and cartilage to the vertebral column, being associated instead with the development of the segmented spinal nerves.

Chronic elbow dislocation: a rare complication of tennis elbow surgery. Successful treatment by open reduction and external fixator.

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Degreef, I; De Smet, L

2007-06-01

A case is presented of chronic dislocation of the elbow after tennis elbow surgery combined with posterior interosseous nerve (PIN) release. An open reduction with repair of the collateral ligaments was performed. Postoperative rehabilitation involved the use of an articulated external fixator and there was a successful outcome. Possible causes of the dislocation are discussed.

Ultrasound assessment on selected peripheral nerve pathologies. Part I: Entrapment neuropathies of the upper limb – excluding carpal tunnel syndrome

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Berta Kowalska

2012-09-01

Full Text Available Ultrasound (US is one of the methods for imaging entrapment neuropathies, post-trau‑ matic changes to nerves, nerve tumors and postoperative complications to nerves. This type of examination is becoming more and more popular, not only for economic reasons, but also due to its value in making accurate diagnosis. It provides a very precise assess‑ ment of peripheral nerve trunk pathology – both in terms of morphology and localization. During examination there are several options available to the specialist: the making of a dynamic assessment, observation of pain radiation through the application of precise palpation and the comparison of resultant images with the contra lateral limb. Entrap‑ ment neuropathies of the upper limb are discussed in this study, with the omission of median nerve neuropathy at the level of the carpal canal, as extensive literature on this subject exists. The following pathologies are presented: pronator teres muscle syndrome, anterior interosseus nerve neuropathy, ulnar nerve groove syndrome and cubital tun‑ nel syndrome, Guyon’s canal syndrome, radial nerve neuropathy, posterior interosseous nerve neuropathy, Wartenberg’s disease, suprascapular nerve neuropathy and thoracic outlet syndrome. Peripheral nerve examination technique has been presented in previous articles presenting information about peripheral nerve anatomy [Journal of Ultrasonog‑ raphy 2012; 12 (49: 120–163 – Normal and sonographic anatomy of selected peripheral nerves. Part I: Sonohistology and general principles of examination, following the exam‑ ple of the median nerve; Part II: Peripheral nerves of the upper limb; Part III: Peripheral nerves of the lower limb]. In this article potential compression sites of particular nerves are discussed, taking into account pathomechanisms of damage, including predisposing anatomical variants (accessory muscles. The parameters of ultrasound assessment have been established – echogenicity and

Superior perioperative analgesia with combined femoral-obturator-sciatic nerve block in comparison with posterior lumbar plexus and sciatic nerve block for ACL reconstructive surgery.

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Bareka, Metaxia; Hantes, Michael; Arnaoutoglou, Eleni; Vretzakis, George

2018-02-01

The purpose of this randomized controlled study is to compare and evaluate the intraoperative and post-operative outcome of PLPS nerve block and that of femoral, obturator and sciatic (FOS) nerve block as a method of anaesthesia, in performing ACL reconstruction. Patients referred for elective arthroscopic ACL reconstruction using hamstring autograft were divided in two groups. The first group received combined femoral-obturator-sciatic nerve block (FOS Group) under dual guidance, whereas the second group received posterior lumbar plexus block under neurostimulation and sciatic nerve block (PLPS Group) under dual guidance. The two groups were comparable in terms of age, sex, BMI and athletic activity. The time needed to perform the nerve blocks was significantly shorter for the FOS group (p block under dual guidance for arthroscopic ACL reconstructive surgery is a safe and tempting anaesthetic choice. The success rate of this technique is higher in comparison with PLPS and results in less peri- and post-operative pain with less opioid consumption. This study provides support for the use of peripheral nerve blocks as an exclusive method for ACL reconstructive surgery in an ambulatory setting with almost no complications. I.

A posterior approach to cervical nerve root block and pulsed radiofrequency treatment for cervical radicular pain: a retrospective study.

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Xiao, Lizu; Li, Jie; Li, Disen; Yan, Dong; Yang, Jun; Wang, Daniel; Cheng, Jianguo

2015-09-01

Catastrophic complications have been reported for selective cervical nerve root block (SCNRB) or pulsed radiofrequency (PRF) via an anterolateral transforaminal approach. A posterior approach to these procedures under computed tomography guidance has been reported. Here, we report the clinical outcomes of 42 patients with chronic cervical radicular pain (CCRP) treated with a combination of SCNRB and PRF through a posterior approach under fluoroscopy guidance. We retrospectively reviewed the clinical outcomes of 42 consecutive patients with CCRP who received a combination of SCNRB and PRF through a posterior approach under fluoroscopy guidance. The thresholds of electrical stimulation and imaging of the nerve roots after contrast injection were used to evaluate the accuracy of needle placement. The numeric rating scale was used to measure the pain and numbness levels as primary clinical outcomes, which were evaluate in scheduled follow-up visits of up to 3 months. A total of 53 procedures were performed on 42 patients at the levels of C5-C8. All patients reported concordant paresthesia in response to electrical stimulation. The average sensory and motor thresholds of stimulation were 0.28 ± 0.14 and 0.36 ± 0.14 V, respectively. Injection of nonionic contrast resulted in excellent spread along the target nerve root in large majority of the procedures. The numeric rating scale scores for both pain and numbness improved significantly at 1 day, 1 week, and 1 and 3 months after the treatment. No serious adverse effects were observed in any of the patients. The posterior approach to combined SCNRB and PRF under fluoroscopy guidance appears to be safe and efficacious in the management of CCRP. Copyright © 2015 Elsevier Inc. All rights reserved.

Retrospective comparison of three-dimensional imaging sequences in the visualization of posterior fossa cranial nerves.

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Ors, Suna; Inci, Ercan; Turkay, Rustu; Kokurcan, Atilla; Hocaoglu, Elif

2017-12-01

To compare efficancy of three-dimentional SPACE (sampling perfection with application-optimized contrasts using different flip-angle evolutions) and CISS (constructive interference in steady state) sequences in the imaging of the cisternal segments of cranial nerves V-XII. Temporal MRI scans from 50 patients (F:M ratio, 27:23; mean age, 44.5±15.9 years) admitted to our hospital with vertigo, tinnitus, and hearing loss were retrospectively analyzed. All patients had both CISS and SPACE sequences. Quantitative analysis of SPACE and CISS sequences was performed by measuring the ventricle-to-parenchyma contrast-to-noise ratio (CNR). Qualitative analysis of differences in visualization capability, image quality, and severity of artifacts was also conducted. A score ranging 'no artefact' to 'severe artefacts and unreadable' was used for the assessment of artifacts and from 'not visualized' to 'completely visualized' for the assesment of image quality, respectively. The distribution of variables was controlled by the Kolmogorov-Smirnov test. Samples t-test and McNemar's test were used to determine statistical significance. Rates of visualization of posterior fossa cranial nerves in cases of complete visualization were as follows: nerve V (100% for both sequences), nerve VI (94% in SPACE, 86% in CISS sequences), nerves VII-VIII (100% for both sequences), IX-XI nerve complex (96%, 88%); nerve XII (58%, 46%) (p<0.05). SPACE sequences showed fewer artifacts than CISS sequences (p<0.002). Copyright © 2017 Elsevier B.V. All rights reserved.

Recovery of Third Nerve Palsy after Endovascular Packing of Internal Carotid-Posterior Communicating Artery Aneurysms

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Mavilio, N.; Pisani, R.; Rivano, C.; Testa, V.; Spaziante, R.; Rosa, M.

2000-01-01

Summary Endovascular packing of intracranial aneurysm with preservation of the parent vessel has become in many cases a valid alternative to surgical clipping. Regression of oculomotor disorders after clipping of internal carotid-posterior communicating artery (ICA-PCoA) aneurysms has been well assessed. This report focuses on the reversal of third nerve palsy after endovascular packing of ICA-PCoA aneurysms. To this end, clinical appearances, neuroradiological features, and endovascular interventional procedures of six treated patient are reported and discussed in the light of the very few previous case observations found in the literature. Results indicate that endovascular packing of ICA-PCoA aneurysms may produce effective recovery of correlated third nerve dysfunction. PMID:20667199

Is it necessary to use the entire root as a donor when transferring contralateral C7 nerve to repair median nerve?

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Gao, Kai-Ming; Lao, Jie; Guan, Wen-Jie; Hu, Jing-Jing

2018-01-01

If a partial contralateral C 7 nerve is transferred to a recipient injured nerve, results are not satisfactory. However, if an entire contralateral C 7 nerve is used to repair two nerves, both recipient nerves show good recovery. These findings seem contradictory, as the above two methods use the same donor nerve, only the cutting method of the contralateral C 7 nerve is different. To verify whether this can actually result in different repair effects, we divided rats with right total brachial plexus injury into three groups. In the entire root group, the entire contralateral C 7 root was transected and transferred to the median nerve of the affected limb. In the posterior division group, only the posterior division of the contralateral C 7 root was transected and transferred to the median nerve. In the entire root + posterior division group, the entire contralateral C 7 root was transected but only the posterior division was transferred to the median nerve. After neurectomy, the median nerve was repaired on the affected side in the three groups. At 8, 12, and 16 weeks postoperatively, electrophysiological examination showed that maximum amplitude, latency, muscle tetanic contraction force, and muscle fiber cross-sectional area of the flexor digitorum superficialis muscle were significantly better in the entire root and entire root + posterior division groups than in the posterior division group. No significant difference was found between the entire root and entire root + posterior division groups. Counts of myelinated axons in the median nerve were greater in the entire root group than in the entire root + posterior division group, which were greater than the posterior division group. We conclude that for the same recipient nerve, harvesting of the entire contralateral C 7 root achieved significantly better recovery than partial harvesting, even if only part of the entire root was used for transfer. This result indicates that the entire root should be used as a

Third nerve palsy caused by compression of the posterior communicating artery aneurysm does not depend on the size of the aneurysm, but on the distance between the ICA and the anterior-posterior clinoid process.

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Anan, Mitsuhiro; Nagai, Yasuyuki; Fudaba, Hirotaka; Kubo, Takeshi; Ishii, Keisuke; Murata, Kumi; Hisamitsu, Yoshinori; Kawano, Yoshihisa; Hori, Yuzo; Nagatomi, Hirofumi; Abe, Tatsuya; Fujiki, Minoru

2014-08-01

Third nerve palsy (TNP) caused by a posterior communicating artery (PCoA) aneurysm is a well-known symptom of the condition, but the characteristics of unruptured PCoA aneurysm-associated third nerve palsy have not been fully evaluated. The aim of this study was to analyze the anatomical features of PCoA aneurysms that caused TNP from the viewpoint of the relationship between the ICA and the skull base. Forty-eight unruptured PCoA aneurysms were treated surgically between January 2008 and September 2013. The characteristics of the aneurysms were evaluated. Thirteen of the 48 patients (27%) had a history of TNP. The distance between the ICA and the anterior-posterior clinoid process (ICA-APC distance) was significantly shorter in the TNP group (pPCoA aneurysms can cause third nerve palsy if the ICA runs close to the skull base. Copyright © 2014 Elsevier B.V. All rights reserved.

Neuropatía compresiva del nervio interoseo posterior a nivel del codo (síndrome de la arcada de frohse: ¿debe incluirse en el listado de enfermedades profesionales? Must the neuropathy compressive of posterior interoseal nerve at the elbow level (arcade of frohse syndrome: be included in the occupational diseases list?

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Raúl Jesús Regal Ramos

2010-09-01

of this review isn't only to show that the compress affection of posterior interosseous nerve can be considered a occupational diseases, but, also, it should be included in the current ODL, among the "main activities able to induce radial nerve affection". Material and methods: To February 2010 it have been reviewed the following bibliographical database: Medline, Embase, Cochrane. Results: This bibliographical review allow us to conclude: SAF can have a occupational origin (fibrosis of short supinator is related with forearm repetitive pronosupinacion movements, and it is more prevalent in certain professions in which are made these kind of movements. SAF is the occupational origin neuropathy compress more frequent of radial nerve, and the most related with hand and forearm repetitive movements. The Arcade of Frohse is the most common radial compression place. Conclusions: Therefore, SAF can be considered a occupational diseases if it carries enough occupational risks factors, and it should be included in the ODL, by being the most frequent occupational origin compression of radial nerve.

Effect of Electrothermal Treatment on Nerve Tissue Within the Triangular Fibrocartilage Complex, Scapholunate, and Lunotriquetral Interosseous Ligaments.

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Pirolo, Joseph M; Le, Wei; Yao, Jeffrey

2016-05-01

To evaluate the effect of thermal treatment on neural tissue in the triangular fibrocartilage complex (TFCC), scapholunate interosseous ligament (SLIL), and lunotriquetral interosseous ligament (LTIL). The intact TFCC, SLIL, and LTIL were harvested from cadaveric specimens and treated with a radiofrequency probe as would be performed intraoperatively. Slides were stained using a triple-stain technique for neurotrophin receptor p75, pan-neuronal marker protein gene product 9.5 (PGP 9.5), and 4',6-diamidino-2-phenylindole for neural identification. Five TFCC, 5 SLIL, and 4 LTIL specimens were imaged with fluorescence microscopy. Imaging software was used to measure fluorescence signals and compare thermally treated areas with adjacent untreated areas. A paired t test was used to compare treated versus untreated areas. P < .05 was considered significant. For the TFCC, a mean of 94.9% ± 2.7% of PGP 9.5-positive neural tissue was ablated within a mean area of 11.7 ± 2.5 mm(2) (P = .02). For the SLIL treated from the radiocarpal surface, 97.4% ± 1.0% was ablated to a mean depth of 2.4 ± 0.3 mm from the surface and a mean horizontal spread of 3.4 ± 0.5 mm (P = .01). For the LTIL, 96.0% ± 1.5% was ablated to a mean depth of 1.7 ± 0.7 mm and a mean horizontal spread of 2.6 ± 1.0 mm (P = .02). Differences in the presence of neural tissue between treated areas and adjacent untreated areas were statistically significant for all specimens. Our study confirms elimination of neuronal markers after thermal treatment of the TFCC, SLIL, and LTIL in cadaveric specimens. This effect penetrates below the surface to innervated collagen tissue that is left structurally intact after treatment. Electrothermal treatment as commonly performed to treat symptomatic SLIL, LTIL, and TFCC tears eliminates neuronal tissue in treated areas and may function to relieve pain through a denervation effect. Copyright © 2016 Arthroscopy Association of North America. Published by

Oculomotor nerve palsy by posterior communicating artery aneurysms: influence of surgical strategy on recovery.

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Güresir, Erdem; Schuss, Patrick; Seifert, Volker; Vatter, Hartmut

2012-11-01

Resolution of oculomotor nerve palsy (ONP) after clipping of posterior communicating artery (PCoA) aneurysms has been well documented. However, whether additional decompression of the oculomotor nerve via aneurysm sac dissection or resection is superior to pure aneurysm clipping is the subject of much debate. Therefore, the objective in the present investigation was to analyze the influence of surgical strategy--specifically, clipping with or without aneurysm dissection--on ONP resolution. Between June 1999 and December 2010, 18 consecutive patients with ruptured and unruptured PCoA aneurysms causing ONP were treated at the authors' institution. Oculomotor nerve palsy was evaluated on admission and at follow-up. The electronic database MEDLINE was searched for additional data in published studies of PCoA aneurysms causing ONP. Two reviewers independently extracted data. Overall, 8 studies from the literature review and 6 patients in the current series (121 PCoA aneurysms) met the study inclusion criteria. Ninety-four aneurysms were treated with simple aneurysm neck clipping and 27 with clipping plus aneurysm sac decompression. The surgical strategy, simple aneurysm neck clipping versus clipping plus oculomotor nerve decompression, had no effect on full ONP resolution on univariate (p = 0.5) and multivariate analyses. On multivariate analysis, patients with incomplete ONP at admission were more likely to have full resolution of the palsy than were those with complete ONP at admission (p = 0.03, OR = 4.2, 95% CI 1.1-16). Data in the present study indicated that ONP caused by PCoA aneurysms improves after clipping without and with oculomotor nerve decompression. The resolution of ONP is inversely associated with the initial severity of ONP.

The role of ultrasound and magnetic resonance imaging in the evaluation of the forearm interosseous membrane. A review

International Nuclear Information System (INIS)

Rodriguez-Martin, Juan; Pretell-Mazzini, Juan

2011-01-01

The interosseous membrane of the forearm is an important structure to consider in cases of elbow and forearm trauma; it can be injured after elbow or forearm fractures, leading to longitudinal forearm instability. Diagnosis of interosseous membrane injuries is challenging, and failure in diagnosis may result in poor clinical outcomes and complications. Magnetic resonance imaging and ultrasound have shown to be valuable methods for the evaluation of this important structure. Both techniques have advantages and limitations, and its use should be adapted to each specific clinical scenario. This article presents an up-to-date literature review regarding the use of ultrasound and magnetic resonance imaging in the forearm interosseous membrane evaluation. (orig.)

The role of ultrasound and magnetic resonance imaging in the evaluation of the forearm interosseous membrane. A review

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Rodriguez-Martin, Juan [Infanta Leonor University Hospital, Trauma and Orthopaedics, Shoulder and Elbow Unit, Madrid (Spain); Pretell-Mazzini, Juan [The Children' s Hospital of Philadelphia, Pediatric Orthopaedic Fellow, Division of Orthopaedic Surgery, Philadelphia, PA (United States)

2011-12-15

The interosseous membrane of the forearm is an important structure to consider in cases of elbow and forearm trauma; it can be injured after elbow or forearm fractures, leading to longitudinal forearm instability. Diagnosis of interosseous membrane injuries is challenging, and failure in diagnosis may result in poor clinical outcomes and complications. Magnetic resonance imaging and ultrasound have shown to be valuable methods for the evaluation of this important structure. Both techniques have advantages and limitations, and its use should be adapted to each specific clinical scenario. This article presents an up-to-date literature review regarding the use of ultrasound and magnetic resonance imaging in the forearm interosseous membrane evaluation. (orig.)

The prevalence of tenosynovitis of the interosseous tendons of the hand in patients with rheumatoid arthritis.

OpenAIRE

Rowbotham, EL; Freeston, JE; Emery, P; Grainger, AJ

2015-01-01

AIM: The aim of this study was to establish the prevalence of tenosynovitis affecting the interosseous tendons of the hand in a rheumatoid arthritis (RA) population and to assess for association with metacarpophalangeal (MCP) joint synovitis, flexor tendon tenosynovitis or ulnar drift. METHODS: Forty-four patients with RA underwent hand MRI along with 20 normal controls. Coronal 3D T1 VIBE sequences pre- and post-contrast were performed and reconstructed. The presence of interosseous tendon t...

High-resolution STIR for 3-T MRI of the posterior fossa: visualization of the lower cranial nerves and arteriovenous structures related to neurovascular compression.

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Hiwatashi, Akio; Yoshiura, Takashi; Yamashita, Koji; Kamano, Hironori; Honda, Hiroshi

2012-09-01

Preoperative evaluation of small vessels without contrast material is sometimes difficult in patients with neurovascular compression disease. The purpose of this retrospective study was to evaluate whether 3D STIR MRI could simultaneously depict the lower cranial nerves--fifth through twelfth--and the blood vessels in the posterior fossa. The posterior fossae of 47 adults (26 women, 21 men) without gross pathologic changes were imaged with 3D STIR and turbo spin-echo heavily T2-weighted MRI sequences and with contrast-enhanced turbo field-echo MR angiography (MRA). Visualization of the cranial nerves on STIR images was graded on a 4-point scale and compared with visualization on T2-weighted images. Visualization of the arteries on STIR images was evaluated according to the segments in each artery and compared with that on MRA images. Visualization of the veins on STIR images was also compared with that on MRA images. Statistical analysis was performed with the Mann-Whitney U test. There were no significant differences between STIR and T2-weighted images with respect to visualization of the cranial nerves (p > 0.05). Identified on STIR and MRA images were 94 superior cerebellar arteries, 81 anteroinferior cerebellar arteries, and 79 posteroinferior cerebellar arteries. All veins evaluated were seen on STIR and MRA images. There were no significant differences between STIR and MRA images with respect to visualization of arteries and veins (p > 0.05). High-resolution STIR is a feasible method for simultaneous evaluation of the lower cranial nerves and the vessels in the posterior fossa without the use of contrast material.

Low Median Nerve Palsy as Initial Manifestation of Churg-Strauss Syndrome.

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Roh, Young Hak; Koh, Young Do; Noh, Jung Ho; Gong, Hyun Sik; Baek, Goo Hyun

2017-06-01

Anterior interosseous nerve (AIN) syndrome is typically characterized by forearm pain and partial or complete dysfunction of the AIN-innervated muscles. Although the exact etiology and pathophysiology of the disorder remain unclear, AIN syndrome is increasingly thought to be an inflammatory condition of the nerve rather than a compressive neuropathy because the symptoms often resolve spontaneously following prolonged observation. However, peripheral neuropathy can be 1 of the first symptoms of systemic vasculitis that needs early systemic immunotherapy to prevent extensive nerve damage. Churg-Strauss syndrome (CSS; eosinophilic granulomatosis with polyangiitis) is 1 type of primary systemic vasculitis that frequently damages the peripheral nervous system. CSS-associated neuropathy usually involves nerves of the lower limb, and few studies have reported on the involvement of the upper limb alone. We report on a rare case of low median nerve palsy as the initial manifestation of CSS. The patient recovered well with early steroid treatment for primary systemic vasculitis. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Spondylolisthesis and Posterior Instability

International Nuclear Information System (INIS)

Niggemann, P.; Beyer, H.K.; Frey, H.; Grosskurth, D.; Simons, P.; Kuchta, J.

2009-01-01

We present the case of a patient with a spondylolisthesis of L5 on S1 due to spondylolysis at the level L5/S1. The vertebral slip was fixed and no anterior instability was found. Using functional magnetic resonance imaging (MRI) in an upright MRI scanner, posterior instability at the level of the spondylolytic defect of L5 was demonstrated. A structure, probably the hypertrophic ligament flava, arising from the spondylolytic defect was displaced toward the L5 nerve root, and a bilateral contact of the displaced structure with the L5 nerve root was shown in extension of the spine. To our knowledge, this is the first case described of posterior instability in patients with spondylolisthesis. The clinical implications of posterior instability are unknown; however, it is thought that this disorder is common and that it can only be diagnosed using upright MRI

Spondylolisthesis and Posterior Instability

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Niggemann, P.; Beyer, H.K.; Frey, H.; Grosskurth, D. (Privatpraxis fuer Upright MRT, Koeln (Germany)); Simons, P.; Kuchta, J. (Media Park Klinik, Koeln (Germany))

2009-04-15

We present the case of a patient with a spondylolisthesis of L5 on S1 due to spondylolysis at the level L5/S1. The vertebral slip was fixed and no anterior instability was found. Using functional magnetic resonance imaging (MRI) in an upright MRI scanner, posterior instability at the level of the spondylolytic defect of L5 was demonstrated. A structure, probably the hypertrophic ligament flava, arising from the spondylolytic defect was displaced toward the L5 nerve root, and a bilateral contact of the displaced structure with the L5 nerve root was shown in extension of the spine. To our knowledge, this is the first case described of posterior instability in patients with spondylolisthesis. The clinical implications of posterior instability are unknown; however, it is thought that this disorder is common and that it can only be diagnosed using upright MRI.

Análise da camada de fibras nervosas pelo GDx em pacientes pseudofácicos com opacidades da cápsula posterior Analysis of the nerve fiber layer using GDx in pseudophakic patients with posterior capsular opacification

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Tatiana Azevedo Arraes

2008-02-01

Full Text Available OBJETIVO: Avaliar se a opacificação de cápsula posterior (OCP influenciaria na análise da camada de fibras nervosas pela polarimetria "scanning laser" (GDx. MÉTODOS: Trinta e sete pacientes pseudofácicos não glaucomatosos foram submetidos a análise da camada de fibras nervosas pelo GDx antes e após a realização de capsulotomia com Nd:YAG laser. RESULTADOS: Em cinco olhos, o GDx não conseguiu imagens aceitáveis pelos parâmetros de aquisição do aparelho. Em todos os outros, não foi observada diferença significante entre os valores médios das variáveis antes e após a realização da capsulotomia posterior. CONCLUSÃO: A presença de OCP em graus moderados e/ou quando há imagens aceitáveis em pacientes pseudofácicos não influencia o resultado da análise das imagens das fibras do nervo óptico pelo GDx. Apenas intensos graus de OCP que impeçam a obtenção de imagem analisável pelo aparelho inviabilizam o exame.PURPOSE: To evaluate if posterior capsule opacification (PCO would alter the analysis of nerve fiber layer using the scanning laser polarimetry (GDx. METHODS: Pseudophakic non-glaucomatosous eyes (37 patients underwent nerve fiber layer analysis using GDx before and after posterior capsulotomy with Nd:YAG Laser. RESULTS: In five eyes, GDx did not obtain acceptable images using the device's parameters of acquisition. In the others, mean variable values did not reach significant difference before and after posterior capsulotomy. CONCLUSION: Moderate degrees of PCO and/or acceptable images in pseudophakic patients do not alter the analysis of nerve fiber layer by GDx. Only intense degrees of PCO that hinder analyzable images make the examination impracticable.

Transient long thoracic nerve injury during posterior spinal fusion for adolescent idiopathic scoliosis: A report of two cases

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Athanasios I Tsirikos

2013-01-01

Full Text Available We present the transient long thoracic nerve (LTN injury during instrumented posterior spinal arthrodesis for idiopathic scoliosis. The suspected mechanism of injury, postoperative course and final outcome is discussed. The LTN is susceptible to injury due to its long and relatively superficial course across the thoracic wall through direct trauma or tension. Radical mastectomies with resection of axillary lymph nodes, first rib resection to treat thoracic outlet syndrome and cardiac surgery can be complicated with LTN injury. LTN injury producing scapular winging has not been reported in association with spinal deformity surgery. We reviewed the medical notes and spinal radiographs of two adolescent patients with idiopathic scoliosis who underwent posterior spinal arthrodesis and developed LTN neuropraxia. Scoliosis surgery was uneventful and intraoperative spinal cord monitoring was stable throughout the procedure. Postoperative neurological examination was otherwise normal, but both patients developed winging of the scapula at 4 and 6 days after spinal arthrodesis, which did not affect shoulder function. Both patients made a good recovery and the scapular winging resolved spontaneously 8 and 11 months following surgery with no residual morbidity. We believe that this LTN was due to positioning of our patients with their head flexed, tilted and rotated toward the contralateral side while the arm was abducted and extended. The use of heavy retractors may have also applied compression or tension to the nerve in one of our patients contributing to the development of neuropraxia. This is an important consideration during spinal deformity surgery to prevent potentially permanent injury to the nerve, which can produce severe shoulder dysfunction and persistent pain.

Ptosis as partial oculomotor nerve palsy due to compression by infundibular dilatation of posterior communicating artery, visualized with three-dimensional computer graphics: case report.

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Fukushima, Yuta; Imai, Hideaki; Yoshino, Masanori; Kin, Taichi; Takasago, Megumi; Saito, Kuniaki; Nakatomi, Hirofumi; Saito, Nobuhito

2014-01-01

Oculomotor nerve palsy (ONP) due to internal carotid-posterior communicating artery (PcomA) aneurysm generally manifests as partial nerve palsy including pupillary dysfunction. In contrast, infundibular dilatation (ID) of the PcomA has no pathogenic significance, and mechanical compression of the cranial nerve is extremely rare. We describe a 60-year-old woman who presented with progressive ptosis due to mechanical compression of the oculomotor nerve by an ID of the PcomA. Three-dimensional computer graphics (3DCG) accurately visualized the mechanical compression by the ID, and her ptosis was improved after clipping of the ID. ID of the PcomA may cause ONP by mechanical compression and is treatable surgically. 3DCG are effective for the diagnosis and preoperative simulation.

Inhibition of micturition reflex by activation of somatic afferents in posterior femoral cutaneous nerve.

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Tai, Changfeng; Shen, Bing; Mally, Abhijith D; Zhang, Fan; Zhao, Shouguo; Wang, Jicheng; Roppolo, James R; de Groat, William C

2012-10-01

This study determined if activation of somatic afferents in posterior femoral cutaneous nerve (PFCN) could modulate the micturition reflex recorded under isovolumetric conditions in α-chloralose anaesthetized cats. PFCN stimulation inhibited reflex bladder activity and significantly (P acid (AA). The optimal frequency for PFCN stimulation-induced bladder inhibition was between 3 and 10 Hz, and a minimal stimulation intensity of half of the threshold for inducing anal twitching was required. Bilateral pudendal nerve transection eliminated PFCN stimulation-induced anal twitching but did not change the stimulation-induced bladder inhibition, excluding the involvement of pudendal afferent or efferent axons in PFCN afferent inhibition.Mechanical or electrical stimulation on the skin surface in the PFCN dermatome also inhibited bladder activity. Prolonged (2 × 30 min) PFCN stimulation induced a post-stimulation inhibition that persists for at least 2 h. This study revealed a new cutaneous-bladder reflex activated by PFCN afferents. Although the mechanisms and physiological functions of this cutaneous-bladder reflex need to be further studied, our data raise the possibility that stimulation of PFCN afferents might be useful clinically for the treatment of overactive bladder symptoms.

A case report of an isolated fracture through the radial bicipital tuberosity

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Kanta Imao

Full Text Available Introduction: Generally, anatomical reduction of shaft fractures through operative treatment is necessary to restore the anatomical relationship of the forearm bones. However, a number of nerves and vessels are located in the proximal radius, which complicates surgery. In this study, we aimed to reduce postoperative complications by using a posterior approach. Presentation of case: We describe an isolated fracture through the radial bicipital tuberosity in a 69-year-old man caused by direct blunt force and our management of the fracture. The patient underwent an operation for the fracture under brachial plexus block. The injury was explored using the posterior approach, and plate fixation was performed after confirming the absence of obstacles to rotation on pronation and supination. One year later, the patient did not have any difficulties in activities of daily living. Discussion: Since an isolated fracture through the radial bicipital tuberosity is more distal than the radial head and neck and more proximal than a common radius diaphysis fracture, we had to consider a different operative approach. The nerve and blood vessels of the forearm, such as the radial nerve and artery, run in a complicated fashion around the proximal radius; thus, we chose the posterior approach because of its simpler surgical technique and lower complication risk, compared with the anterior approach. Conclusion: Surgeons can obtain a favorable treatment result using the posterior approach to the fracture and reduce complications by ensuring with rigid fixation using a locking plate. Keywords: Radial bicipital tuberosity, Posterior approach, Posterior interosseous nerve, Shaft fracture

Posterior fossa gangliocytoma with facial nerve invasion: case report

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Koerbel Andrei

2003-01-01

Full Text Available A 5 year-old boy with a cerebellar gangliocytoma with a peripheral right facial paresis and ataxia is presented. His MRI showed a heterogenous, diffuse lesion, isointense on T1 and hyperintense on T2-weigthed sequences, involving the right cerebellar hemisphere with direct extension into the right facial nerve. The present case is the first description of a gangliocytoma with direct facial nerve invasion, as demonstrated for the facial nerve paresis and supported by MRI and surgical inspection.

A clear map of the lower cranial nerves at the superior carotid triangle.

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Cavalcanti, Daniel D; Garcia-Gonzalez, Ulises; Agrawal, Abhishek; Tavares, Paulo L M S; Spetzler, Robert F; Preul, Mark C

2010-07-01

The lower cranial nerves must be identified to avoid iatrogenic injury during skull base and high cervical approaches. Prompt recognition of these structures using basic landmarks could reduce surgical time and morbidity. The anterior triangle of the neck was dissected in 30 cadaveric head sides. The most superficial segments of the glossopharyngeal, vagus and its superior laryngeal nerves, accessory, and hypoglossal nerves were exposed and designated into smaller anatomic triangles. The midpoint of each nerve segment inside the triangles was correlated to the angle of the mandible (AM), mastoid tip (MT), and bifurcation of the common carotid artery. A triangle bounded by the styloglossus muscle, external carotid artery, and facial artery housed the glossopharyngeal nerve. This nerve segment was 0.06 ± 0.71 cm posterior to the AM and 2.50 ± 0.59 cm inferior to the MT. The vagus nerve ran inside the carotid sheath posterior to internal carotid artery and common carotid artery bifurcation in 48.3% of specimens. A triangle formed by the posterior belly of digastric muscle, sternocleidomastoid muscle, and internal jugular vein housed the accessory nerve, 1.90 ± 0.60 cm posterior to the AM and 2.30 ± 0.57 cm inferior to the MT. A triangle outlined by the posterior belly of digastric muscle, internal jugular vein, and common facial vein housed the hypoglossal nerve, which was 0.82 ± 0.84 cm posterior to the AM and 3.64 ± 0.70 cm inferior to the MT. Comprehensible landmarks can be defined to help expose the lower cranial nerves to avoid injury to this complex region. Copyright © 2010 Elsevier Inc. All rights reserved.

Mental nerve paresthesia secondary to initiation of endodontic therapy: a case report

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Andrabi, Syed Mukhtar-Un-Nisar; Alam, Sharique; Zia, Afaf; Khan, Masood Hasan; Kumar, Ashok

2014-01-01

Whenever endodontic therapy is performed on mandibular posterior teeth, damage to the inferior alveolar nerve or any of its branches is possible. Acute periapical infection in mandibular posterior teeth may also sometimes disturb the normal functioning of the inferior alveolar nerve. The most common clinical manifestation of these insults is the paresthesia of the inferior alveolar nerve or mental nerve paresthesia. Paresthesia usually manifests as burning, prickling, tingling, numbness, itch...

Diffusion-weighted MR neurography of the tibial nerve and the common peroneal nerve with different motion probing gradients

International Nuclear Information System (INIS)

Zhao Lianxin; Wang Guangbin; Liu Yubo; Wu Lebin; Bai Xue; Yang Li; Chen Weibo

2014-01-01

Objective: To compare the image quality of diffusion-weighted MR neurography (DW-MRN) of the tibial nerve and the common peroneal nerve prospectively using different motion probing gradients (MPGs). Methods: A total of 21 healthy volunteers underwent DW-MRN at the knee (unilateral imaging) on a 3.0 T magnetic resonance system with unidirectional MPGs. The protocol included anterior-posterior unidirectional, right-left unidirectional, three-directional and six-directional MPGs. The apparent SNR and CNR of tibial nerve and common peroneal nerve were calculated. Three-dimensional MIP images of the nerves were evaluated blindly by two radiologists using a four-point grading scale on basis of entirety depiction and the signal intensity. Significance was determined by using Friedman and paired Wilcoxon tests. Results: The SNR of tibial nerves on DW-MRN with anterior-posterior, right-left, three directional and six directional MPGs were 4.17 (2.70-5.65), 4.35 (0.47-4.69), 3.46 (2.27-4.62) and 3.30 (2.06-4.43), respectively. CNR were 0.61 (0.46-0.70), 0.63 (0.36-0.73), 0.55 (0.39-0.64) and 0.53(0.35-0.63), respectively. The scores of tibial nerve image quality were 4.0 (2.0-4.0), 4.0 (3.0-4.0), 2.5 (2.0-3.5), 2.0 (1.0-2.5), respectively. Interobserver agreement was good and the Kappa value was 0.69 (P<0.05). The SNR of the common peroneal nerves on DW-MRN with anterior-posterior, right-left, three directional and six directional MPGs were 3.05 (2.30-4.20), 3.05 (2.26-4.34), 2.72 (1.84-13.80) and 2.68 (1.87-3.67), respectively. CNR were 0.51 (0.39-0.62), 0.51 (0.39-0.63), 0.46(0.30-0.86) and 0.46 (0.30-0.57), respectively. The scores of the common peroneal nerve image quality were 3.5 (2.0-4.0), 4.0 (2.0-4.0), 2.0 (1.0-3.0) and 2.0 (1.0-2.5), respectively. Interobserver agreement was good and the Kappa value was 0.70 (P<0.05). For SNR, CNR and nerve image quality of the tibial nerves and the common peroneal nerves, there were significant differences among different MPGs (�

Anatomical study of phrenic nerve course in relation to neck dissection.

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Hamada, Tomohiro; Usami, Akinobu; Kishi, Asuka; Kon, Hideki; Takada, Satoshi

2015-04-01

The present study sought to clarify the course of the phrenic nerve and its correlation with anatomical landmarks in the neck region. We examined 17 cadavers (30 sides). In each, the phrenic nerves was dissected from the lateral side of the neck, and its position within the triangle formed by the mastoid process and sternal and acromial ends of the clavicle was determined. The point where the phrenic nerve arises in the posterior triangle was found to be similar to the point where the cutaneous blanches of the cervical plexus emerge at the middle of the posterior border of the sternocleidomastoid muscle. In the supraclavian triangle, the phrenic nerve crosses the anterior border of the anterior scalene muscle near Erb's point where the superficial point is 2-3 cm superior from the clavicle and posterior border of the sternocleidomastoid muscle. The phrenic nerve arises in the posterior triangle near the nerve point, then descends to the anterior surface of the anterior scalene muscle in the supraclavian triangle. It is necessary to be aware of the supraclavian triangle below Erb's point during neck dissection procedures.

Anatomy and biomechanics of the forearm interosseous membrane.

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Farr, Leela D; Werner, Frederick W; McGrattan, Michael L; Zwerling, Sierra R; Harley, Brian J

2015-06-01

To examine the anatomy and function of the forearm interosseous membrane by exploring the anatomical insertions of the central band (CB) on the radius and the ulna and by quantifying the length of the intact ligament and replacement grafts located at the original CB attachment sites and alternative locations. Eight fresh cadaver forearms were supinated and pronated and the wrist was extended and flexed while the motion between the distal radius and ulna were recorded. The length of the CB was computed for the intact CB as well for several alternative graft orientations and positions. The maximum length of the CB did not significantly change among different wrist motions. However, with the wrist in a static neutral position, the CB length was significantly shorter in forearm supination than in neutral. During active forearm rotation when CB replacement grafts were positioned distal or proximal to the original CB site, yet still parallel to it, each had a similar trend to be longer in neutral than in supination. If a graft was more transversely oriented, the computed CB length would be 1.6 mm shorter in supination than in neutral. These results support tensioning a CB graft with the forearm in supination if the goal is to maximize graft tension and to maintain the native 22° angle for a CB graft between the radius and ulna. The results also suggest that the CB graft can probably be located slightly distal or slightly proximal to its original attachment sites. Reconstruction of the interosseous membrane has been hampered by a lack of understanding of its length changes with forearm or wrist motion. These results provide a starting point in helping clinicians understand how to more precisely reconstruct this ligament in an anatomical manner. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Resolution of Oculomotor Nerve Palsy Secondary to Posterior Communicating Artery Aneurysms: Comparison of Clipping and Coiling.

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McCracken, D Jay; Lovasik, Brendan P; McCracken, Courtney E; Caplan, Justin M; Turan, Nefize; Nogueira, Raul G; Cawley, C Michael; Dion, Jacques E; Tamargo, Rafael J; Barrow, Daniel L; Pradilla, Gustavo

2015-12-01

Previous studies have attempted to determine the best treatment for oculomotor nerve palsy (ONP) secondary to posterior communicating artery (PCoA) aneurysms, but have been limited by small sample sizes and limited treatment. To analyze the treatment of ONP secondary to PCoA with both coiling and clipping in ruptured and unruptured aneurysms. Data from 2 large academic centers was retrospectively collected over 22 years, yielding a total of 93 patients with ONP secondary to PCoA aneurysms. These patients were combined with 321 patients from the literature review for large data analyses. Onset symptoms, recovery, and time to resolution were evaluated with respect to treatment and aneurysm rupture status. For all patients presenting with ONP (n = 414) 56.6% of those treated with microsurgical clipping made a full recovery vs 41.5% of those treated with endovascular coil embolization (P = .02). Of patients with a complete ONP (n = 229), full recovery occurred in 47.3% of those treated with clipping but in only 20% of those undergoing coiling (P = .01). For patients presenting with ruptured aneurysms (n = 130), full recovery occurred in 70.9% compared with 49.3% coiled patients (P = .01). Additionally, although patients with full ONP recovery had a median time to treatment of 4 days, those without full ONP recovery had a median time to treatment of 7 days (P = .01). Patients with ONP secondary to PCoA aneurysms treated with clipping showed higher rates of full ONP resolution than patients treated with coil embolization. Larger prospective studies are needed to determine the true potential of recovery associated with each treatment. EUH, Emory University HospitalIQR, interquartile rangeJHU, Johns Hopkins UniversitymRS, modified Rankin ScaleONP, oculomotor nerve palsyPCoA, posterior communicating arterySAH, subarachnoid hemorrhage.

[Four surgical tips in the treatment of epicondylitis].

Science.gov (United States)

Jiménez, I; Marcos-García, A; Muratore-Moreno, G; Medina, J

2016-01-01

Lateral epicondylitis is a common injury in the population. Most patients improve with conservative treatment, but in a small percentage surgery is necessary. The aim of this study is to analyse the clinical results obtained by a «4 surgical tips» technique. This is a retrospective study of 35 operated elbows, with a mean follow-up of 5.3 years. In all cases epicondylar denervation, removal of the angiofibroblastic degeneration core, epicondylectomy, and release of posterior interosseous nerve, was performed. Each patient was evaluated using the Broberg and Morrey Rating System (BMRS), Mayo Elbow Performance Score (MEPS), Visual Analogue Scale (VAS), DASH questionnaire, and a survey of subjective assessment. BMRS mean score was 97.2 points, with 95.71 points with the MEPS. The mean decrease in VAS was 8.12 points, and the mean score on the DASH was 1.68 points. The results were rated as excellent or very good by 94.3% of patients. There was one recurrence, which resolved with further surgery. Two neuropraxia of the posterior interosseous nerve occurred, which completely recovered in 10 weeks. Using the «4 surgical tips» technique, clinical resolution of symptoms in 97.1% was achieved at the first operation. Therefore, it appears to be an effective, reproducible technique with few complications, in the surgical treatment of lateral epicondylitis resistant to conservative treatment. Copyright © 2015 SECOT. Published by Elsevier Espana. All rights reserved.

Phrenic nerve neurotization utilizing the spinal accessory nerve: technical note with potential application in patients with high cervical quadriplegia.

Science.gov (United States)

Tubbs, R Shane; Pearson, Blake; Loukas, Marios; Shokouhi, Ghaffar; Shoja, Mohammadali M; Oakes, W Jerry

2008-11-01

High cervical quadriplegia is associated with high morbidity and mortality. Artificial respiration in these patients carries significant long-term risks such as infection, atelectasis, and respiratory failure. As phrenic nerve pacing has been proven to free many of these patients from ventilatory dependency, we hypothesized that neurotization of the phrenic nerve with the spinal accessory nerve (SAN) may offer one potential alternative to phrenic nerve stimulation via pacing and may be more efficacious and longer lasting without the complications of an implantable device. Ten cadavers (20 sides) underwent exposure of the cervical phrenic nerve and the SAN in the posterior cervical triangle. The SAN was split into anterior and posterior halves and the anterior half transposed to the ipsilateral phrenic nerve as it crossed the anterior scalene muscle. The mean distance between the cervical phrenic nerve and the SAN in the posterior cervical triangle was 2.5 cm proximally, 4 cm at a midpoint, and 6 cm distally. The range for these measurements was 2 to 4 cm, 3.5 to 5 cm, and 4 to 8.5 cm, respectively. The mean excess length of SAN available after transposition to the more anteromedially placed phrenic nerve was 5 cm (range 4 to 6.5 cm). The mean diameter of these regional parts of the spinal accessory and phrenic nerves was 2 and 2.5 mm, respectively. No statistically significant difference was found for measurements between sides. To our knowledge, using the SAN for neurotization to the phrenic nerve for potential use in patients with spinal cord injury has not been previously explored. Following clinical trials, these data may provide a mechanism for self stimulation of the diaphragm and obviate phrenic nerve pacing in patients with high cervical quadriplegia. Our study found that such a maneuver is technically feasible in the cadaver.

Variant palmaris profundus enclosed by an unusual loop of the median nerve

Science.gov (United States)

CHOU, HSIU-CHU; JENG, HELLEN; KO, TSUI-LING; PAI, MAN-HUI; CHANG, CHIU-YUN; WU, CHING-HSIANG

2001-01-01

According to the usual description in most anatomy texts, the median nerve in the forearm passes between the 2 heads of pronator teres. It continues distally between flexor digitorum superficialis and profundus almost to the retinaculum. Muscular branches leave the nerve near the elbow and supply all superficial muscles of the anterior part of the forearm except flexor carpi ulnaris. Many variations of the median nerve in the forearm have been reported (Urban & Krosman, 1992). The palmaris profundus is also a rare anomaly of the forearm (Dyreby & Engber, 1982). It originates from the radial side of the common flexor tendon in the proximal forearm and inserts into the undersurface of the palmar aponeurosis. The origin of palmaris profundus may be close to the median nerve and its branches, and may be involved in compressive neuropathy of the anterior interosseous nerve. Its tendon crossing through the carpal canal has been implicated in the carpal tunnel syndrome (reviewed by Lahey & Aulicino, 1986). In some cases, palmaris profundus was found enclosed in a common fascial sheath with the median nerve (Stark, 1992; Sahinoglu et al. 1994). To indicate its close association with the median nerve, the palmaris profundus was also named ‘musculus comitans nervi mediani’ (Sahinoglu et al. 1994). This article reports an unusual loop of the median nerve encircling an anomalous palmaris profundus in the forearm, which, to the best of our knowledge, has not been previously described. PMID:11693311

Direct Coaptation of the Phrenic Nerve With the Posterior Division of the Lower Trunk to Restore Finger and Elbow Extension Function in Patients With Total Brachial Plexus Injuries.

Science.gov (United States)

Wang, Shu-feng; Li, Peng-cheng; Xue, Yun-hao; Zou, Ji-yao; Li, Wen-jun; Li, Yucheng

2016-02-01

To overcome the mismatch in nerve sizes in phrenic nerve transfer to the radial nerve for elbow and finger extension reanimation for patients with total brachial plexus injuries (TBPI), a selective neurotization procedure was designed. To investigate the long-term results of phrenic nerve transfer to the posterior division of the lower trunk with direct coaptation in restoring elbow and finger extension after TBPI. Phrenic nerve was transferred to and directly coapted with the posterior division of the lower trunk in 27 patients with TBPI. Seven patients were <18 years old (adolescent group), and the remaining 20 patients ≥18 years (adult group). Postoperative mean follow-up period was 54 ± 9 months (range, 48-85 months). The motor function attained M3 or greater in 81.5% of patients for elbow extension and in 48% of patients for finger extension. The percentage of patients who regained M3 or greater muscle power of finger extension in the adolescent group and the adult group was 71.4%, and 40%, respectively. Meanwhile, 85.7% in the adolescent group and 80% in the adult group achieved M3 or greater muscle power of elbow extension. There were no significant differences between the 2 groups. The elbow extension and finger extension were synchronous contractions and did not become independent of respiratory effort. This procedure simultaneously and effectively restores the function of elbow and finger extension in patients after TBPI. However, the patients could not do elbow and finger extension separately.

Acute calcific tendonitis of dorsal interosseous muscles of the hand: uncommon site of a frequent disease

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D. Schneider

2017-05-01

Full Text Available Acute calcific tendinopathy is one of the manifestations of hydroxyapatite crystal deposition disease. While it is more frequent in the shoulder, it has been described in virtually all areas of the body, but rarely in the muscles of the hand. Its etiopathogenesis is not yet fully understood and despite being a fairly frequent condition, it is commonly misdiagnosed. The onset of the disease is usually acute and resolves spontaneously. Acute calcific tendinitis of the interosseous tendons of the hand is an uncommon site of a frequent condition. The clinical presentation is similar to other entities, thus errors in diagnosis frequently occur, resulting in over-treatment or unnecessary tests. We describe a case of acute calcific tendinitis of the interosseous muscles of the hand with a brief review of the current literature with emphasis on diagnostic imaging methods.

Reconstruction of the abdominal vagus nerve using sural nerve grafts in canine models.

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Liu, Jingbo; Wang, Jun; Luo, Fen; Wang, Zhiming; Wang, Yin

2013-01-01

Recently, vagus nerve preservation or reconstruction of vagus has received increasing attention. The present study aimed to investigate the feasibility of reconstructing the severed vagal trunk using an autologous sural nerve graft. Ten adult Beagle dogs were randomly assigned to two groups of five, the nerve grafting group (TG) and the vagal resection group (VG). The gastric secretion and emptying functions in both groups were assessed using Hollander insulin and acetaminophen tests before surgery and three months after surgery. All dogs underwent laparotomy under general anesthesia. In TG group, latency and conduction velocity of the action potential in a vagal trunk were measured, and then nerves of 4 cm long were cut from the abdominal anterior and posterior vagal trunks. Two segments of autologous sural nerve were collected for performing end-to-end anastomoses with the cut ends of vagal trunk (8-0 nylon suture, 3 sutures for each anastomosis). Dogs in VG group only underwent partial resections of the anterior and posterior vagal trunks. Laparotomy was performed in dogs of TG group, and latency and conduction velocity of the action potential in their vagal trunks were measured. The grafted nerve segment was removed, and stained with anti-neurofilament protein and toluidine blue. Latency of the action potential in the vagal trunk was longer after surgery than before surgery in TG group, while the conduction velocity was lower after surgery. The gastric secretion and emptying functions were weaker after surgery in dogs of both groups, but in TG group they were significantly better than in VG group. Anti-neurofilament protein staining and toluidine blue staining showed there were nerve fibers crossing the anastomosis of the vagus and sural nerves in dogs of TG group. Reconstruction of the vagus nerve using the sural nerve is technically feasible.

Reconstruction of the abdominal vagus nerve using sural nerve grafts in canine models.

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Jingbo Liu

Full Text Available BACKGROUND: Recently, vagus nerve preservation or reconstruction of vagus has received increasing attention. The present study aimed to investigate the feasibility of reconstructing the severed vagal trunk using an autologous sural nerve graft. METHODS: Ten adult Beagle dogs were randomly assigned to two groups of five, the nerve grafting group (TG and the vagal resection group (VG. The gastric secretion and emptying functions in both groups were assessed using Hollander insulin and acetaminophen tests before surgery and three months after surgery. All dogs underwent laparotomy under general anesthesia. In TG group, latency and conduction velocity of the action potential in a vagal trunk were measured, and then nerves of 4 cm long were cut from the abdominal anterior and posterior vagal trunks. Two segments of autologous sural nerve were collected for performing end-to-end anastomoses with the cut ends of vagal trunk (8-0 nylon suture, 3 sutures for each anastomosis. Dogs in VG group only underwent partial resections of the anterior and posterior vagal trunks. Laparotomy was performed in dogs of TG group, and latency and conduction velocity of the action potential in their vagal trunks were measured. The grafted nerve segment was removed, and stained with anti-neurofilament protein and toluidine blue. RESULTS: Latency of the action potential in the vagal trunk was longer after surgery than before surgery in TG group, while the conduction velocity was lower after surgery. The gastric secretion and emptying functions were weaker after surgery in dogs of both groups, but in TG group they were significantly better than in VG group. Anti-neurofilament protein staining and toluidine blue staining showed there were nerve fibers crossing the anastomosis of the vagus and sural nerves in dogs of TG group. CONCLUSION: Reconstruction of the vagus nerve using the sural nerve is technically feasible.

Diaphragm-Sparing Nerve Blocks for Shoulder Surgery.

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Tran, De Q H; Elgueta, Maria Francisca; Aliste, Julian; Finlayson, Roderick J

Shoulder surgery can result in significant postoperative pain. Interscalene brachial plexus blocks (ISBs) constitute the current criterion standard for analgesia but may be contraindicated in patients with pulmonary pathology due to the inherent risk of phrenic nerve block and symptomatic hemidiaphragmatic paralysis. Although ultrasound-guided ISB with small volumes (5 mL), dilute local anesthetic (LA) concentrations, and LA injection 4 mm lateral to the brachial plexus have been shown to reduce the risk of phrenic nerve block, no single intervention can decrease its incidence below 20%. Ultrasound-guided supraclavicular blocks with LA injection posterolateral to the brachial plexus may anesthetize the shoulder without incidental diaphragmatic dysfunction, but further confirmatory trials are required. Ultrasound-guided C7 root blocks also seem to offer an attractive, diaphragm-sparing alternative to ISB. However, additional large-scale studies are needed to confirm their efficacy and to quantify the risk of periforaminal vascular breach. Combined axillary-suprascapular nerve blocks may provide adequate postoperative analgesia for minor shoulder surgery but do not compare favorably to ISB for major surgical procedures. One intriguing solution lies in the combined use of infraclavicular brachial plexus blocks and suprascapular nerve blocks. Theoretically, the infraclavicular approach targets the posterior and lateral cords, thus anesthetizing the axillary nerve (which supplies the anterior and posterior shoulder joint), as well as the subscapular and lateral pectoral nerves (both of which supply the anterior shoulder joint), whereas the suprascapular nerve block anesthetizes the posterior shoulder. Future randomized trials are required to validate the efficacy of combined infraclavicular-suprascapular blocks for shoulder surgery.

Morphology of Donor and Recipient Nerves Utilised in Nerve Transfers to Restore Upper Limb Function in Cervical Spinal Cord Injury

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Aurora Messina

2016-09-01

Full Text Available Loss of hand function after cervical spinal cord injury (SCI impacts heavily on independence. Multiple nerve transfer surgery has been applied successfully after cervical SCI to restore critical arm and hand functions, and the outcome depends on nerve integrity. Nerve integrity is assessed indirectly using muscle strength testing and intramuscular electromyography, but these measures cannot show the manifestation that SCI has on the peripheral nerves. We directly assessed the morphology of nerves biopsied at the time of surgery, from three patients within 18 months post injury. Our objective was to document their morphologic features. Donor nerves included teres minor, posterior axillary, brachialis, extensor carpi radialis brevis and supinator. Recipient nerves included triceps, posterior interosseus (PIN and anterior interosseus nerves (AIN. They were fixed in glutaraldehyde, processed and embedded in Araldite Epon for light microscopy. Eighty percent of nerves showed abnormalities. Most common were myelin thickening and folding, demyelination, inflammation and a reduction of large myelinated axon density. Others were a thickened perineurium, oedematous endoneurium and Renaut bodies. Significantly, very thinly myelinated axons and groups of unmyelinated axons were observed indicating regenerative efforts. Abnormalities exist in both donor and recipient nerves and they differ in appearance and aetiology. The abnormalities observed may be preventable or reversible.

Isolated abducens nerve palsy associated with subarachnoid hemorrhage: a localizing sign of ruptured posterior inferior cerebellar artery aneurysms.

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Burkhardt, Jan-Karl; Winkler, Ethan A; Lasker, George F; Yue, John K; Lawton, Michael T

2018-06-01

OBJECTIVE Compressive cranial nerve syndromes can be useful bedside clues to the diagnosis of an enlarging intracranial aneurysm and can also guide subsequent evaluation, as with an acute oculomotor nerve (cranial nerve [CN] III) palsy that is presumed to be a posterior communicating artery aneurysm and a surgical emergency until proven otherwise. The CN VI has a short cisternal segment from the pontomedullary sulcus to Dorello's canal, remote from most PICA aneurysms but in the hemodynamic pathway of a rupturing PICA aneurysm that projects toward Dorello's canal. The authors describe a cranial nerve syndrome for posterior inferior cerebellar artery (PICA) aneurysms that associates subarachnoid hemorrhage (SAH) and an isolated abducens nerve (CN VI) palsy. METHODS Clinical and radiological data from 106 surgical patients with PICA aneurysms (66 ruptured and 40 unruptured) were retrospectively reviewed. Data from a group of 174 patients with other aneurysmal SAH (aSAH) were analyzed in a similar manner to control for nonspecific effects of SAH. Univariate statistical analysis compared incidence and risk factors associated with CN VI palsy in subarachnoid hemorrhage. RESULTS Overall, 13 (4.6%) of 280 patients had CN VI palsy at presentation, and all of them had ruptured aneurysms (representing 13 [5.4%] of the 240 cases of ruptured aneurysms). CN VI palsies were observed in 12 patients with ruptured PICA aneurysms (12/66 [18.1%]) and 1 patient with other aSAH (1/174 [0.1%], p < 0.0001). PICA aneurysm location in ruptured aneurysms was an independent predictor for CN VI palsy on multivariate analysis (p = 0.001). PICA aneurysm size was not significantly different in patients with or without CN VI palsy (average size 4.4 mm and 5.2 mm, respectively). Within the PICA aneurysm cohort, modified Fisher grade (p = 0.011) and presence of a thick cisternal SAH (modified Fisher Grades 3 and 4) (p = 0.003) were predictors of CN VI palsy. In all patients with ruptured PICA

Prevention of upper limb symptoms and signs of nerve afflictions in computer operators: The effect of intervention by stretching

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Thomsen Gert

2008-01-01

Full Text Available Abstract Background In a previous study of computer operators we have demonstrated the relation of upper limb pain to individual and patterns of neurological findings (reduced function of muscles, sensory deviations from normal and mechanical allodynia of nerve trunks. The identified patterns were in accordance with neural afflictions at three specific locations (brachial plexus at chord level, posterior interosseous and median nerve on elbow level. We have introduced an intervention program aiming to mobilize nerves at these locations and tested its efficacy. Methods 125 and 59, respectively, computer operators in two divisions of an engineering consultancy company were invited to answer a questionnaire on upper limb symptoms and to undergo a blinded neurological examination. Participants in one division were subsequently instructed to participate in an upper limb stretching course at least three times during workdays in a six month period. Subjects from the other division served as controls. At the end of the intervention both groups were invited to a second identical evaluation by questionnaire and physical examination. Symptoms and findings were studied in the right upper limb. Perceived changes of pain were recorded and individual and patterns of physical findings assessed for both groups at baseline and at follow-up. In subjects with no or minimal preceding pain we additionally studied the relation of incident pain to the summarized findings for parameters contained in the definition of nerve affliction at the three locations. Results Summarized pain was significantly reduced in the intervention group but unchanged in controls. After the intervention, fewer neurological abnormalities in accordance with nerve affliction were recorded for the whole material but no conclusion could be drawn regarding the relation to the intervention of this reduction. Incident pain correlated to findings in accordance with the three locations of nerve

Posterior Communicating Artery Aneurysm in a 20 Year Old Boy ...

African Journals Online (AJOL)

Result: A clinical diagnosis of left third and fourth cranial nerve palsies from intracranial space-occupying lesion was made. Computed tomography and computed tomography angiography confirmed left posterior communicating artery aneurysm. Conclusion: Any degree of pupillary involvement in third nerve palsy, whether ...

3DCRT for posterior fossa: Sparing of surrounding organs at risk

African Journals Online (AJOL)

Azza Helal

2013-06-25

Jun 25, 2013 ... including non-posterior fossa brain, pituitary, cochlea, eyes, optic nerves, optic chiasm, ... grams; Rt.C, right cochlea; Lt. C, left cochlea; Non P.F, non posterior ... child's cognitive function and quality of life.6 Although the.

Reinnervation of bilateral posterior cricoarytenoid muscles using the left phrenic nerve in patients with bilateral vocal fold paralysis.

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Meng Li

Full Text Available OBJECTIVE: To evaluate the feasibility, effectiveness, and safety of reinnervation of the bilateral posterior cricoarytenoid (PCA muscles using the left phrenic nerve in patients with bilateral vocal fold paralysis. METHODS: Forty-four patients with bilateral vocal fold paralysis who underwent reinnervation of the bilateral PCA muscles using the left phrenic nerve were enrolled in this study. Videostroboscopy, perceptual evaluation, acoustic analysis, maximum phonation time, pulmonary function testing, and laryngeal electromyography were performed preoperatively and postoperatively. Patients were followed-up for at least 1 year after surgery. RESULTS: Videostroboscopy showed that within 1 year after reinnervation, abductive movement could be observed in the left vocal folds of 87% of patients and the right vocal folds of 72% of patients. Abductive excursion on the left side was significantly larger than that on the right side (P 0.05. No patients developed immediate dyspnea after surgery, and the pulmonary function parameters recovered to normal reference value levels within 1 year. Postoperative laryngeal electromyography confirmed successful reinnervation of the bilateral PCA muscles. Eighty-seven percent of patients in this series were decannulated and did not show obvious dyspnea after physical activity. Those who were decannulated after subsequent arytenoidectomy were not included in calculating the success rate of decannulation. CONCLUSIONS: Reinnervation of the bilateral PCA muscles using the left phrenic nerve can restore inspiratory vocal fold abduction to a physiologically satisfactory extent while preserving phonatory function at the preoperative level without evident morbidity.

Reinnervation of Bilateral Posterior Cricoarytenoid Muscles Using the Left Phrenic Nerve in Patients with Bilateral Vocal Fold Paralysis

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Zheng, Hongliang; Chen, Donghui; Zhu, Minhui; Wang, Wei; Liu, Fei; Zhang, Caiyun

2013-01-01

Objective To evaluate the feasibility, effectiveness, and safety of reinnervation of the bilateral posterior cricoarytenoid (PCA) muscles using the left phrenic nerve in patients with bilateral vocal fold paralysis. Methods Forty-four patients with bilateral vocal fold paralysis who underwent reinnervation of the bilateral PCA muscles using the left phrenic nerve were enrolled in this study. Videostroboscopy, perceptual evaluation, acoustic analysis, maximum phonation time, pulmonary function testing, and laryngeal electromyography were performed preoperatively and postoperatively. Patients were followed-up for at least 1 year after surgery. Results Videostroboscopy showed that within 1 year after reinnervation, abductive movement could be observed in the left vocal folds of 87% of patients and the right vocal folds of 72% of patients. Abductive excursion on the left side was significantly larger than that on the right side (P 0.05). No patients developed immediate dyspnea after surgery, and the pulmonary function parameters recovered to normal reference value levels within 1 year. Postoperative laryngeal electromyography confirmed successful reinnervation of the bilateral PCA muscles. Eighty-seven percent of patients in this series were decannulated and did not show obvious dyspnea after physical activity. Those who were decannulated after subsequent arytenoidectomy were not included in calculating the success rate of decannulation. Conclusions Reinnervation of the bilateral PCA muscles using the left phrenic nerve can restore inspiratory vocal fold abduction to a physiologically satisfactory extent while preserving phonatory function at the preoperative level without evident morbidity. PMID:24098581

The superiority of 3D-CISS sequence in displaying the cisternal segment of posterior nerves and their pathological changes%3D-CISS MRI序列对脑池段后组脑神经及其病变显示的优势

Institute of Scientific and Technical Information of China (English)

梁长虎; 柳澄; 李坤成; 武乐斌; 庞琦; 乌大尉; 王海燕; 于富华

2009-01-01

目的 通过脑池段后组脑神经3D-CISS序列与3D-TSE序列成像质量的比较,评估3D-CISS序列对脑池段后组脑神经及其病变显示的作用.方法 对45例正常体检者和12例患有各种后组脑神经异常症状的病人进行3D-CISS序列、3D-TSE序列扫描,对后组腑神经成像进行评分.结果 舌咽、迷走、副神经及舌下神经在3D-CISS、3D-TSE序列的显示率依次为:100%、57.1%;100%、52.3%;100%、41.1%;91.0%、59.3%.应用3D-CISS序列:对8例血管性神经痛病人显示了责任血管压迫点,对3例后组脑神经微小肿瘤进行了显示,对1例蛛网膜囊肿病人显示了压迫点.结论 对于被脑脊液围绕的后组脑神经显示成像,3D-CISS序列是较好的选择.%Objective To evaluate the efficacy of 3D-CISS on image quality of posterior nerves surrounded by CSF when compared with that of 3D-TSE. Method A total of 45 volunteers and 12 patients with abnormality of posterior cranial nerves were examined using 3D-CISS and 3D-TSE sequences respectively. The image quality were graded for glossopharyngeal nerve、vagus nerve、accessory nerve、 hypoglossal nerves (CN Ⅸ、Ⅹ、Ⅺ、Ⅻ) and their related arteries. Results The identification rates for cisternal segment of posterior nerves were as follows: glossopharyngeal nerve (100% in 3D-CISS and 57.1% in 31)-TSE)、vagus nerve(100% in 3D-CISS and 52.3% in 3I)-TSE)、accessory nerve(100% in 3D-CISS and 41.1% in 3D-TSE)、hypoglossal nerves(91.0% in 3D-CISS and 59.3% in 3D-TSE);12 patients with pathological changes in posterior nerves were all displayed well, among them 8 were pressed by artery, 1 by arachnoid cyst,3 caused by tumors. Conclusions 3D-CISS sequence is preferable when imaging posterior cranial nerves surrounded by CSF.

Finite Element Modeling of the Posterior Eye in Microgravity

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Feola, Andrew; Raykin, Julia; Mulugeta, Lealem; Gleason, Rudolph; Myers, Jerry G.; Nelson, Emily S.; Samuels, Brian; Ethier, C. Ross

2015-01-01

Microgravity experienced during spaceflight affects astronauts in various ways, including weakened muscles and loss of bone density. Recently, visual impairment and intracranial pressure (VIIP) syndrome has become a major concern for space missions lasting longer than 30 days. Astronauts suffering from VIIP syndrome have changes in ocular anatomical and visual impairment that persist after returning to earth. It is hypothesized that a cephalad fluid shift in microgravity may increase the intracranial pressure (ICP), which leads to an altered biomechanical environment of the posterior globe and optic nerve sheath (ONS).Currently, there is a lack of knowledge of how elevated ICP may lead to vision impairment and connective tissue changes in VIIP. Our goal was to develop a finite element model to simulate the acute effects of elevated ICP on the posterior eye and optic nerve sheath. We used a finite element (FE) analysis approach to understand the response of the lamina cribrosa and optic nerve to the elevations in ICP thought to occur in microgravity and to identify which tissue components have the greatest impact on strain experienced by optic nerve head tissues.

Intraoperative Hypoglossal Nerve Mapping During Carotid Endarterectomy: Technical Note.

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Kojima, Atsuhiro; Saga, Isako; Ishikawa, Mami

2018-05-01

Hypoglossal nerve deficit is a possible complication caused by carotid endarterectomy (CEA). The accidental injury of the hypoglossal nerve during surgery is one of the major reasons for permanent hypoglossal nerve palsy. In this study, we investigated the usefulness of intraoperative mapping of the hypoglossal nerve to identify this nerve during CEA. Five consecutive patients who underwent CEA for the treatment of symptomatic or asymptomatic carotid artery stenosis were studied. A hand-held probe was used to detect the hypoglossal nerve in the operative field, and the tongue motor evoked potentials (MEPs) were recorded. The tongue MEPs were obtained in all the patients. The invisible hypoglossal nerve was successfully identified without any difficulty when the internal carotid artery was exposed. Intraoperative mapping was particularly useful for identifying the hypoglossal nerve when the hypoglossal nerve passed beneath the posterior belly of the digastric muscle. In 1 of 2 cases, MEP was also elicited when the ansa cervicalis was stimulated, although the resulting amplitude was much smaller than that obtained by direct stimulation of the hypoglossal nerve. Postoperatively, none of the patients presented with hypoglossal nerve palsy. Intraoperative hypoglossal nerve mapping enabled us to locate the invisible hypoglossal nerve during the exposure of the internal carotid artery accurately without retracting the posterior belly of the digastric muscle and other tissues in the vicinity of the internal carotid artery. Copyright © 2018 Elsevier Inc. All rights reserved.

Optic Nerve Hemangioblastoma: A Case Report

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Holly Zywicke

2012-01-01

Full Text Available Hemangioblastomas are World Health Organization (WHO grade I tumors of uncertain histologic origin. These central nervous system tumors are most often found in the posterior fossa, brainstem, and spinal cord. There are fewer than 20 reported cases of optic nerve hemangioblastomas in the literature. We present a patient with visual decline found to have a mass arising from within the posterior orbital canal that grossly involved the optic nerve sheath. Neuropathologic evaluation showed hemangioblastoma. Although not a common tumor in this location, consideration of hemangioblastoma in the differential diagnosis is important as they can have a more aggressive course than other tumors of this region and have a detrimental effect on visual prognosis.

Hemodynamic and morphological characteristics of unruptured posterior communicating artery aneurysms with oculomotor nerve palsy.

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Lv, Nan; Yu, Ying; Xu, Jinyu; Karmonik, Christof; Liu, Jianmin; Huang, Qinghai

2016-08-01

OBJECT Unruptured posterior communicating artery (PCoA) aneurysms with oculomotor nerve palsy (ONP) have a very high risk of rupture. This study investigated the hemodynamic and morphological characteristics of intracranial aneurysms with high rupture risk by analyzing PCoA aneurysms with ONP. METHODS Fourteen unruptured PCoA aneurysms with ONP, 33 ruptured PCoA aneurysms, and 21 asymptomatic unruptured PCoA aneurysms were included in this study. The clinical, morphological, and hemodynamic characteristics were compared among the different groups. RESULTS The clinical characteristics did not differ among the 3 groups (p > 0.05), whereas the morphological and hemodynamic analyses showed that size, aspect ratio, size ratio, undulation index, nonsphericity index, ellipticity index, normalized wall shear stress (WSS), and percentage of low WSS area differed significantly (p PCoA aneurysms with ONP demonstrated a distinctive morphological-hemodynamic pattern that was significantly different compared with asymptomatic unruptured PCoA aneurysms and was similar to ruptured PCoA aneurysms. The larger size, more irregular shape, and lower WSS might be related to the high rupture risk of PCoA aneurysms.

A novel method of lengthening the accessory nerve for direct coaptation during nerve repair and nerve transfer procedures.

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Tubbs, R Shane; Maldonado, Andrés A; Stoves, Yolanda; Fries, Fabian N; Li, Rong; Loukas, Marios; Oskouian, Rod J; Spinner, Robert J

2018-01-01

OBJECTIVE The accessory nerve is frequently repaired or used for nerve transfer. The length of accessory nerve available is often insufficient or marginal (under tension) for allowing direct coaptation during nerve repair or nerve transfer (neurotization), necessitating an interpositional graft. An attractive maneuver would facilitate lengthening of the accessory nerve for direct coaptation. The aim of the present study was to identify an anatomical method for such lengthening. METHODS In 20 adult cadavers, the C-2 or C-3 connections to the accessory nerve were identified medial to the sternocleidomastoid (SCM) muscle and the anatomy of the accessory nerve/cervical nerve fibers within the SCM was documented. The cervical nerve connections were cut. Lengths of the accessory nerve were measured. Samples of the cut C-2 and C-3 nerves were examined using immunohistochemistry. RESULTS The anatomy and adjacent neural connections within the SCM are complicated. However, after the accessory nerve was "detethered" from within the SCM and following transection, the additional length of the accessory nerve increased from a mean of 6 cm to a mean of 10.5 cm (increase of 4.5 cm) after cutting the C-2 connections, and from a mean of 6 cm to a mean length of 9 cm (increase of 3.5 cm) after cutting the C-3 connections. The additional length of accessory nerve even allowed direct repair of an infraclavicular target (i.e., the proximal musculocutaneous nerve). The cervical nerve connections were shown not to contain motor fibers. CONCLUSIONS An additional length of the accessory nerve made available in the posterior cervical triangle can facilitate direct repair or neurotization procedures, thus eliminating the need for an interpositional nerve graft, decreasing the time/distance for regeneration and potentially improving clinical outcomes.

The intracranial facial nerve as seen through different surgical windows: an extensive anatomosurgical study.

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Bernardo, Antonio; Evins, Alexander I; Visca, Anna; Stieg, Phillip E

2013-06-01

The facial nerve has a short intracranial course but crosses critical and frequently accessed surgical structures during cranial base surgery. When performing approaches to complex intracranial regions, it is essential to understand the nerve's conventional and topographic anatomy from different surgical perspectives as well as its relationship with surrounding structures. To describe the entire intracranial course of the facial nerve as observed via different neurosurgical approaches and to provide an analytical evaluation of the degree of nerve exposure achieved with each approach. Anterior petrosectomies (middle fossa, extended middle fossa), posterior petrosectomies (translabyrinthine, retrolabyrinthine, transcochlear), a retrosigmoid, a far lateral, and anterior transfacial (extended maxillectomy, mandibular swing) approaches were performed on 10 adult cadaveric heads (20 sides). The degree of facial nerve exposure achieved per segment for each approach was assessed and graded independently by 3 surgeons. The anterior petrosal approaches offered good visualization of the nerve in the cerebellopontine angle and intracanalicular portion superiorly, whereas the posterior petrosectomies provided more direct visualization without the need for cerebellar retraction. The far lateral approach exposed part of the posterior and the entire inferior quadrants, whereas the retrosigmoid approach exposed parts of the superior and inferior quadrants and the entire posterior quadrant. Anterior and anteroinferior exposure of the facial nerve was achieved via the transfacial approaches. The surgical route used must rely on the size, nature, and general location of the lesion, as well as on the capability of the particular approach to better expose the appropriate segment of the facial nerve.

Role of magnetic resonance imaging in entrapment and compressive neuropathy - what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: Part 2. Upper extremity

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Kim, Sungjun [Yonsei University, Department of Diagnostic Radiology, College of Medicine, Seoul (Korea); Hanyang University, Kuri Hospital, Department of Diagnostic Radiology, College of Medicine, Kuri City, Kyunggi-do (Korea); Choi, Jin-Young; Huh, Yong-Min; Song, Ho-Taek; Lee, Sung-Ah [Yonsei University, Department of Diagnostic Radiology, College of Medicine, Seoul (Korea); Kim, Seung Min [Yonsei University, Department of Neurology, College of Medicine, Seoul (Korea); Suh, Jin-Suck [Yonsei University, Department of Diagnostic Radiology, College of Medicine, Seoul (Korea); Yonsei University, Research Institute of Radiological Science, College of Medicine, Seoul (Korea)

2007-02-15

The diagnosis of nerve entrapment and compressive neuropathy has been traditionally based on the clinical and electrodiagnostic examinations. As a result of improvements in the magnetic resonance (MR) imaging modality, it plays not only a fundamental role in the detection of space-occupying lesions, but also a compensatory role in clinically and electrodiagnostically inconclusive cases. Although ultrasound has undergone further development in the past decades and shows high resolution capabilities, it has inherent limitations due to its operator dependency. We review the course of normal peripheral nerves, as well as various clinical demonstrations and pathological features of compressed and entrapped nerves in the upper extremities on MR imaging, according to the nerves involved. The common sites of nerve entrapment of the upper extremity are as follows: the brachial plexus of the thoracic outlet; axillary nerve of the quadrilateral space; radial nerve of the radial tunnel; ulnar nerve of the cubital tunnel and Guyon's canal; median nerve of the pronator syndrome, anterior interosseous nerve syndrome, and carpal tunnel syndrome. Although MR imaging can depict the peripheral nerves in the extremities effectively, radiologists should be familiar with nerve pathways, common sites of nerve compression, and common space-occupying lesions resulting in nerve compression in MR imaging. (orig.)

Role of magnetic resonance imaging in entrapment and compressive neuropathy - what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: Part 2. Upper extremity

International Nuclear Information System (INIS)

Kim, Sungjun; Choi, Jin-Young; Huh, Yong-Min; Song, Ho-Taek; Lee, Sung-Ah; Kim, Seung Min; Suh, Jin-Suck

2007-01-01

The diagnosis of nerve entrapment and compressive neuropathy has been traditionally based on the clinical and electrodiagnostic examinations. As a result of improvements in the magnetic resonance (MR) imaging modality, it plays not only a fundamental role in the detection of space-occupying lesions, but also a compensatory role in clinically and electrodiagnostically inconclusive cases. Although ultrasound has undergone further development in the past decades and shows high resolution capabilities, it has inherent limitations due to its operator dependency. We review the course of normal peripheral nerves, as well as various clinical demonstrations and pathological features of compressed and entrapped nerves in the upper extremities on MR imaging, according to the nerves involved. The common sites of nerve entrapment of the upper extremity are as follows: the brachial plexus of the thoracic outlet; axillary nerve of the quadrilateral space; radial nerve of the radial tunnel; ulnar nerve of the cubital tunnel and Guyon's canal; median nerve of the pronator syndrome, anterior interosseous nerve syndrome, and carpal tunnel syndrome. Although MR imaging can depict the peripheral nerves in the extremities effectively, radiologists should be familiar with nerve pathways, common sites of nerve compression, and common space-occupying lesions resulting in nerve compression in MR imaging. (orig.)

Magnetic resonance imaging of the cranial nerves in the posterior fossa: a comparative study of t2-weighted spin-echo sequences at 1.5 and 3.0 tesla.

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Fischbach, F; Müller, M; Bruhn, H

2008-04-01

High-field magnetic resonance imaging (MRI) at 3.0 Tesla (T) is rapidly gaining clinical acceptance. Whether doubling of the field strength of 1.5T and the subsequent increase in signal-to-noise ratio (SNR) leads to a significant improvement of image quality is not automatically given. To evaluate the depiction of fine anatomic detail in the posterior fossa, focusing on brain nerves, on T2-weighted imaging, and to define the potential advantage of imaging at 3.0T versus 1.5T. In total, 10 brainstem nerve pairs of 12 volunteers were identified on T2-weighted MR images of 2- and 5-mm section thickness acquired at 1.5T and 3.0T. The MR images were compared for each subject at both field strengths by three independent readers who rated image quality according to depiction of anatomic detail and contrast by using a rating scale. In general, MR images at 3.0T were considered more conspicuous and less noisy than images at 1.5T. The SNR value measured was almost doubled. With respect to structural identification and contrast according to the rating scale, observer scores were significantly improved both for standard imaging with 5-mm sections and high-resolution imaging with 2-mm sections at 3.0T. Direct comparison revealed a significant increase for evaluated image quality criteria and the number of nerves detected. The comparison revealed a clear advantage in favor of T2-weighted MRI at 3.0T vs. 1.5T in depicting the roots and course of brain nerves in the posterior fossa.

Microgravity-Driven Optic Nerve/Sheath Biomechanics Simulations

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Ethier, C. R.; Feola, A.; Myers, J. G.; Nelson, E.; Raykin, J.; Samuels, B.

2016-01-01

Visual Impairment and Intracranial Pressure (VIIP) syndrome is a concern for long-duration space flight. Current thinking suggests that the ocular changes observed in VIIP syndrome are related to cephalad fluid shifts resulting in altered fluid pressures [1]. In particular, we hypothesize that increased intracranial pressure (ICP) drives connective tissue remodeling of the posterior eye and optic nerve sheath (ONS). We describe here finite element (FE) modeling designed to understand how altered pressures, particularly altered ICP, affect the tissues of the posterior eye and optic nerve sheath (ONS) in VIIP. METHODS: Additional description of the modeling methodology is provided in the companion IWS abstract by Feola et al. In brief, a geometric model of the posterior eye and optic nerve, including the ONS, was created and the effects of fluid pressures on tissue deformations were simulated. We considered three ICP scenarios: an elevated ICP assumed to occur in chronic microgravity, and ICP in the upright and supine positions on earth. Within each scenario we used Latin hypercube sampling (LHS) to consider a range of ICPs, ONH tissue mechanical properties, intraocular pressures (IOPs) and mean arterial pressures (MAPs). The outcome measures were biomechanical strains in the lamina cribrosa, optic nerve and retina; here we focus on peak values of these strains, since elevated strain alters cell phenotype and induce tissue remodeling. In 3D, the strain field can be decomposed into three orthogonal components, denoted as first, second and third principal strains. RESULTS AND CONCLUSIONS: For baseline material properties, increasing ICP from 0 to 20 mmHg significantly changed strains within the posterior eye and ONS (Fig. 1), indicating that elevated ICP affects ocular tissue biomechanics. Notably, strains in the lamina cribrosa and retina became less extreme as ICP increased; however, within the optic nerve, the occurrence of such extreme strains greatly increased as

Musculocutaneous nerve substituting for the distal part of radial nerve: A case report and its embryological basis

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A S Yogesh

2011-01-01

Full Text Available In the present case, we have reported a unilateral variation of the radial and musculocutaneous nerves on the left side in a 64-year-old male cadaver. The radial nerve supplied all the heads of the triceps brachii muscle and gave cutaneous branches such as lower lateral cutaneous nerve of the arm and posterior cutaneous nerve of forearm. The radial nerve ended without continuing further. The musculocutaneous nerve supplied the brachioradialis, extensor carpi radialis longus and extensor carpi radialis brevis muscles. The musculocutaneous nerve divided terminally into two branches, superficial and deep. The deep branch of musculocutaneous nerve corresponded to usual deep branch of the radial nerve while the superficial branch of musculocutaneous nerve corresponded to usual superficial branch of the radial nerve. The dissection was continued to expose the entire brachial plexus from its origin and it was found to be normal. The structures on the right upper limb were found to be normal. Surgeons should keep such variations in mind while performing the surgeries of the upper limb.

Prospective clinical study comparing intraligamentary anesthesia and inferior alveolar nerve block for extraction of posterior mandibular teeth.

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Kämmerer, P W; Adubae, A; Buttchereit, I; Thiem, D G E; Daubländer, M; Frerich, B

2018-04-01

The aim of the study was to compare the efficacy of intraligamentary anesthesia (ILA) with conventional inferior alveolar nerve block (IANB) for extraction of mandibular posterior teeth. In a prospective clinical trial, a total of 301 mandibular posterior teeth were extracted in 266 patients. Randomization was conducted into those who received ILA (patients n = 98; teeth n = 105) and those who received IANB (patient n = 140; teeth n = 140). Twenty-eight patients were subjected to bilateral mandibular dental extractions and received both ILA und IANB (teeth n = 56 (ILA n = 28; IANB n = 28)). The primary objective was to evaluate the differences in pain during injection, in pain during tooth extraction (numeric rating scale (NRS)), and in anesthetic quality (complete/sufficient vs. insufficient/no effect). Differences in latency time, amount of anesthetic solution, need for second injection, and duration of local numbness as well as in the incidence of dry socket were assessed. ILA had significant lower pain of injection (p < 0.001), shorter latency time (p < 0.001), and shorter duration of local numbness (p < 0.001) and required lesser amount of local anesthetic solution (p < 0.001) together with a similar anesthetic quality (p = 0.082) compared to IANB. Concerning pain during extraction (p = 0.211), frequency of second injection (p = 0.197), and incidence of dry socket (p = 0.178), no significant differences were detected. ILA fulfills the requirements of a minimal invasive and patient-friendly local anesthetic technique. In accordance, it represents a safe and reliable alternative to IANB for extraction of mandibular posterior teeth. ILA can be recommended for routine dental extractions.

Nerve transection repair using laser-activated chitosan in a rat model.

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Bhatt, Neel K; Khan, Taleef R; Mejias, Christopher; Paniello, Randal C

2017-08-01

Cranial nerve transection during head and neck surgery is conventionally repaired with microsuture. Previous studies have demonstrated recovery with laser nerve welding (LNW), a novel alternative to microsuture. LNW has been reported to have poorer tensile strength, however. Laser-activated chitosan, an adhesive biopolymer, may promote nerve recovery while enhancing the tensile strength of the repair. Using a rat posterior tibial nerve injury model, we compared four different methods of nerve repair in this pilot study. Animal study. Animals underwent unilateral posterior tibial nerve transection. The injury was repaired by potassium titanyl phosphate (KTP) laser alone (n = 20), KTP + chitosan (n = 12), microsuture + chitosan (n = 12), and chitosan alone (n = 14). Weekly walking tracks were conducted to measure functional recovery (FR). Tensile strength (TS) was measured at 6 weeks. At 6 weeks, KTP laser alone had the best recovery (FR = 93.4% ± 8.3%). Microsuture + chitosan, KTP + chitosan, and chitosan alone all showed good FR (87.4% ± 13.5%, 84.6% ± 13.0%, and 84.1% ± 10.0%, respectively). One-way analysis of variance was performed (F(3,56) = 2.6, P = .061). A TS threshold of 3.8 N was selected as a control mean recovery. Three groups-KTP alone, KTP + chitosan, and microsuture + chitosan-were found to meet threshold 60% (95% confidence interval [CI]: 23.1%-88.3%), 75% (95% CI: 46.8%-91.1%), and 100% (95% CI: 75.8%-100.0%), respectively. In the posterior tibial nerve model, all repair methods promoted nerve recovery. Laser-activated chitosan as a biopolymer anchor provided good TS and appears to be a novel alternative to microsuture. This repair method may have surgical utility following cranial nerve injury during head and neck surgery. NA Laryngoscope, 127:E253-E257, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

[Dynamics of lagophthalmos depending on facial nerve repair and its intraoperative monitoring in neurosurgical patients].

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Tabachnikova, T V; Serova, N K; Shimansky, V N

2014-01-01

Over 200 patients with acoustic neuromas and over 100 patients with posterior cranial fossa meningiomas are annually operated on at the N.N. Burdenko Neurosurgical Institute. Intraoperative monitoring of the facial nerve function is used in most patients with tumors of the posterior cranial fossa to identify the facial nerve in the surgical wound. If the anatomical integrity of the facial nerve in the cranial cavity cannot be retained, facial nerve repair is performed to restore the facial muscle function. Intraoperative electrical stimulation of the facial nerve has a great prognostic significance to evaluate the dynamics of lagophthalmos in the late postoperative period and to select the proper method for lagophthalmos correction. When the facial nerve was reinnervated by the descending branch or trunk of the hypoglossal nerve, sufficient eyelid closure was observed only in 3 patients out of 17.

Anterior transposition of the radial nerve--a cadaveric study.

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Yakkanti, Madhusudhan R; Roberts, Craig S; Murphy, Joshua; Acland, Robert D

2008-01-01

The radial nerve is at risk during the posterior plating of the humerus. The purpose of this anatomic study was to assess the extent of radial nerve dissection required for anterior transposition through the fracture site (transfracture anterior transposition). A cadaver study was conducted approaching the humerus by a posterior midline incision. The extent of dissection of the nerve necessary for plate fixation of the humerus fracture was measured. An osteotomy was created to model a humeral shaft fracture at the spiral groove (OTA classification 12-A2, 12-A3). The radial nerve was then transposed anterior to the humeral shaft through the fracture site. The additional dissection of the radial nerve and the extent of release of soft tissue from the humerus shaft to achieve the transposition were measured. Plating required a dissection of the radial nerve 1.78 cm proximal and 2.13 cm distal to the spiral groove. Transfracture anterior transposition of the radial nerve required an average dissection of 2.24 cm proximal and 2.68 cm distal to the spiral groove. The lateral intermuscular septum had to be released for 2.21 cm on the distal fragment to maintain laxity of the transposed nerve. Transfracture anterior transposition of the radial nerve before plating is feasible with dissection proximal and distal to the spiral groove and elevation of the lateral intermuscular septum. Potential clinical advantages of this technique include enhanced fracture site visualization, application of broader plates, and protection of the radial nerve during the internal fixation.

Clipping Versus Coiling in the Management of Posterior Communicating Artery Aneurysms with Third Nerve Palsy: A Systematic Review and Meta-Analysis.

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Gaberel, Thomas; Borha, Alin; di Palma, Camille; Emery, Evelyne

2016-03-01

To compare surgical clipping with endovascular coiling in terms of recovery from oculomotor nerve palsy (ONP) in the management of posterior communicating artery (PCoA) aneurysms causing third nerve palsy. We conducted a systematic review of the literature and meta-analysis. The meta-analysis included 11 relevant studies involving 384 patients with third nerve palsy caused by PCoA aneurysms at baseline, of whom 257 (67.0%) were treated by clipping and 127 were treated by coiling (33.0%). Pooled odds ratios of the impact of clipping or coiling on complete ONP recovery, lack of ONP recovery, and procedure-related death were calculated. The overall complete ONP recovery rate was 42.5% in the coiling group compared with 83.6% in the clipping group. The increase in complete ONP recovery in the clipping group corresponds to an overall pooled Mantel-Haenszel odds ratio of 4.44 (95% confidence interval = 1.66-11.84). Subgroup analysis revealed a clear benefit of clipping over coiling in patients with ruptured aneurysms, but not in patients with unruptured aneurysms. No procedure-related deaths were reported by any of the 11 studies. Surgical clipping of PCoA aneurysms causing third nerve palsy achieves better ONP recovery than endovascular coiling; this could be particularly true in the case of ruptured aneurysms. In view of the purely observational data, statements about this effect should be made with great caution. A randomized trial would better address the therapeutic dilemma, but pending the results of such a trial, we recommend treating PCoA aneurysms causing ONP with surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

A Way to Avoid Muscular Fibrosis in the First Dorsal Interosseous Muscle after Acupuncture Injection Therapy

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Yiu Ming Wong

2017-09-01

Full Text Available Fibrosis of skeletal muscle following acupuncture is an iatrogenic disorder. The present case illustrates a patient with a unilateral fibrotic formation on a thumb muscle after acupuncture injection therapy with red sage. The patient in the present case was a counter-terrorism police officer with right-handedness; he noted a palpable nodule three months after injection therapy at his left first dorsal interosseous in which the acupuncture point LI4 (He Gu is located. He also found a reduction in the strength of his left pinch grip that noticeably affected his left handgun marksmanship. However, being ambidextrous in single-hand pistol shooting is an essential requirement for counter-terrorism police officers. Based on the patient’s medical history and claims, no underlying disease or trauma was found to be associated with his current complaint. During physical examination, a fibrotic formation in his left first dorsal interosseous muscle was visualized by using diagnostic ultrasound; also, as confirmed with dynamometry, the strength of his left pinch grip was significantly lower than that of the right counterpart. Because acupuncture injection therapy has three components, antiseptic practices, the mechanical action of syringe insertion, and the pharmacological effect of the sterile herb extract, any one of the components may have contributed to the present adverse event. The first dorsal interosseous muscle is small in dimension and rather vascular; thus, it is not an ideal site for intramuscular injection. When a clinician needs to treat a patient by performing acupuncture at the LI4 acupoint and injecting a herbal extract simultaneously, the clinician should only mechanically stimulate the LI4 acupoint while injecting the herbal medicine into the LI14 (Bi Noe acupoint on the same meridian, the LI14 acupoint being located in the distal portion of the deltoid muscle and being fairly close to the universally agreed upon site on the upper arm

Mental nerve paresthesia secondary to initiation of endodontic therapy: a case report

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Alam, Sharique; Zia, Afaf; Khan, Masood Hasan; Kumar, Ashok

2014-01-01

Whenever endodontic therapy is performed on mandibular posterior teeth, damage to the inferior alveolar nerve or any of its branches is possible. Acute periapical infection in mandibular posterior teeth may also sometimes disturb the normal functioning of the inferior alveolar nerve. The most common clinical manifestation of these insults is the paresthesia of the inferior alveolar nerve or mental nerve paresthesia. Paresthesia usually manifests as burning, prickling, tingling, numbness, itching or any deviation from normal sensation. Altered sensation and pain in the involved areas may interfere with speaking, eating, drinking, shaving, tooth brushing and other events of social interaction which will have a disturbing impact on the patient. Paresthesia can be short term, long term or even permanent. The duration of the paresthesia depends upon the extent of the nerve damage or persistence of the etiology. Permanent paresthesia is the result of nerve trunk laceration or actual total nerve damage. Paresthesia must be treated as soon as diagnosed to have better treatment outcomes. The present paper describes a case of mental nerve paresthesia arising after the start of the endodontic therapy in left mandibular first molar which was managed successfully by conservative treatment. PMID:25110646

Assessment of Optic Nerve Impairment in Patients with Neuromyelitis Optica by MR Diffusion Tensor Imaging.

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Zhiye Chen

Full Text Available Diffusion tensor imaging (DTI has been used for the evaluation of the white matter integrity. In this study, we evaluated optic nerve impairment in patients with neuromyelitis optica (NMO using DTI.Optic nerve DTI were performed on 28 NMO patients and 38 normal controls. Fractional anisotropy (FA values were measured in the anterior, middle, and posterior parts of the intraorbital optic nerve segment. For the posterior intraorbital optic nerve, FA values of BI (0.20±0.07, MI (0.24±0.16, and NA (0.25±0.14 decreased significantly compared with that of NC (0.43±0.07 (P<0.05, and ROC analysis demonstrated that the area under the curve (AUC measurements for BI vs. NC, MI vs. NC, NA vs. NC, and NMO (including BI, MI, and NA vs. NC were 0.99, 0.93, 0.88, and 0.96, respectively. The corresponding diagnostic sensitivities of ROC analysis were 100%, 80%, 80%, and 91%; and the specificities were 93%, 97%, 91%, and 93%.Decreased FA value in the intraorbital optic nerve, especially in the posterior part of the nerve, was demonstrated as a characteristic MR feature for NMO-related optic nerve impairment.

Arterial supply of the upper cranial nerves: a comprehensive review.

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Hendrix, Philipp; Griessenauer, Christoph J; Foreman, Paul; Shoja, Mohammadali M; Loukas, Marios; Tubbs, R Shane

2014-11-01

The arterial supply to the upper cranial nerves is derived from a complex network of branches derived from the anterior and posterior cerebral circulations. We performed a comprehensive literature review of the arterial supply of the upper cranial nerves with an emphasis on clinical considerations. Arteries coursing in close proximity to the cranial nerves regularly give rise to small vessels that supply the nerve. Knowledge of the arteries supplying the cranial nerves is of particular importance during surgical approaches to the skull base. © 2014 Wiley Periodicals, Inc.

Direct Posterior Bipolar Cervical Facet Radiofrequency Rhizotomy: A Simpler and Safer Approach to Denervate the Facet Capsule.

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Palea, Ovidiu; Andar, Haroon M; Lugo, Ramon; Granville, Michelle; Jacobson, Robert E

2018-03-14

Radiofrequency cervical rhizotomy has been shown to be effective for the relief of chronic neck pain, whether it be due to soft tissue injury, cervical spondylosis, or post-cervical spine surgery. The target and technique have traditionally been taught using an oblique approach to the anterior lateral capsule of the cervical facet joint. The goal is to position the electrode at the proximal location of the recurrent branch after it leaves the exiting nerve root and loops back to the cervical facet joint. The standard oblique approach to the recurrent nerve requires the testing of both motor and sensory components to verify the correct position and ensure safety so as to not damage the slightly more anterior nerve root. Bilateral lesions require the repositioning of the patient's neck. Poorly positioned electrodes can also pass anteriorly and contact the nerve root or vertebral artery. The direct posterior approach presented allows electrode positioning over a broader expanse of the facet joint without risk to the nerve root or vertebral artery. Over a four-year period, direct posterior radiofrequency ablation was performed under fluoroscopic guidance at multiple levels without neuro-stimulation testing with zero procedural neurologic events even as high as the C2 spinal segment. The direct posterior approach allows either unipolar or bipolar lesioning at multiple levels. Making a radiofrequency lesion along the larger posterior area of the facet capsule is as effective as the traditional target point closer to the nerve root but technically easier, allowing bilateral access and safety. The article will review the anatomy and innervation of the cervical facet joint and capsule, showing the diffuse nerve supply extending into the capsule of the facet joint that is more extensive than the recurrent medial sensory branches that have been the focus of radiofrequency lesioning.

Sciatic nerve compression by neurogenic heterotopic ossification: use of CT to determine surgical indications

International Nuclear Information System (INIS)

Salga, Marjorie; Jourdan, Claire; Durand, Marie-Christine; Hangard, Chloe; Carlier, Robert-Yves; Denormandie, Philippe; Genet, Francois

2015-01-01

To describe the characteristics of neurogenic heterotopic ossification (NHO) based on clinical tests, electroneuromyography (ENMG) and CT in a database of patients with lesions of the central nervous system who required sciatic nerve neurolysis along with posterior hip NHO resection, and to determine the respective roles of ENMG and CT in the management of posterior hip NHOs in patients who are unable to communicate or express pain. The consistency of the ENMG results with clinical findings, CT results and macroscopic signs of lesions was retrospectively assessed after sciatic nerve neurolysis and ablation of 55 posterior hip NHOs. Sciatic nerve neurolysis was necessary in 55 cases (47.4 %; 55 out of 116). CT showed contact of the NHO with the nerve in all cases: 5 in contact with no deflection, 3 in contact with deflection, 21 moulded into a gutter and 26 entrapped in the NHO. There were clinical signs of sciatic nerve lesion in 21.8 % of cases (12 out of 55). ENMG showed signs of sciatic nerve lesions in only 55.6 % (10 out of 18), only 4 of whom presented with clinical signs of a nerve lesion. No significant relationship was found between clinical symptoms and ENMG findings of sciatic nerve compression (n = 13, p = 0.77). Nerve compression by NHO is likely an underdiagnosed condition, particularly in patients who are unable to communicate. Diagnosis of sciatic compression by NHO should be based on regular clinical examinations and CT. ENMG is not sufficiently sensitive to be used alone for surgical decision-making. (orig.)

Sciatic nerve compression by neurogenic heterotopic ossification: use of CT to determine surgical indications

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Salga, Marjorie [Hopital Raymond Poincare, APHP, CIC-IT 805, Department of Physical Medicine and Rehabilitation, Garches (France); Jourdan, Claire [Hopital Raymond Poincare, APHP, CIC-IT 805, Department of Physical Medicine and Rehabilitation, Garches (France); Universite de Versailles Saint Quentin en Yvelines, Handi-Resp, (EA4047), Versailles (France); Durand, Marie-Christine [Hopital Raymond Poincare, APHP, CIC-IT 805, Department of Neurophysiology, Garches (France); Universite de Versailles Saint Quentin en Yvelines, Groupement de Recherche Clinique et Technologique sur le Handicap (GRCTH, EA 4497), Versailles (France); Hangard, Chloe; Carlier, Robert-Yves [Hopital Raymond Poincare, APHP, CIC-IT 805, Department of Medical Imaging, Garches (France); Denormandie, Philippe [Universite de Versailles Saint Quentin en Yvelines, Groupement de Recherche Clinique et Technologique sur le Handicap (GRCTH, EA 4497), Versailles (France); Hopital Raymond Poincare, APHP, CIC-IT 805, Department of Orthopaedic Surgery, Garches (France); Genet, Francois [Hopital Raymond Poincare, APHP, CIC-IT 805, Department of Physical Medicine and Rehabilitation, Garches (France); Universite de Versailles Saint Quentin en Yvelines, Groupement de Recherche Clinique et Technologique sur le Handicap (GRCTH, EA 4497), Versailles (France); Military Medical Service, Hopital d' Instruction des Armees Percy, Department of Physical Medicine and Rehabilitation, Clamart (France)

2014-09-14

To describe the characteristics of neurogenic heterotopic ossification (NHO) based on clinical tests, electroneuromyography (ENMG) and CT in a database of patients with lesions of the central nervous system who required sciatic nerve neurolysis along with posterior hip NHO resection, and to determine the respective roles of ENMG and CT in the management of posterior hip NHOs in patients who are unable to communicate or express pain. The consistency of the ENMG results with clinical findings, CT results and macroscopic signs of lesions was retrospectively assessed after sciatic nerve neurolysis and ablation of 55 posterior hip NHOs. Sciatic nerve neurolysis was necessary in 55 cases (47.4 %; 55 out of 116). CT showed contact of the NHO with the nerve in all cases: 5 in contact with no deflection, 3 in contact with deflection, 21 moulded into a gutter and 26 entrapped in the NHO. There were clinical signs of sciatic nerve lesion in 21.8 % of cases (12 out of 55). ENMG showed signs of sciatic nerve lesions in only 55.6 % (10 out of 18), only 4 of whom presented with clinical signs of a nerve lesion. No significant relationship was found between clinical symptoms and ENMG findings of sciatic nerve compression (n = 13, p = 0.77). Nerve compression by NHO is likely an underdiagnosed condition, particularly in patients who are unable to communicate. Diagnosis of sciatic compression by NHO should be based on regular clinical examinations and CT. ENMG is not sufficiently sensitive to be used alone for surgical decision-making. (orig.)

End-to-side neurotization with the phrenic nerve in restoring the function of toe extension: an experimental study in a rat model.

Science.gov (United States)

Jia, Xiaotian; Chen, Chao; Yang, Jianyun; Yu, Cong

2018-06-01

The phrenic nerve being transferred to the posterior division of the lower trunk with end-to-end neurorrhaphy is reported to be effective in restoring the function of digit extension in literature. However, the phrenic nerve is extremely important in respiration. We designed an animal experiment to discover whether the phrenic nerve being transferred to the posterior division of the lower trunk with end-to-side neurotization was feasible and provided the theoretical basis. A sum of 36 Sprague-Dawley rats was randomly assigned to one of two groups. In Group A, the phrenic nerve was transferred to the posterior division of the lower trunk with end-to-side neurotization. In Group B, the posterior division of the lower trunk was directly sutured. The results of behavioral assessment, electrophysiology, histology and nerve fiber count and muscle weight at 12 weeks postoperatively were recorded. In Group A, none of the rats experienced tachypnea. The motion of slight toe extension was observed. The results of electrophysiology, histology and nerve fiber count and muscle weight in Group A were not as well as those of Group B, but gradually improved with time. The phrenic nerve being transferred to the posterior division of lower trunk with end-to-side neurotization can partially restore the function of toe extension in a rat model. Whether the function of digit extension can be restored by the phrenic nerve with end-to-side neurotization in humans still needs more practice in clinic.

Anatomical relations of anterior and posterior ankle arthroscopy portals: a cadaveric study.

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Oliva, Xavier Martin; Méndez López, José Manuel; Monzo Planella, Mariano; Bravo, Alex; Rodrigues-Pinto, Ricardo

2015-04-01

Ankle arthroscopy is an increasingly used technique. Knowledge of the anatomical structures in relation to its portals is paramount to avoid complications. Twenty cadaveric ankles were analysed to assess the distance between relevant neurovascular structures to the anteromedial, anterolateral, posteromedial, and posterolateral arthroscopy portals. The intermediate dorsal branch of the superficial peroneal nerve was the closest structure to any of the portals (4.8 mm from the anterolateral portal), followed by the posterior tibial nerve (7.3 mm from the posteromedial portal). All structures analysed but one (posterior tibial artery) were, at least in one specimen, portals. This study provides information on the anatomical relations of ankle arthroscopy portals and relevant neurovascular structures, confirming previous studies identifying the superficial peroneal nerve as the structure at highest risk of injury, but also highlighting some important variations. Techniques to minimise the injury to these structures are discussed.

Spinal accessory nerve schwannomas masquerading as a fourth ventricular lesion

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Shyam Sundar Krishnan

2015-01-01

Full Text Available Schwannomas are benign lesions that arise from the nerve sheath of cranial nerves. The most common schwannomas arise from the 8 th cranial nerve (the vestibulo-cochlear nerve followed by trigeminal and facial nerves and then from glossopharyngeal, vagus, and spinal accessory nerves. Schwannomas involving the oculomotor, trochlear, abducens and hypoglossal nerves are very rare. We report a very unusual spinal accessory nerve schwannoma which occupied the fourth ventricle and extended inferiorly to the upper cervical canal. The radiological features have been detailed. The diagnostic dilemma was due to its midline posterior location mimicking a fourth ventricular lesion like medulloblastoma and ependymoma. Total excision is the ideal treatment for these tumors. A brief review of literature with tabulations of the variants has been listed.

Lacerations to Zones VIII and IX: It Is Not Just a Tendon Injury

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Charla R. Fischer

2011-01-01

Full Text Available Extensor tendon injuries are widely believed to be straightforward problems that are relatively simple to manage. However, these injuries can be complex and demand a thorough understanding of anatomy to achieve the best functional outcomes. When lacerations occur in the forearm as in Zones VIII and IX injury, the repair of the extensor tendon and muscle, and posterior interosseous nerve (PIN is often challenging. A review of the literature shows little guidance and attention for these injuries. We present four patients with injuries to Zones VIII and IX as well as a review of surgical technique, postoperative rehabilitation, and pearls that may be of benefit to those managing these injuries.

Removal of vestibular schwannoma and facial nerve preservation using small suboccipital retrosigmoid craniotomy

Institute of Scientific and Technical Information of China (English)

CHEN Ling; CHEN Li-hua; LING Feng; LIU Yun-sheng; Madjid Samii; Amir Samii

2010-01-01

Background Vestibular schwannoma, the commonest form of intracranial schwannoma, arises from the Schwann cells investing the vestibular nerve. At present, the surgery for vestibular schwannoma remains one of the most complicated operations demanding for surgical skills in neurosurgery. And the trend of minimal invasion should also be the major influence on the management of patients with vestibular schwannomas. We summarized the microsurgical removal experience in a recent series of vestibular schwannomas and presented the operative technique and cranial nerve preservation in order to improve the rates of total tumor removal and facial nerve preservation.Methods A retrospective analysis was performed in 145 patients over a 7-year period who suffered from vestibular schwannomas that had been microsurgicaily removed by suboccipital retrosigmoid transmeatus approach with small craniotomy. CT thinner scans revealed the tumor size in the internal auditory meatus and the relationship of the posterior wall of the internal acoustic meatus to the bone labyrinths preoperatively. Brain stem evoked potential was monitored intraoperatively. The posterior wall of the internal acoustic meatus was designedly drilled off. Patient records and operative reports, including data from the electrophysiological monitoring, follow-up audiometric examinations, and neuroradiological findings were analyzed.Results Total tumor resection was achieved in 140 cases (96.6%) and subtotal resection in 5 cases. The anatomical integrity of the facial nerve was preserved in 91.0% (132/145) of the cases. Intracranial end-to-end anastomosis of the facial nerve was performed in 7 cases. Functional preservation of the facial nerve was achieved in 115 patients (Grade Ⅰ and Grade Ⅱ, 79.3%). No patient died in this series. Preservation of nerves and vessels were as important as tumor removal dudng the operation. CT thinner scan could show the relationship between the posterior wall of the internal

Iodine-125 radiation of posterior uveal melanoma

International Nuclear Information System (INIS)

Packer, S.

1987-01-01

Twenty-eight cases of posterior choroidal melanoma were treated with iodine-125 in gold eye plaques. Eleven cases were located within 3.0 mm of the optic nerve (group A), nine were within 3.0 mm of the fovea (group B), and eight were within 3.0 mm of the optic nerve and fovea (group C). The mean follow-up of group A was 46.3 months; group B, 25.5 months; and group C, 42.7 months. Complications included macular edema, cataract and tumor growth. Visual acuity remained within two lines of that tested preoperatively for 4 of 11 patients in group A, 4 of 9 in group B, and 5 of 8 in group C. These results with iodine-125 suggest it as an appropriate treatment for patients with choroidal melanoma located near optic nerve and/or macula

Iodine-125 radiation of posterior uveal melanoma

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Packer, S.

1987-12-01

Twenty-eight cases of posterior choroidal melanoma were treated with iodine-125 in gold eye plaques. Eleven cases were located within 3.0 mm of the optic nerve (group A), nine were within 3.0 mm of the fovea (group B), and eight were within 3.0 mm of the optic nerve and fovea (group C). The mean follow-up of group A was 46.3 months; group B, 25.5 months; and group C, 42.7 months. Complications included macular edema, cataract and tumor growth. Visual acuity remained within two lines of that tested preoperatively for 4 of 11 patients in group A, 4 of 9 in group B, and 5 of 8 in group C. These results with iodine-125 suggest it as an appropriate treatment for patients with choroidal melanoma located near optic nerve and/or macula.

MR imaging of the cranial nerves and the intracranial vessels using 3D-SPGR

International Nuclear Information System (INIS)

Hosoya, Takaaki; Sato, Nami; Yamaguchi, Koichi; Sugai, Yukio; Ogushi, Masatoshi; Kubota, Hisashi

1992-01-01

MR angiography (MRA) has developed rapidly, but it is still insufficient to demonstrate the detail of the intracranial vascular anatomy. We found that original images of MRA render more information than MRA images about not only intracranial vessels but also cranial nerves. We have tried to demonstrate cranial nerves and intracranial vessels on 26 patients and evaluated using real time reformation of original images of MRA. MR images were obtained by SPGR (3DFT) after injection of Gd-DTPA. The optic nerve, the oculomotor nerve, the trigeminal nerve, the facial nerve and the vestibulocochlear nerve were visualized clearly on almost patients and detectabilities of these nerves were 100%, 98%, 100%, 94% and 100%, respectively. The abducent nerve was also detectable in 76%. The trochlear nerve, which could not be observed by any modality, was detected at prepontine cistern in 10%. Arteries around brain stem such as the superior cerebellar artery (SCA), the anterior inferior cerebellar artery (AICA), the posterior inferior cerebellar artery (PICA) and the posterior communicating artery (PcomA) were clearly visible, and branching of these arteries and anatomical detail were completely coincide with angiogram on 12 patients. The basal vein of Rosenthal and the petrosal vein were confirmed in 100% and their anastomose were demonstrated obviously. We concluded that this method was extremely useful to observe cranial nerves and intracranial small vessels. (author)

Hypoglossal Nerve Palsy After Cervical Spine Surgery.

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Ames, Christopher P; Clark, Aaron J; Kanter, Adam S; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

2017-04-01

Multi-institutional retrospective study. The goal of the current study is to quantify the incidence of 2 extremely rare complications of cervical spine surgery; hypoglossal and glossopharyngeal nerve palsies. A total of 8887 patients who underwent cervical spine surgery from 2005 to 2011 were included in the study from 21 institutions. No glossopharyngeal nerve injuries were reported. One hypoglossal nerve injury was reported after a C3-7 laminectomy (0.01%). This deficit resolved with conservative management. The rate by institution ranged from 0% to 1.28%. Although not directly injured by the surgical procedure, the transient nerve injury might have been related to patient positioning as has been described previously in the literature. Hypoglossal nerve injury during cervical spine surgery is an extremely rare complication. Institutional rates may vary. Care should be taken during posterior cervical surgery to avoid hyperflexion of the neck and endotracheal tube malposition.

Levels of Bifurcation of the Sciatic Nerve among Ugandans at ...

African Journals Online (AJOL)

Background: The sciatic nerve is derived from the lumbo-sacral plexus, It is the thickest nerve in the whole body, it exits the gluteal region through the lower part of the greater sciatic foramen, it is the main innervator of the posterior thigh, the leg and foot, it usually ends halfway down the back of the thigh by dividing into the ...

Lumbar posterior marginal intra-osseous cartilaginous node

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Laredo, J.D.; Bard, M.; Chretien, J.; Kahn, M.F.

1986-03-01

This report concerns 12 patients, eight young adults and four adolescents, presenting with lumbar or sciatic pain. This was associated with an unusual defect of the inferior and posterior edges of the vertebral bodies of L4 or L5, together with a small bony ridge protruding into the spinal canal. We found 11 similar cases in the literature, all involving adolescents except for one young adult. It has been considered to be the result of a fracture of the posterior ring apophysis in association with a herniated disc. In our cases, in the absence of any known previous trauma, the radiological features and surgical results and the similarity and frequent association with typical lesions of Scheuermann disease, all suggest a posterior marginal cartilaginous node. The inferior lumbar location and frequent association with herniated disc and sciatic nerve root compression in young patients are discussed.

Lumbar posterior marginal intra-osseous cartilaginous node

International Nuclear Information System (INIS)

Laredo, J.D.; Bard, M.; Chretien, J.; Kahn, M.F.

1986-01-01

This report concerns 12 patients, eight young adults and four adolescents, presenting with lumbar or sciatic pain. This was associated with an unusual defect of the inferior and posterior edges of the vertebral bodies of L4 or L5, together with a small bony ridge protruding into the spinal canal. We found 11 similar cases in the literature, all involving adolescents except for one young adult. It has been considered to be the result of a fracture of the posterior ring apophysis in association with a herniated disc. In our cases, in the absence of any known previous trauma, the radiological features and surgical results and the similarity and frequent association with typical lesions of Scheuermann disease, all suggest a posterior marginal cartilaginous node. The inferior lumbar location and frequent association with herniated disc and sciatic nerve root compression in young patients are discussed. (orig.)

Photodocumentation of the Development of Type I Posterior Glottic Stenosis after Intubation Injury

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Nelson Scott Howard

2015-01-01

Full Text Available Bilateral vocal fold immobility may result from bilateral recurrent laryngeal nerve paralysis or physiologic insults to the airway such as glottic scars. The progression of mucosal injury to granulation tissue, and then posterior glottis stenosis, is an accepted theory but has not been photodocumented. This paper presents serial images from common postintubation injury to less common posterior glottic stenosis with interarytenoid synechia.

Fast imaging employing steady-state acquisition (FIESTA) MRI to investigate cerebrospinal fluid (CSF) within dural reflections of posterior fossa cranial nerves.

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Noble, David J; Scoffings, Daniel; Ajithkumar, Thankamma; Williams, Michael V; Jefferies, Sarah J

2016-11-01

There is no consensus approach to covering skull base meningeal reflections-and cerebrospinal fluid (CSF) therein-of the posterior fossa cranial nerves (CNs VII-XII) when planning radiotherapy (RT) for medulloblastoma and ependymoma. We sought to determine whether MRI and specifically fast imaging employing steady-state acquisition (FIESTA) sequences can answer this anatomical question and guide RT planning. 96 posterior fossa FIESTA sequences were reviewed. Following exclusions, measurements were made on the following scans for each foramen respectively (left, right); internal acoustic meatus (IAM) (86, 84), jugular foramen (JF) (83, 85) and hypoglossal canal (HC) (42, 45). A protocol describes measurement procedure. Two observers measured distances for five cases and agreement was assessed. One observer measured all the remaining cases. IAM and JF measurement interobserver variability was compared. Mean measurement difference between observers was -0.275 mm (standard deviation 0.557). IAM and JF measurements were normally distributed. Mean IAM distance was 12.2 mm [95% confidence interval (CI) 8.8-15.6]; JF was 7.3 mm (95% CI 4.0-10.6). The HC was difficult to visualize on many images and data followed a bimodal distribution. Dural reflections of posterior fossa CNs are well demonstrated by FIESTA MRI. Measuring CSF extension into these structures is feasible and robust; mean CSF extension into IAM and JF was measured. We plan further work to assess coverage of these structures with photon and proton RT plans. Advances in knowledge: We have described CSF extension beyond the internal table of the skull into the IAM, JF and HC. Oncologists planning RT for patients with medulloblastoma and ependymoma may use these data to guide contouring.

A Novel Rodent Model of Posterior Ischemic Optic Neuropathy

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Wang, Yan; Brown, Dale P.; Duan, Yuanli; Kong, Wei; Watson, Brant D.; Goldberg, Jeffrey L.

2014-01-01

Objectives To develop a reliable, reproducible rat model of posterior ischemic optic neuropathy (PION) and study the cellular responses in the optic nerve and retina. Methods Posterior ischemic optic neuropathy was induced in adult rats by photochemically induced ischemia. Retinal and optic nerve vasculature was examined by fluorescein isothiocyanate–dextran extravasation. Tissue sectioning and immunohistochemistry were used to investigate the pathologic changes. Retinal ganglion cell survival at different times after PION induction, with or without neurotrophic application, was quantified by fluorogold retrograde labeling. Results Optic nerve injury was confirmed after PION induction, including local vascular leakage, optic nerve edema, and cavernous degeneration. Immunostaining data revealed microglial activation and focal loss of astrocytes, with adjacent astrocytic hypertrophy. Up to 23%, 50%, and 70% retinal ganglion cell loss was observed at 1 week, 2 weeks, and 3 weeks, respectively, after injury compared with a sham control group. Experimental treatment by brain-derived neurotrophic factor and ciliary neurotrophic factor remarkably prevented retinal ganglion cell loss in PION rats. At 3 weeks after injury, more than 40% of retinal ganglion cells were saved by the application of neurotrophic factors. Conclusions Rat PION created by photochemically induced ischemia is a reproducible and reliable animal model for mimicking the key features of human PION. Clinical Relevance The correspondence between the features of this rat PION model to those of human PION makes it an ideal model to study the pathophysiologic course of the disease, most of which remains to be elucidated. Furthermore, it provides an optimal model for testing therapeutic approaches for optic neuropathies. PMID:23544206

Pleural malignant mesothelioma causing cord infiltration through the nerve root. Case report.

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Okura, Hidehiro; Suga, Yasuo; Akiyama, Osamu; Kudo, Kentaro; Tsutsumi, Satoshi; Abe, Yusuke; Yasumoto, Yukimasa; Ito, Masanori; Izumi, Hiroshi; Shiomi, Kazu

2009-04-01

A 61-year-old man presented with a rare pleural malignant mesothelioma of the spine manifesting as progressive weakness of the bilateral lower extremities, numbness in the body and both legs, and dysfunction of the bladder and bowel. He had previous occupational exposure to asbestos while working at a car repair shop and had undergone right panpleuropneumonectomy under a diagnosis of sarcomatous type mesothelioma in the right pleural space. Magnetic resonance imaging of the spine with gadolinium showed an enhanced intramedullary tumor at the T4 level. Operative findings disclosed the clouded and swollen right posterior nerve root, and the pial surface was covered by clouded arachnoid-like membrane. The removed part of the T4 posterior nerve root and intramedullary tumor revealed malignant mesothelioma with invasion spreading along the posterior nerve root. He died of respiratory failure 3 months after the diagnosis. This case shows that spinal metastasis must be considered if a patient with pleural malignant mesothelioma shows neurological worsening and neuroimaging shows an abnormal lesion in the thoracic spinal cord. However, the patient's neurological condition is very difficult to improve in the presence of spinal cord infiltration.

CT anatomy of right phrenic nerve and pulmonary ligament

International Nuclear Information System (INIS)

Berkmen, Y.M.; Kazam, E.; Auh, Y.

1988-01-01

The relationship between the right phrenic nerve and the right pulmonary ligament was studied in eight cadavers and 100 computed tomographic (CT) examinations. The pulmonary ligament originates below the inferior pulmonary vein and is constantly posterior to the inferior vena cava. The lower end of the right phrenic nerve, on the other hand, descends over the lateral surface of the inferior vena cava, accompanied by the right cardiophrenic artery. The nerve spreads over the diaphragm within a thick parietal pleural fold, wrapped in a fatty tissue, and this should not be confused with pulmonary ligament on CT

Modeling the Effects of Spaceflight on the Posterior Eye in VIIP

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Ethier, C. R.; Feola, A. J.; Raykin, J.; Mulugeta, L.; Gleason, R.; Myers, J. G.; Nelson, E. S.; Samuels, B.

2015-01-01

Purpose: Visual Impairment and Intracranial Pressure (VIIP) syndrome is a new and significant health concern for long-duration space missions. Its etiology is unknown, but is thought to involve elevated intracranial pressure (ICP)that induces connective tissue changes and remodeling in the posterior eye (Alexander et al. 2012). Here we study the acute biomechanical response of the lamina cribrosa (LC) and optic nerve to elevations in ICP utilizing finite element (FE) modeling. Methods: Using the geometry of the posterior eye from previous axisymmetric FE models (Sigal et al. 2004), we added an elongated optic nerve and optic nerve sheath, including the pia and dura. Tissues were modeled as linear elastic solids. Intraocular pressure and central retinal vessel pressures were set at 15 mmHg and 55 mmHg, respectively. ICP varied from 0 mmHg (suitable for standing on earth) to 30 mmHg (representing severe intracranial hypertension, thought to occur in space flight). We focused on strains and deformations in the LC and optic nerve (within 1 mm of the LC) since we hypothesize that they may contribute to vision loss in VIIP. Results: Elevating ICP from 0 to 30 mmHg significantly altered the strain distributions in both the LC and optic nerve (Figure), notably leading to more extreme strain values in both tension and compression. Specifically, the extreme (95th percentile) tensile strains in the LC and optic nerve increased by 2.7- and 3.8-fold, respectively. Similarly, elevation of ICP led to a 2.5- and 3.3-fold increase in extreme (5th percentile) compressive strains in the LC and optic nerve, respectively. Conclusions: The elevated ICP thought to occur during spaceflight leads to large acute changes in the biomechanical environment of the LC and optic nerve, and we hypothesize that such changes can activate mechanosensitive cells and invoke tissue remodeling. These simulations provide a foundation for more comprehensive studies of microgravity effects on human vision, e

Intermuscular aponeuroses between the flexor muscles of the forearm and their relationships with the ulnar nerve.

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Won, Hyung-Sun; Liu, Hong-Fu; Kim, Jun-Ho; Kwak, Dai-Soon; Chung, In-Hyuk; Kim, In-Beom

2016-12-01

The aim of this study was to clarify the morphological characteristics of the intermuscular aponeurosis between the flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS; IMAS), and that between the FCU and flexor digitorum profundus (FDP; IMAP), and their topographic relationships with the ulnar nerve. Fifty limbs of 38 adult cadavers were studied. The IMAS extended along the deep surface of the FCU adjoining the FDS, having the appearance of a ladder, giving off "steps" that decreased in width from superficial to deep around the middle of the forearm. Its proximal part divided into two bands connected by a thin membrane, and was attached to the medial epicondyle and the tubercle (the most medial prominent part of the coronoid process of the ulna), respectively. The IMAP extended deep between the FCU and FDP from the antebrachial fascia, and its distal end was located on the posterior border of the FCU. The IMAP became broader toward its proximal part, and its proximal end was attached anterior and posterior to the tubercle and the olecranon, respectively. The ulnar nerve passed posterior to the medial epicondyle and then medial to the tubercle, and was crossed by the deep border of the IMAS at 58.3 ± 14.1 mm below the medial epicondyle. The deep border of the IMAS and aberrant tendinous structure passing across the ulnar nerve, or the parts of the IMAS and IMAP passing posterior to the ulnar nerve are potential causes of ulnar nerve compression.

Surgical anatomy of the styloid muscles and the extracranial glossopharyngeal nerve.

Science.gov (United States)

Prades, J M; Gavid, M; Asanau, A; Timoshenko, A P; Richard, C; Martin, C H

2014-03-01

The purpose of the study was to determine the relationships between the extracranial glossopharyngeal (IX) nerve and the muscles of the styloid diaphragm. In humans, the IX nerve is a hidden retrostyloid nerve which plays a critical role notably in swallowing and has to be preserved during infratemporal fossa and parapharyngeal spaces surgical procedures. In ten adult heads from cadavers (20 sides) fixed in formalin, dissection of the extracranial IX nerve was performed under operating microscope with special attention given to the relationships between this nerve and the styloid muscles of the styloid diaphragm. The three styloid muscles delimit three triangular intermuscular intervals which were each thoroughly explored. Different osseous landmarks were investigated for easy nerve location. The styloid process (SP) is the main superior osseous landmark for the three muscles of the styloid diaphragm. The stylohyoid muscle (SHM) is anteromedially located to the posterior belly of the digastric muscle. The styloglossus muscle (SGM) is medial and anterior to the SHM. The stylopharyngeal muscle (SPM) is the most vertical and medial of the three styloid muscles. It courses from the medial surface of the SP in a deep plane hidden between the SHM and the SGM. The extracranial IX nerve turns around the SPM superiorly with a vertical segment posterior to the SPM and inferiorly with a horizontal segment lateral to the SPM. The meeting point of the two segments of the IX nerve is about 10 mm anteriorly located from the transverse process of the atlas. The external carotid artery and some of its branches lie in contact with the lateral side of the IX nerve. Such relationships between the extracranial IX nerve, the styloid muscles and the transverse process of the atlas should be appreciated by clinician who treats patients with stylohyoid complex syndromes and by the surgeon for the parapharyngeal spaces approach.

Forearm interosseous membrane imaging and anatomy

International Nuclear Information System (INIS)

McGinley, Joseph C.; Roach, Neil; Gaughan, John P.; Kozin, Scott H.

2004-01-01

To determine the regional thickness variation of the interosseous membrane (IOM) along the forearm and validate magnetic resonance imaging of the IOM with laser micrometry. Axial thickness measurements of 12 cadaver forearms were obtained using magnetic resonance imaging (MRI) at radial, central, and ulnar locations. The specimens were dissected, and IOM thickness measured using a laser micrometer. MRI and laser measurements of the main and oblique IOM bundles were compared. An axial thickness profile was plotted versus forearm length, and radial, central, and ulnar positions were compared. The main bundle thickness was 2.18±0.20 mm using laser micrometry, which was not significantly different from MRI measurements (1.86±0.25 mm, p=0.11, power = 0.84). The dorsal oblique bundle thickness was not significantly different between measurement methods (2.93±0.77 mm and 3.30±1.64 mm using laser micrometry and MRI respectively, p=0.75, power = 0.04). Both methods demonstrated a progressive increase in thickness proximally within the forearm. MRI measurements demonstrated a significantly greater thickness increase in the radial location compared to the central location (slope = 2.26 and 1.05, r 2 =0.31 and 0.12 respectively, p 2 =0.02, p>0.05). Our findings describe the varying IOM anatomy using MRI, and determined the location of the clinically important IOM fiber bundles. This study confirms the accuracy of MR imaging of the IOM by comparison with a laser micrometer, and demonstrates the thickness variation along the forearm. This information may be used to identify changes in IOM anatomy with both acute IOM injury and chronic fiber attenuation. (orig.)

Forearm interosseous membrane imaging and anatomy.

Science.gov (United States)

McGinley, Joseph C; Roach, Neil; Gaughan, John P; Kozin, Scott H

2004-10-01

To determine the regional thickness variation of the interosseous membrane (IOM) along the forearm and validate magnetic resonance imaging of the IOM with laser micrometry. Axial thickness measurements of 12 cadaver forearms were obtained using magnetic resonance imaging (MRI) at radial, central, and ulnar locations. The specimens were dissected, and IOM thickness measured using a laser micrometer. MRI and laser measurements of the main and oblique IOM bundles were compared. An axial thickness profile was plotted versus forearm length, and radial, central, and ulnar positions were compared. The main bundle thickness was 2.18+/-0.20 mm using laser micrometry, which was not significantly different from MRI measurements (1.86+/-0.25 mm, p=0.11, power = 0.84). The dorsal oblique bundle thickness was not significantly different between measurement methods (2.93+/-0.77 mm and 3.30+/-1.64 mm using laser micrometry and MRI respectively, p=0.75, power = 0.04). Both methods demonstrated a progressive increase in thickness proximally within the forearm. MRI measurements demonstrated a significantly greater thickness increase in the radial location compared to the central location (slope = 2.26 and 1.05, r(2)=0.31 and 0.12 respectively, p0.05). Our findings describe the varying IOM anatomy using MRI, and determined the location of the clinically important IOM fiber bundles. This study confirms the accuracy of MR imaging of the IOM by comparison with a laser micrometer, and demonstrates the thickness variation along the forearm. This information may be used to identify changes in IOM anatomy with both acute IOM injury and chronic fiber attenuation.

Percutaneous tibial nerve stimulation vs sacral nerve stimulation for faecal incontinence: a comparative case-matched study.

Science.gov (United States)

Al Asari, S; Meurette, G; Mantoo, S; Kubis, C; Wyart, V; Lehur, P-A

2014-11-01

The study assessed the initial experience with posterior tibial nerve stimulation (PTNS) for faecal incontinence and compared it with sacral nerve stimulation (SNS) performed in a single centre during the same timespan. A retrospective review of a prospectively collected database was conducted at the colorectal unit, University Hospital, Nantes, France, from May 2009 to December 2010. Seventy-eight patients diagnosed with chronic severe faecal incontinence underwent neurostimulation including PTNS in 21 and SNS in 57. The main outcome measures were faecal incontinence (Wexner score) and quality of life (Fecal Incontinence Quality of Life, FIQL) scores in a short-term follow-up. No significant differences were observed in patients' characteristics. Of 57 patients having SNS, 18 (32%) failed peripheral nerve evaluation and 39 (68%) received a permanent implant. Two (5%) developed a wound infection. No adverse effects were recorded in the PTNS group. There was no significant difference in the mean Wexner and FIQL scores between patients having PTNS and SNS at 6 (P = 0.39 and 0.09) and 12 months (P = 0.79 and 0.37). A 50% or more improvement in Wexner score was seen at 6 and 12 months in 47% and 30% of PTNS patients and in 50% and 58% of SNS patients with no significant difference between the groups. Posterior tibial nerve stimulation is a valid method of treating faecal incontinence in the short term when conservative treatment has failed. It is easier, simpler, cheaper and less invasive than SNS with a similar short-term outcome. Colorectal Disease © 2014 The Association of Coloproctology of Great Britain and Ireland.

Nerve canals at the fundus of the internal auditory canal on high-resolution temporal bone CT

International Nuclear Information System (INIS)

Ji, Yoon Ha; Youn, Eun Kyung; Kim, Seung Chul

2001-01-01

To identify and evaluate the normal anatomy of nerve canals in the fundus of the internal auditory canal which can be visualized on high-resolution temporal bone CT. We retrospectively reviewed high-resolution (1 mm thickness and interval contiguous scan) temporal bone CT images of 253 ears in 150 patients who had not suffered trauma or undergone surgery. Those with a history of uncomplicated inflammatory disease were included, but those with symptoms of vertigo, sensorineural hearing loss, or facial nerve palsy were excluded. Three radiologists determined the detectability and location of canals for the labyrinthine segment of the facial, superior vestibular and cochlear nerve, and the saccular branch and posterior ampullary nerve of the inferior vestibular nerve. Five bony canals in the fundus of the internal auditory canal were identified as nerve canals. Four canals were identified on axial CT images in 100% of cases; the so-called singular canal was identified in only 68%. On coronal CT images, canals for the labyrinthine segment of the facial and superior vestibular nerve were seen in 100% of cases, but those for the cochlear nerve, the saccular branch of the inferior vestibular nerve, and the singular canal were seen in 90.1%, 87.4% and 78% of cases, respectiveIy. In all detectable cases, the canal for the labyrinthine segment of the facial nerve was revealed as one which traversed anterolateralIy, from the anterosuperior portion of the fundus of the internal auditory canal. The canal for the cochlear nerve was located just below that for the labyrinthine segment of the facial nerve, while that canal for the superior vestibular nerve was seen at the posterior aspect of these two canals. The canal for the saccular branch of the inferior vestibular nerve was located just below the canal for the superior vestibular nerve, and that for the posterior ampullary nerve, the so-called singular canal, ran laterally or posteolateralIy from the posteroinferior aspect of

Nerve canals at the fundus of the internal auditory canal on high-resolution temporal bone CT

Energy Technology Data Exchange (ETDEWEB)

Ji, Yoon Ha; Youn, Eun Kyung; Kim, Seung Chul [Sungkyunkwan Univ., School of Medicine, Seoul (Korea, Republic of)

2001-12-01

To identify and evaluate the normal anatomy of nerve canals in the fundus of the internal auditory canal which can be visualized on high-resolution temporal bone CT. We retrospectively reviewed high-resolution (1 mm thickness and interval contiguous scan) temporal bone CT images of 253 ears in 150 patients who had not suffered trauma or undergone surgery. Those with a history of uncomplicated inflammatory disease were included, but those with symptoms of vertigo, sensorineural hearing loss, or facial nerve palsy were excluded. Three radiologists determined the detectability and location of canals for the labyrinthine segment of the facial, superior vestibular and cochlear nerve, and the saccular branch and posterior ampullary nerve of the inferior vestibular nerve. Five bony canals in the fundus of the internal auditory canal were identified as nerve canals. Four canals were identified on axial CT images in 100% of cases; the so-called singular canal was identified in only 68%. On coronal CT images, canals for the labyrinthine segment of the facial and superior vestibular nerve were seen in 100% of cases, but those for the cochlear nerve, the saccular branch of the inferior vestibular nerve, and the singular canal were seen in 90.1%, 87.4% and 78% of cases, respectiveIy. In all detectable cases, the canal for the labyrinthine segment of the facial nerve was revealed as one which traversed anterolateralIy, from the anterosuperior portion of the fundus of the internal auditory canal. The canal for the cochlear nerve was located just below that for the labyrinthine segment of the facial nerve, while that canal for the superior vestibular nerve was seen at the posterior aspect of these two canals. The canal for the saccular branch of the inferior vestibular nerve was located just below the canal for the superior vestibular nerve, and that for the posterior ampullary nerve, the so-called singular canal, ran laterally or posteolateralIy from the posteroinferior aspect of

Complete Spinal Accessory Nerve Palsy From Carrying Climbing Gear.

Science.gov (United States)

Coulter, Jess M; Warme, Winston J

2015-09-01

We report an unusual case of spinal accessory nerve palsy sustained while transporting climbing gear. Spinal accessory nerve injury is commonly a result of iatrogenic surgical trauma during lymph node excision. This particular nerve is less frequently injured by blunt trauma. The case reported here results from compression of the spinal accessory nerve for a sustained period-that is, carrying a load over the shoulder using a single nylon rope for 2.5 hours. This highlights the importance of using proper load-carrying equipment to distribute weight over a greater surface area to avoid nerve compression in the posterior triangle of the neck. The signs and symptoms of spinal accessory nerve palsy and its etiology are discussed. This report is particularly relevant to individuals involved in mountaineering and rock climbing but can be extended to anyone carrying a load with a strap over one shoulder and across the body. Copyright © 2015 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

Bloqueio do plexo braquial pela via posterior com uso de neuroestimulador e ropivacaína a 0,5% Bloqueo del plexo braquial por la vía posterior con el uso de neuroestimulador y ropivacaína a 0,5% Posterior brachial plexus block with nerve stimulator and 0.5% ropivacaine

Directory of Open Access Journals (Sweden)

Lúcia Beato

2005-08-01

ícula y húmero proximal. El objetivo de este estudio fue mostrar los resultados observados en pacientes sometidos a bloqueo del plexo braquial por la vía posterior con el uso del neuroestimulador y ropivacaína a 0,5%. MÉTODO: Veintidós pacientes con edad entre 17 y 76 años, estado físico ASA I y II, sometidos a cirugías ortopédicas envolviendo el hombro, clavícula y húmero proximal fueron anestesiados con bloqueo de plexo braquial por la vía posterior utilizando neuroestimulador desde 1 mA. Lograda la contracción deseada, la corriente fue disminuida para 0,5 MA y, permaneciendo la respuesta contráctil, fueron inyectados 40 mL de ropivacaína a 0,5%. Fueron evaluados los siguientes parámetros: latencia, analgesia, duración de la cirugía, duración de la analgesia y del bloqueo motor, complicaciones y efectos colaterales. RESULTADOS: El bloqueo fue efectivo en 20 de los 22 pacientes; la latencia media fue de 15,52 min; la duración media de la cirugía fue de 1,61 hora. La media de duración de la analgesia fue de 15,85 horas y del bloqueo motor 11,16 horas. No fueron observados señales y síntomas clínicos de toxicidad del anestésico local y ningún paciente presentó efectos adversos del bloqueo. CONCLUSIONES: En las condiciones de este estudio el bloqueo del plexo braquial por la vía posterior con el uso del neuroestimulador y ropivacaína a 0,5% demostró que es una técnica efectiva, confortable para el paciente y de fácil realización.BACKGROUND AND OBJECTIVES: There are several approaches to the brachial plexus depending on the experience of the anesthesiologist and the site of the surgery. Posterior brachial plexus block may be an alternative for shoulder, clavicle and proximal humerus surgery. This study aims at presenting the results of patients submitted to posterior brachial plexus block with 0.5% ropivacaine and the aid of nerve stimulator. METHODS: Participated in this study 22 patients aged 17 to 76 years, physical status ASA I and II

Normal computed tomographic anatomy of the cisterns and cranial nerves

International Nuclear Information System (INIS)

Manelfe, C.; Bonafe, A.

1980-01-01

This study, based on the normal CT anatomy of the cisterns investigated with Metrizamide, aims at attempting to find out with accuracy which plane of section is the most suitable for the investigation of each group of cisterns (posterior fossa, mesencephalon, suprasellar). Moreover we felt it necessary to include our study the normal appearance of the cranial nerves as their normal CT anatymy - optic nerves expected - is not well known yet. (orig./AJ) [de

Bilateral posterior tarsal tunnel syndrome caused by accessory flexor digitorum longus; case report and surgical technique.

Science.gov (United States)

Schmidt-Hebbel, A; Elgueta, J; Villa, A; Mery, P; Filippi, J

To present a case report of bilateral posterior tarsal tunnel syndrome (PTTS) caused by an accessory flexor digitorum longus (AFDL), including the surgical technique and a review of the literature. Twenty-nine year old male diagnosed with bilateral PTTS, refractory to conservative management, with 53 points on the preoperative AOFAS score. MR of both ankles showed an AFDL within the tarsal tunnel, in close relationship to the posterior tibial nerve. Bilateral tarsal tunnel decompression and AFDL resection was performed. There were no post-operative complications. At 6 months after surgery, the patient had no pain and had 87 points on the AOFAS score. The PTTS is an entrapment neuropathy of the posterior tibial nerve or one of its terminal branches. A rare cause is the presence of an AFDL, and its resection is associated with good clinical results. Careful scar tissue resection and neurolysis is recommended. Knowing the normal pathway and anatomical variability of the posterior tibial nerve and its branches is essential to avoid iatrogenic injury. In our case report, MR and intraoperative findings identified a bilateral FDLA in close relationship to the common flexor digitorum, an unusual finding, with few reports in current literature. Careful tarsal tunnel decompression and AFDL resection in our patient with bilateral symptomatic PTTS has good clinical results and no complications, particularly when diagnosed and treated early. Copyright © 2015 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

Forearm interosseous membrane imaging and anatomy

Energy Technology Data Exchange (ETDEWEB)

McGinley, Joseph C. [Temple University, School of Medicine, Philadelphia, Pennsylvania (United States); Roach, Neil [Hospital of the University of Pennsylvania, Department of Radiology, Philadelphia, Pennsylvania (United States); Gaughan, John P. [Temple University, Department of Biostatistics, Philadelphia, Pennsylvania (United States); Kozin, Scott H. [Shriners Hospitals for Children, Pediatric Hand and Upper Extremity Surgery, Philadelphia (United States); Temple University, Department of Orthopaedic Surgery, Philadelphia, Pennsylvania (United States)

2004-10-01

To determine the regional thickness variation of the interosseous membrane (IOM) along the forearm and validate magnetic resonance imaging of the IOM with laser micrometry. Axial thickness measurements of 12 cadaver forearms were obtained using magnetic resonance imaging (MRI) at radial, central, and ulnar locations. The specimens were dissected, and IOM thickness measured using a laser micrometer. MRI and laser measurements of the main and oblique IOM bundles were compared. An axial thickness profile was plotted versus forearm length, and radial, central, and ulnar positions were compared. The main bundle thickness was 2.18{+-}0.20 mm using laser micrometry, which was not significantly different from MRI measurements (1.86{+-}0.25 mm, p=0.11, power = 0.84). The dorsal oblique bundle thickness was not significantly different between measurement methods (2.93{+-}0.77 mm and 3.30{+-}1.64 mm using laser micrometry and MRI respectively, p=0.75, power = 0.04). Both methods demonstrated a progressive increase in thickness proximally within the forearm. MRI measurements demonstrated a significantly greater thickness increase in the radial location compared to the central location (slope = 2.26 and 1.05, r{sup 2}=0.31 and 0.12 respectively, p<0.05). The ulnar slope was not significantly different from zero (r{sup 2}=0.02, p>0.05). Our findings describe the varying IOM anatomy using MRI, and determined the location of the clinically important IOM fiber bundles. This study confirms the accuracy of MR imaging of the IOM by comparison with a laser micrometer, and demonstrates the thickness variation along the forearm. This information may be used to identify changes in IOM anatomy with both acute IOM injury and chronic fiber attenuation. (orig.)

Optic nerve head biomechanics in aging and disease.

Science.gov (United States)

Downs, J Crawford

2015-04-01

This nontechnical review is focused upon educating the reader on optic nerve head biomechanics in both aging and disease along two main themes: what is known about how mechanical forces and the resulting deformations are distributed in the posterior pole and ONH (biomechanics) and what is known about how the living system responds to those deformations (mechanobiology). We focus on how ONH responds to IOP elevations as a structural system, insofar as the acute mechanical response of the lamina cribrosa is confounded with the responses of the peripapillary sclera, prelaminar neural tissues, and retrolaminar optic nerve. We discuss the biomechanical basis for IOP-driven changes in connective tissues, blood flow, and cellular responses. We use glaucoma as the primary framework to present the important aspects of ONH biomechanics in aging and disease, as ONH biomechanics, aging, and the posterior pole extracellular matrix (ECM) are thought to be centrally involved in glaucoma susceptibility, onset and progression. Copyright © 2015 Elsevier Ltd. All rights reserved.

Effect of intraosseous injection versus inferior alveolar nerve block as primary pulpal anaesthesia of mandibular posterior teeth with symptomatic irreversible pulpitis: a prospective randomized clinical trial.

Science.gov (United States)

Farhad, Alireza; Razavian, Hamid; Shafiee, Maryam

2018-01-27

This study sought to assess the success rate, effect on blood pressure, and pain of intraosseous injection (IO) and inferior alveolar nerve block (IANB) for pulpal anaesthesia of mandibular posterior teeth with symptomatic irreversible pulpitis as the primary anaesthetic technique. This randomized clinical trial (IRCT2013022712634N1) was conducted on 60 patients between 18 and 65 years suffering from symptomatic irreversible pulpitis of a mandibular posterior tooth. Patients were randomly divided into two groups. Group one received IO while group two received IANB with 3% mepivacaine. After anaesthetic injection, success rate of pulpal anaesthesia was assessed by pulp testing in the two groups. Systolic and diastolic blood pressures of patients were compared before and after the anaesthetic injections. Level of pain during injection was scored using a visual analogue scale. The data were analyzed using SPSS version 20, t-test and chi square test at p = .05 level of significance. Success rate of IO (56.7%) was significantly higher than that of IANB (23.3%) (p = .008). There was no significant difference in pain during anaesthetic injection (p = .304) or change in systolic (p = .80) and diastolic (p = .28) blood pressures following injection between the two techniques. IO had a higher success rate than IANB for pulpal anaesthesia of mandibular posterior teeth with symptomatic irreversible pulpitis. Neither technique provided profound pulpal anaesthesia.

Phrenic nerve block caused by interscalene brachial plexus block: breathing effects of different sites of injection.

Science.gov (United States)

Bergmann, Lars; Martini, Stefan; Kesselmeier, Miriam; Armbruster, Wolf; Notheisen, Thomas; Adamzik, Michael; Eichholz, Rϋdiger

2016-07-29

Interscalene brachial plexus (ISB) block is often associated with phrenic nerve block and diaphragmatic paresis. The goal of our study was to test if the anterior or the posterior ultrasound guided approach of the ISB is associated with a lower incidence of phrenic nerve blocks and impaired lung function. This was a prospective, randomized and single-blinded study of 84 patients scheduled for elective shoulder surgery who fullfilled the inclusion and exclusion critereria. Patients were randomized in two groups to receive either the anterior (n = 42) or the posterior (n = 42) approach for ISB. Clinical data were recorded. In both groups patients received ISB with a total injection volume of 15 ml of ropivacaine 1 %. Spirometry was conducted at baseline (T0) and 30 min (T30) after accomplishing the block. Changes in spirometrical variables between T0 and T30 were investigated by Wilcoxon signed-rank test for each puncture approach. The temporal difference between the posterior and the anterior puncture approach groups were again analyzed by the Wilcoxon-Mann-Whitney test. The spirometric results showed a significant decrease in vital capacity, forced expiratory volume per second, and maximum nasal inspiratory breathing after the Interscalene brachial plexus block; indicating a phrenic nerve block (p Wilcoxon signed-rank). A significant difference in the development of the spirometric parameters between the anterior and the posterior group could not be identified (Wilcoxon-Mann-Whitney test). Despite the changes in spirometry, no cases of dyspnea were reported. A different site of injection (anterior or posterior) did not show an effect in reducing the cervical block spread of the local anesthetic and the incidence of phrenic nerve blocks during during ultrasound guided Interscalene brachial plexus block. Clinical breathing effects of phrenic nerve blocks are, however, usually well compensated, and subjective dyspnea did not occur in our patients. German

Roentgenological investigation of cavernous sinus structure with special reference to paracavernous cranial nerves

International Nuclear Information System (INIS)

Tsuha, M.; Aoki, H.; Okamura, T.

1987-01-01

We have evaluated the anatomical structure of cavernous sinuses in parasellar blocks obtained from adult cadavers to gain clinically useful information. Ten microdissectional studies of parasellar blocks (20 sides of cavernous sinus) were carried out with special emphasis on the course of paracavernous cranial nerves (3rd to 6th). These were also examined on plain radiographs. Secondly, CT investigations of the cavernous sinuses (notably as to paracavernous cranial nerves) were undertaken in twenty clinical cases having presumed parasellar lesions and in three parasellar blocks from cadavers. The results from microdisectional studies and plain radiographs were as follows. It was found that the 3rd cranial nerve entered the lateral wall of the cavernous sinus close to the antero-inferior part of the posterior clinoid on lateral projection. The 4th cranial nerve, on the other hand, entered near the postero-inferior portion of the posterior clinoid on the same view. Variations in Parkinson's triangle were fairly often noted, although marked asymmetry was not seen in individual cases. From CT findings, it was found that a postenhanced, magnified direct coronal study was essential for identifying paracavernous cranial nerves more clearly. The 3rd and 5th cranial nerves were fairly well identified on axial and coronal projections. Careful radiological investigation including plain skull radiographs and CT seems to be of value for those who diagnose or treat parasellar lesions. (orig.)

Intramuscular Distribution of the Abducens Nerve in the Lateral Rectus Muscle for the Management of Strabismus.

Science.gov (United States)

Shin, Hyun Jin; Lee, Shin-Hyo; Shin, Kang-Jae; Koh, Ki-Seok; Song, Wu-Chul

2018-06-01

To elucidate the intramuscular distribution and branching patterns of the abducens nerve in the lateral rectus (LR) muscle so as to provide anatomical confirmation of the presence of compartmentalization, including for use in clinical applications such as botulinum toxin injections. Thirty whole-mount human cadaver specimens were dissected and then Sihler's stain was applied. The basic dimensions of the LR and its intramuscular nerve distribution were investigated. The distances from the muscle insertion to the point at which the abducens nerve enters the LR and to the terminal nerve plexus were also measured. The LR was 46.0 mm long. The abducens nerve enters the muscle on the posterior one-third of the LR and then typically divides into a few branches (average of 1.8). This supports a segregated abducens nerve selectively innervating compartments of the LR. The intramuscular nerve distribution showed a Y-shaped ramification with root-like arborization. The intramuscular nerve course finished around the middle of the LR (24.8 mm posterior to the insertion point) to form the terminal nerve plexus. This region should be considered the optimal target site for botulinum toxin injections. We have also identified the presence of an overlapping zone and communicating nerve branches between the neighboring LR compartments. Sihler's staining is a useful technique for visualizing the entire nerve network of the LR. Improving the knowledge of the nerve distribution patterns is important not only for researchers but also clinicians to understand the functions of the LR and the diverse pathophysiology of strabismus.

Anterior Transfer of Tibialis Posterior through the Interosseous ...

African Journals Online (AJOL)

Postoperative plaster of Paris cast for 6 weeks and ankle foot orthosis were used. We evaluated for correction and ability of the transferred tendon to actively dorsiflex at the ankle joint. Nineteen patients had good results 8 fair and 3 poor there was no neurovascular deficit. The purpose of this paper is to outline our outcome ...

Use of a single bipolar electrode in the posterior arytenoid muscles for bilateral monitoring of the recurrent laryngeal nerves in thyroid surgery.

Science.gov (United States)

Haerle, Stephan; Sidler, D; Linder, Th; Mueller, W

2008-12-01

The aims were to assess the technical feasibility of using a single electrode in the posterior arytenoid muscles (PAM) for intraoperative monitoring of the recurrent laryngeal nerve (RLN) in thyroid surgery, to validate the new method against the insertion of electrodes placed in the vocal cord muscle, and to report the results of the clinical application of the new concept. A total of 52 patients were enrolled. The handling and safety of RLN monitoring was tested by simultaneous registration of the EMG response from vocal fold electrodes and PAM electrodes. Acoustically and electromyographically we found nearly the same values for the arytenoid muscles as for the vocal folds, although the signals taken from the vocal folds were slightly stronger. PAM recording using a single bipolar electrode is technically feasible and as reliable compared to the standard vocal cord monitoring.

Anatomical study of the motor branches of the median nerve to the forearm and guidelines for selective neurectomy.

Science.gov (United States)

Parot, Catalina; Leclercq, Caroline

2016-07-01

The median nerve is responsible for the motor innervation of most of the muscles usually involved in upper limb spasticity. Selective neurectomy is one of the treatments utilized to reduce spasticity. The purpose of this study was to describe the variations of the motor branches of the median nerve in the forearm and draw recommendations for an appropriate planning of selective neurectomy. The median nerve was dissected in the forearm of 20 fresh cadaver upper limbs. Measurements included number, origin, division, and entry point of each motor branch into the muscles. One branch for the pronator teres was the most common pattern. In 9/20 cases, it arose as a common trunk with other branches. A single trunk innervated the flexor carpi radialis with a common origin with other branches in 17/20 cases. Two, three or four branches innervated the flexor digitorum superficialis, the first one frequently through a common trunk with other branches. They were very difficult to identify unless insertions of pronator teres and flexor digitorum superficialis were detached. The flexor digitorum profundus received one to five branches and flexor pollicis longus one to two branches from the anterior interosseous nerve. There is no regular pattern of the motor branches of the median nerve in the forearm. Our findings differ in many points from the classical literature. Because of the frequency of common trunks for different muscles, we recommend the use of peroperative electrical stimulation. Selective neurotomy of flexor digitorum superficialis is technically difficult, because the entry point of some of their terminal branches occurs just below the arch and deep to the muscle belly.

Peripheral origins and functional characteristics of vibration-sensitive VIIIth nerve fibers in the frog Rana temporaria

DEFF Research Database (Denmark)

Jøgensen, Morten Buhl; Christensen-Dalsgaard, Jakob

1991-01-01

were studied. 2) Vibration-sensitive fibers were found in both the anterior and posterior branch of the VIIIth nerve. 3) No vibration-sensitive fibers were found in the lagenar nerve. 4) The vibration-sensitive fibers in the posterior branch probably innervated the amphibian papilla and many...... of these fibers also responded to low-frequency sound. 5) The vibration-sensitive fibers in the anterior branch probably innervated the sacculus and the utriculus. 6) Hence, the grassfrog has at least two, and probably three, vibration-sensitive organs in the inner ear. 7) All fibers had V-shaped vibrational...... tuning curves. In the posterior branch best frequencies (BFs) ranged from 10 to 300 Hz, in the anterior branch from 10 to 100 Hz. In the posterior branch spike-rate thresholds at BF ranged from 0.04 to 1.28 cm/s2, in the anterior branch from 0.02 to 1.28 cm/s2. All fibers showed strong synchronization...

MR imaging of the cisternal segment of the posterior group of cranial nerves: Neurovascular relationships and abnormal changes

Energy Technology Data Exchange (ETDEWEB)

Liang Changhu, E-mail: tigerlch@163.co [Shandong University, Shandong Medical Imaging Research Institute, CT Room, 324, Jingwu Road, Jinan, Shandong (China); Du Yinglin, E-mail: duyinglinzhuo@sohu.co [Shandong Provincial Center for Disease Control and Prevention, Public Health Institute, 72, Jingshi Road, Jinan, Shandong (China); Xu Jinfa, E-mail: xuke5598@icom.c [Liao Cheng City People' s Hospital, Dongchang Road, Liaocheng, Shandong (China); Wu Lebin, E-mail: Lebinwu518@163.co [Shandong University, Shandong Medical Imaging Research Institute, CT Room, 324, Jingwu Road, Jinan, Shandong (China); Liu Cheng, E-mail: cacab2a@126.co [Shandong University, Shandong Medical Imaging Research Institute, CT Room, 324, Jingwu Road, Jinan, Shandong (China); Wang Ximing, E-mail: wxming369@163.co [Shandong University, Shandong Medical Imaging Research Institute, CT Room, 324, Jingwu Road, Jinan, Shandong (China); Wang Haiyan, E-mail: whyott@163.co [Shandong University, Shandong Medical Imaging Research Institute, CT Room, 324, Jingwu Road, Jinan, Shandong (China); Yu Fuhua, E-mail: changhu1970@163.co [Weifang Medical College, 7166, West Road Baotong Weifang, Shandong (China)

2010-07-15

Objective: To evaluate the detailed anatomic features, neurovascular relationships of the cisternal segment of the posterior group of cranial nerves (PGCN: IX, X, XI, XII); to evaluate the utility of magnetic resonance (MR) in demonstrating the PGCN with disorders caused by abnormal compression related to artery or tumor. Methods: A total of 59 volunteers, 12 patients with abnormal symptom in the PGCN underwent three-dimensional (3D) Fourier transformation constructive interference in steady-state (CISS) MR imaging, and 22 of these volunteers and 12 patients also underwent MR angiography in which a time-of-flight (TOF) sequence was used to further distinguish the PGCN from the adjacent blood vessels. Anatomical features, neurovascular relationships of the PGCN in 59 volunteers and abnormal changes in 12 patients caused by neurovascular compression or tumor were observed from multi-planar reconstruction (MPR) images, cryomicrotome section and 3D-CISS MR imaging of cranial cadaver were used to testify the PGCN displayed in 59 volunteers. Results: 3D-CISS MR imaging depicted the proximal cisternal segment of the cranial nerves complex (CN IX, X, XI) at the oblique axial, sagittal planes in 100% (118/118), 99% (117/118) of 118 sides; CNXII in the oblique axial, sagittal planes in 90% (106/118), 91% (107/118) of 118 sides. At the sagittal planes, the CN IX, X, XI were found parallel to each other in the cisternal segment in 45.2% (53/117) of 117 sides, gathering into a bundle of nerves complex before entering the jugular foramen (JF) in 54.7% (64/117) of 117sides. VAs were blood vessels more often identified, they were found to be in contact with the PGCN in 28.0% (33/118) of 118 sides, and not in contact in 72.0% (85/118) of 118 sides. 3D-CISS MR imaging of volunteers revealed the similar result corresponding to cryomicrotome section and 3D-CISS MR imaging of cranial cadaver. Twelve patients with abnormal changes in the PGCN were all displayed well, among them 8 were

MR imaging of the cisternal segment of the posterior group of cranial nerves: Neurovascular relationships and abnormal changes

International Nuclear Information System (INIS)

Liang Changhu; Du Yinglin; Xu Jinfa; Wu Lebin; Liu Cheng; Wang Ximing; Wang Haiyan; Yu Fuhua

2010-01-01

Objective: To evaluate the detailed anatomic features, neurovascular relationships of the cisternal segment of the posterior group of cranial nerves (PGCN: IX, X, XI, XII); to evaluate the utility of magnetic resonance (MR) in demonstrating the PGCN with disorders caused by abnormal compression related to artery or tumor. Methods: A total of 59 volunteers, 12 patients with abnormal symptom in the PGCN underwent three-dimensional (3D) Fourier transformation constructive interference in steady-state (CISS) MR imaging, and 22 of these volunteers and 12 patients also underwent MR angiography in which a time-of-flight (TOF) sequence was used to further distinguish the PGCN from the adjacent blood vessels. Anatomical features, neurovascular relationships of the PGCN in 59 volunteers and abnormal changes in 12 patients caused by neurovascular compression or tumor were observed from multi-planar reconstruction (MPR) images, cryomicrotome section and 3D-CISS MR imaging of cranial cadaver were used to testify the PGCN displayed in 59 volunteers. Results: 3D-CISS MR imaging depicted the proximal cisternal segment of the cranial nerves complex (CN IX, X, XI) at the oblique axial, sagittal planes in 100% (118/118), 99% (117/118) of 118 sides; CNXII in the oblique axial, sagittal planes in 90% (106/118), 91% (107/118) of 118 sides. At the sagittal planes, the CN IX, X, XI were found parallel to each other in the cisternal segment in 45.2% (53/117) of 117 sides, gathering into a bundle of nerves complex before entering the jugular foramen (JF) in 54.7% (64/117) of 117sides. VAs were blood vessels more often identified, they were found to be in contact with the PGCN in 28.0% (33/118) of 118 sides, and not in contact in 72.0% (85/118) of 118 sides. 3D-CISS MR imaging of volunteers revealed the similar result corresponding to cryomicrotome section and 3D-CISS MR imaging of cranial cadaver. Twelve patients with abnormal changes in the PGCN were all displayed well, among them 8 were

Schwannoma of the Recurrent Laryngeal Nerve : A Rare Entity

NARCIS (Netherlands)

de Heer, Linda M; Teding van Berkhout, F; Priesterbach, Loudy; Buijsrogge, Marc P

Neurogenic tumors are the most common posterior mediastinal tumors in adults. Schwannomas originating from the recurrent laryngeal nerve are rare. The present study describes a 46-year-old man with a tumor in the left superior mediastinum. Because of the narrow relationship with the aorta and the

Forearm interosseous membrane trauma: MRI diagnostic criteria and injury patterns

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McGinley, Joseph C. [Stanford University Medical Center, Department of Radiology, Stanford, CA (United States); Roach, Neil [Hospital of the University of Pennsylvania, Department of Radiology, Philadelphia, PA (United States); Hopgood, Brendon C. [Albert Einstein Medical Center, Department of Surgery, Philadelphia, PA (United States); Limmer, Karl [Temple University School of Medicine, Philadelphia, PA (United States); Kozin, Scott H. [Shriners Hospital for Children, Temple University and Pediatric Hand and Upper Extremity Surgeon, Philadelphia, PA (United States)

2006-05-15

Define criteria for interosseous membrane (IOM) injury diagnosis using MRI, and characterize patterns of IOM disruption following forearm trauma. Our hypothesis is that most IOM injuries occur along the ulnar insertion, and MRI should be obtained following forearm trauma to assess IOM competency. Sixteen cadaver forearms were subjected to longitudinal impact trauma. Prior to and following injury, MR images were examined by a board-certified musculoskeletal radiologist using pre-defined criteria for determining IOM integrity. Each specimen was dissected and the viability/pattern of injury examined. The MRI and dissection results were compared using a double-blinded methodology. Eight of the 16 specimens demonstrated IOM trauma. Seven specimens demonstrated complete IOM disruption from the ulnar insertion, and one revealed a mid-substance tear with intact origin and insertion. The dorsal oblique bundle was disrupted in four specimens. MRI analysis identified IOM injury in seven of the eight forearms. The injury location was correctly identified in six specimens when compared to dissection observations. MRI determination of IOM injury demonstrated a positive predictive value of 100%, a negative predictive value of 89%, a sensitivity of 87.5% and a specificity of 100%. (orig.)

Forearm interosseous membrane trauma: MRI diagnostic criteria and injury patterns

International Nuclear Information System (INIS)

McGinley, Joseph C.; Roach, Neil; Hopgood, Brendon C.; Limmer, Karl; Kozin, Scott H.

2006-01-01

Define criteria for interosseous membrane (IOM) injury diagnosis using MRI, and characterize patterns of IOM disruption following forearm trauma. Our hypothesis is that most IOM injuries occur along the ulnar insertion, and MRI should be obtained following forearm trauma to assess IOM competency. Sixteen cadaver forearms were subjected to longitudinal impact trauma. Prior to and following injury, MR images were examined by a board-certified musculoskeletal radiologist using pre-defined criteria for determining IOM integrity. Each specimen was dissected and the viability/pattern of injury examined. The MRI and dissection results were compared using a double-blinded methodology. Eight of the 16 specimens demonstrated IOM trauma. Seven specimens demonstrated complete IOM disruption from the ulnar insertion, and one revealed a mid-substance tear with intact origin and insertion. The dorsal oblique bundle was disrupted in four specimens. MRI analysis identified IOM injury in seven of the eight forearms. The injury location was correctly identified in six specimens when compared to dissection observations. MRI determination of IOM injury demonstrated a positive predictive value of 100%, a negative predictive value of 89%, a sensitivity of 87.5% and a specificity of 100%. (orig.)

Intraoperative EMG monitoring for protection of the posterior cranial nerves nucleus%术中肌电监测对累及第四脑室底面肿瘤切除中后组脑神经核团的保护研究

Institute of Scientific and Technical Information of China (English)

漆松涛; 刘文; 张喜安; 方陆雄; 潘军; 杨开军

2009-01-01

Objective In order to protect the posterior cranial nerves nucleus,the intraoperative EMG monintoring was used during the surgical resection of brain tumors related to the forth ventrical floor.Method 23 brain tumors were surgically removed in our hospital from February 2007 to April 2008, which including 8 case of medulloblastoms, 7 enpendymomas, 3 brain stem gliomas.All the tumors were microsurgical removed and intraoperative EMG monitoring was applied during the operation. The dates of the posterior cranial nerves function,the surgical procedure and EMG monitor changes were analyzed in order to find their relationship.Results 17 tumors were totally removed and 6 subtotally removed.The patients posterior cranial nerves function were protected well in 6 cases, 13 cases of slight dysfunction and 4 cases of moderate dysfunction.There was no serious damage in our group.The myoelectricity induced by the posterior cranial nerve nucleus stimulation could be recorded successfully under normal anesthesia condition.Conclusion The intraoperative EMG monitoring could avoid posterior cranial nerves nucleus damage and provide objective judgment for resection strategy of tumors related to the forth ventrical floor.%目的 探讨术中肌电监测在累及第四脑室底面肿瘤切除术中,后组脑神经核团的保护作用.方法 2007年2月至2008年4月治疗23例累及第四脑室底面的肿瘤,其中巨大髓母细胞瘤8例,室管膜瘤7例,脑干起源外生性胶质瘤3例,脑干背侧血管网状细胞瘤2例,脑干海绵状血管瘤3例.全部患者通过显微手术切除肿瘤,术中全程监测后组脑神经肌电活动.对患者术后脑神经功能状态、手术过程和监测情况分析.结果 肿瘤全切除17例,次全切除6例,无后组脑神经功能障碍6例,轻度后组腩神经损伤13例,中度后组腩神经损伤4例,无严重损伤者.术中全部患者在正常麻醉和肌松药状态下,可以稳定引出各种刺激诱发的后组�

Expansions of the neurovascular scleral canal and contained optic nerve occur early in the hypertonic saline rat experimental glaucoma model.

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Pazos, Marta; Yang, Hongli; Gardiner, Stuart K; Cepurna, William O; Johnson, Elaine C; Morrison, John C; Burgoyne, Claude F

2016-04-01

To characterize early optic nerve head (ONH) structural change in rat experimental glaucoma (EG). Unilateral intraocular pressure (IOP) elevation was induced in Brown Norway rats by hypertonic saline injection into the episcleral veins and animals were sacrificed 4 weeks later by perfusion fixation. Optic nerve cross-sections were graded from 1 (normal) to 5 (extensive injury) by 5 masked observers. ONHs with peripapillary retina and sclera were embedded, serial sectioned, 3-D reconstructed, delineated, and quantified. Overall and animal-specific EG versus Control eye ONH parameter differences were assessed globally and regionally by linear mixed effect models with significance criteria adjusted for multiple comparisons. Expansions of the optic nerve and surrounding anterior scleral canal opening achieved statistical significance overall (p < 0.0022), and in 7 of 8 EG eyes (p < 0.005). In at least 5 EG eyes, significant expansions (p < 0.005) in Bruch's membrane opening (BMO) (range 3-10%), the anterior and posterior scleral canal openings (8-21% and 5-21%, respectively), and the optic nerve at the anterior and posterior scleral canal openings (11-30% and 8-41%, respectively) were detected. Optic nerve expansion was greatest within the superior and inferior quadrants. Optic nerve expansion at the posterior scleral canal opening was significantly correlated to optic nerve damage (R = 0.768, p = 0.042). In the rat ONH, the optic nerve and surrounding BMO and neurovascular scleral canal expand early in their response to chronic experimental IOP elevation. These findings provide phenotypic landmarks and imaging targets for detecting the development of experimental glaucomatous optic neuropathy in the rat eye. Copyright © 2015 Elsevier Ltd. All rights reserved.

Anatomical variations within the deep posterior compartment of the leg and important clinical consequences.

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Hislop, M; Tierney, P

2004-09-01

The management of musculoskeletal conditions makes up a large part of a sports medicine practitioner's practice. A thorough knowledge of anatomy is an essential component of the armament necessary to decipher the large number of potential conditions that may confront these practitioners. To cloud the issue further, anatomical variations may be present, such as supernumerary muscles, thickened fascial bands or variant courses of nerves and blood vessels, which can themselves manifest as acute or chronic conditions that lead to significant morbidity or limitation of activity. There are a number of contentious areas within the literature surrounding the anatomy of the leg, particularly involving the deep posterior compartment. Conditions such as chronic exertional compartment syndrome, tibial periostitis (shin splints), peripheral nerve entrapment and tarsal tunnel syndrome may all be affected by subtle anatomical variations. This paper primarily focuses on the deep posterior compartment of the leg and uses the gross dissection of cadaveric specimens to describe definitively the anatomy of the deep posterior compartment. Variant fascial attachments of flexor digitorum longus are documented and potential clinical sequelae such as chronic exertional compartment syndrome and tarsal tunnel syndrome are discussed.

Modified skin incision for avoiding the lesser occipital nerve and occipital artery during retrosigmoid craniotomy: potential applications for enhancing operative working distance and angles while minimizing the risk of postoperative neuralgias and intraoperative hemorrhage.

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Tubbs, R Shane; Fries, Fabian N; Kulwin, Charles; Mortazavi, Martin M; Loukas, Marios; Cohen-Gadol, Aaron A

2016-10-01

Chronic postoperative neuralgias and headache following retrosigmoid craniotomy can be uncomfortable for the patient. We aimed to better elucidate the regional nerve anatomy in an effort to minimize this postoperative complication. Ten adult cadaveric heads (20 sides) were dissected to observe the relationship between the lesser occipital nerve and a traditional linear versus modified U incision during retrosigmoid craniotomy. Additionally, the relationship between these incisions and the occipital artery were observed. The lesser occipital nerve was found to have two types of course. Type I nerves (60%) remained close to the posterior border of the sternocleidomastoid muscle and some crossed anteriorly over the sternocleidomastoid muscle near the mastoid process. Type II nerves (40%) left the posterior border of the sternocleidomastoid muscle and swung medially (up to 4.5cm posterior to the posterior border of the sternocleidomastoid muscle) as they ascended over the occiput. The lesser occipital nerve was near a midpoint of a line between the external occipital protuberance and mastoid process in all specimens with the type II nerve configuration. Based on our findings, the inverted U incision would be less likely to injure the type II nerves but would necessarily cross over type I nerves, especially more cranially on the nerve at the apex of the incision. As the more traditional linear incision would most likely transect the type I nerves and more so near their trunk, the U incision may be the overall better choice in avoiding neural and occipital artery injury during retrosigmoid approaches. Copyright © 2016 Elsevier Ltd. All rights reserved.

Anatomical variations of pronator teres muscle: predispositional role for nerve entrapment

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Edie Benedito Caetano

Full Text Available ABSTRACT OBJECTIVE: To assess the anatomical variations of the pronator teres muscle (PTM and its implication in the compression of the median nerve, which passes through the humeral and ulnar heads of the PTM. METHODS: For the present study, 100 upper limbs from human cadavers from the anatomy laboratory were dissected. Forty-six specimens were male and four, female, whose aged ranged from 28 to 77 years; 27 were white and 23, non-white. A pilot study consisting of six hands from three fresh cadaver dissections was conducted to familiarize the authors with the local anatomy; these were not included in the present study. RESULTS: The humeral and ulnar heads of PTM were present in 86 limbs. In 72 out of the 86 limbs, the median nerve was positioned between the two heads of the PTM; in 11, it passed through the muscle belly of ulnar head of the PTM, and in three, posteriorly to both heads of the PTM. When both heads were present, the median nerve was not observed as passing through the muscle belly of the humeral head of PTM. In 14 out of the 100 dissected limbs, the ulnar head of the PTM was not observed; in this situation, the median nerve was positioned posteriorly to the humeral head in 11 limbs, and passed through the humeral head in three. In 17 limbs, the ulnar head of PTM was little developed, with a fibrous band originating from the ulnar coronoid process, associated with a distal muscle component near the union with the humeral head. In four limbs, the ulnar head of the MPR was represented by a fibrous band. In both limbs of one cadaver, a fibrous band was observed between the supinator muscle and the humeral head of the PTM, passing over median nerve. CONCLUSION: The results suggest that these anatomical variations in relationship median nerve and PTM are potential factors for median nerve compression, as they narrow the space through which the median nerve passes.

Posterior circulation aneurysms: A 10-year institutional analysis

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Saurabh Sharma

2012-01-01

Full Text Available Background : Aneurysms are uncommon and challenging to manage. Materials and Methods: A retrospective study was designed to report 53 patients who are treated from June 2002 to June 2011. Results: The mean age at presentation was 46.34 ± 13.67 years (males, 26. Clinical features included subarachnoid hemorrhage (median Hunt and Hess Grade II, n = 42, cranial nerve palsies (9, hydrocephalus (5, and incidentally diagnosed (5. Locations included superior cerebellar artery (3, posterior cerebral artery (2, basilar trunk (4, vertebral (8, anterior inferior cerebellar artery (AICA (5, posterior inferior cerebellar artery (PICA (13, vertebrobasilar junction (6, and basilar top (13. Management included both endovascular intervention (26 and surgery (19, and both (2. Five patients presented as poor grade and underwent only extraventricular drain placement while one patient had thrombosed aneurysm and was managed conservatively. Mortality was 26.4% (n = 14 and morbidity included vasospasm (10, meningitis (2, pseudomeningocele (2, pneumonitis (2, and myocardial infarction (1. Conclusion: Posterior circulation aneurysms are highly challenging. They require the multimodality approach, and decision regarding surgery or embolization has to be individualized.

Transcutaneous stimulation of the posterior tibial nerve for treating refractory urge incontinence of idiopathic and neurogenic origin.

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Valles-Antuña, C; Pérez-Haro, M L; González-Ruiz de L, C; Quintás-Blanco, A; Tamargo-Diaz, E M; García-Rodríguez, J; San Martín-Blanco, A; Fernandez-Gomez, J M

2017-09-01

To assess the efficacy of treatment with transcutaneous posterior tibial nerve stimulation (TPTNS) in patients with urge urinary incontinence, of neurogenic or nonneurogenic origin, refractory to first-line therapeutic options. We included 65 patients with urge urinary incontinence refractory to medical treatment. A case history review, a urodynamic study and a somatosensory evoked potentials (SEP) study were conducted before the TPTNS, studying the functional urological condition by means of a voiding diary. The treatment consisted of 10 weekly sessions of TPTNS lasting 30minutes. Some 57.7% of the patients showed abnormal tibial SEPs, and 42% showed abnormal pudendal SEPs. A statistically significant symptomatic improvement was observed in all clinical parameters after treatment with TPTNS, and 66% of the patients showed an overall improvement, regardless of sex, the presence of underlying neurological disorders, detrusor hyperactivity in the urodynamic study or SEP disorders. There were no adverse effects during the treatment. TPTNS is an effective and well tolerated treatment in patients with urge incontinence refractory to first-line therapies and should be offered early in the treatment strategy. New studies are needed to identify the optimal parameters of stimulation, the most effective treatment protocols and long-term efficacy, as well as its applicability to patients with a neurogenic substrate. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Clinical significance of vagus nerve variation in radiofrequency ablation of thyroid nodules

International Nuclear Information System (INIS)

Ha, Eun Ju; Baek, Jung Hwan; Lee, Jeong Hyun; Shong, Young Kee; Kim, Jae Kyun

2011-01-01

To evaluate the types and incidence of vagus nerve variations and to assess factors related to the vulnerability of vagus nerves during the radiofrequency (RF) ablation of thyroid nodules. Bilateral vagus nerves of 304 consecutive patients who underwent ultrasound of the neck were assessed. Two radiologists evaluated vagus nerve type (types 1-4; lateral/anterior/medial/posterior), the shortest distance between the thyroid gland and vagus nerve, and thyroid contour. Vagus nerve vulnerability was defined as a vagus nerve located within 2 mm of the thyroid gland through the ex vivo experiments, and factors associated with vulnerability were assessed. We were unable to find one vagus nerve. Of the 607 vagus nerves, 467 (76.9%) were type 1, 128 (21.1%) were type 2, 10 (1.6%) were type 3, and 2 (0.3%) were type 4, with 81 (13.3%) being vulnerable. Univariate analysis showed that sex, location, thyroid contour and type were significantly associated with vagus nerve vulnerability. Multivariate analysis showed that bulging contour caused by thyroid nodules (P = 0.001), vagus nerve types 2/4 (P < 0.001) and type 3 (P < 0.001) were independent predictors. The operator should pay attention to anatomical variations and the resulting vagus nerve injury during RF ablation of bulging thyroid nodules. (orig.)

The Posterior Transpetrosal Approach in a Case of Large Retrochiasmatic Craniopharyngioma: Operative Video and Technical Nuances.

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Labidi, Moujahed; Watanabe, Kentaro; Loit, Marie-Pier; Hanakita, Shunya; Froelich, Sébastien

2018-02-01

Objectives  To discuss the use of the posterior petrosal approach for the resection of a retrochiasmatic craniopharyngioma. Design  Operative video. Results  In this case video, the authors discuss the surgical management of a large craniopharyngioma, presenting with mass effect on the third ventricle and optic apparatus. A first surgical stage, through an endoscopic endonasal transtubercular approach, allowed satisfactory decompression of the optic chiasma and nerves in preparation for adjuvant therapy. However, accelerated growth of the tumor, with renewed visual deficits and mass effect on the hypothalamus and third ventricle, warranted a supplementary resection. A posterior transpetrosal 1 2 (also called "retrolabyrinthine transtentorial") was performed to obtain a better exposure of the tumor and the surrounding anatomy (floor and walls of the third ventricle, perforating vessels, optic nerves, etc.) 3 . Nuances of technique and surgical pearls related to the posterior transpetrosal are discussed and illustrated in this operative video, including the posterior mobilization of the transverse-sigmoid sinuses junction, preservation of the venous anatomy during the tentorial incision, identification and preservation of the floor of the third ventricle during tumor resection, and a careful multilayer closure. Conclusion  Retrochiasmatic craniopharyngiomas are difficult to reach tumors that often require skull base approaches, either endoscopic endonasal or transcranial. The posterior transpetrosal approach is an important part of the surgical armamentarium to safely resect these complex tumors. The link to the video can be found at: https://youtu.be/2MyGLJ_v1kI .

Infraclavicular brachial plexus block: Comparison of posterior cord stimulation with lateral or medial cord stimulation, a prospective double blinded study

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Dushyant Sharma

2013-01-01

Full Text Available Background: Infraclavicular approach to the brachial plexus sheath provides anesthesia for surgery on the distal arm, elbow, forearm, wrist, and hand. It has been found that evoked distal motor response or radial nerve-type motor response has influenced the success rate of single-injection infraclavicular brachial plexus block. Aim: We conducted this study to compare the extent and effectiveness of infraclavicular brachial plexus block achieved by injecting a local anesthetic drug after finding specific muscle action due to neural stimulator guided posterior cord stimulation and lateral cord/medial cord stimulation. Methods: After ethical committee approval, patients were randomly assigned to one of the two study groups of 30 patients each. In group 1, posterior cord stimulation was used and in group 2 lateral/medial cord stimulation was used for infraclavicular brachial plexus block. The extent of motor block and effectiveness of sensory block were assessed. Results: All four motor nerves that were selected for the extent of block were blocked in 23 cases (76.7% in group 1 and in 15 cases (50.0% in group 2 (P:0.032. The two groups did not differ significantly in the number of cases in which 0, 1, 2, and 3 nerves were blocked (P>0.05. In group 1, significantly lesser number of patients had pain on surgical manipulation compared with patients of group 2 (P:0.037. Conclusion: Stimulating the posterior cord guided by a nerve stimulator before local anesthetic injection is associated with greater extent of block (in the number of motor nerves blocked and effectiveness of block (in reporting no pain during the surgery than stimulation of either the lateral or medial cord.

Clinical repercussions of Martin-Gruber anastomosis: anatomical study

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Cristina Schmitt Cavalheiro

2016-04-01

Full Text Available OBJECTIVE: The main objective of this study was to describe Martin-Gruber anastomosis anatomically and to recognize its clinical repercussions. METHOD: 100 forearms of 50 adult cadavers were dissected in an anatomy laboratory. The dissection was performed by means of a midline incision along the entire forearm and the lower third of the upper arm. Two flaps including skin and subcutaneous tissue were folded back on the radial and ulnar sides, respectively. RESULTS: Nerve communication between the median and ulnar nerves in the forearm (Martin-Gruber anastomosis was found in 27 forearms. The anastomosis was classified into six types: type I: anastomosis between the anterior interosseous nerve and the ulnar nerve (n = 9; type II: anastomosis between the anterior interosseous nerve and the ulnar nerve at two points (double anastomosis (n = 2; type III: anastomosis between the median nerve and the ulnar nerve (n = 4; type IV: anastomosis between branches of the median nerve and ulnar nerve heading toward the flexor digitorum profundus muscle of the fingers; these fascicles form a loop with distal convexity (n = 5; type V: intramuscular anastomosis (n = 5; and type VI: anastomosis between a branch of the median nerve to the flexor digitorum superficialis muscle and the ulnar nerve (n = 2. CONCLUSION: Knowledge of the anatomical variations relating to the innervation of the hand has great importance, especially with regard to physical examination, diagnosis, prognosis and surgical treatment. If these variations are not given due regard, errors and other consequences will be inevitable.

Acetabular paralabral cyst causing compression of the sciatic nerve

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Caoimhe Byrne, MB BCh BAO

2017-12-01

Full Text Available Acetabular paralabral cysts are common. They vary in their clinical presentation and may be asymptomatic or cause pain and restriction at the hip joint. In rare instances they may cause symptoms by compressing local neurovascular structures. We report a case of symptomatic compression of the sciatic nerve by a posteriorly displaced acetabular paralabral cyst.

Preservation of cranial nerves during removal of the brain for an enhanced student experience in neuroanatomy classes.

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Long, Jennifer; Roberts, David J H; Pickering, James D

2014-01-01

Neuroanatomy teaching at the University of Leeds includes the examination of isolated brains by students working in small groups. This requires the prosected brains to exhibit all 12 pairs of cranial nerves. Traditional methods of removing the brain from the skull involve elevating the frontal lobes and cutting each cranial nerve as the brain is reflected posteriorly. This can leave a substantial length of each nerve attached to the skull base rather than to the removed brain. We have found a posterior approach more successful. In this study, five adult heads were disarticulated at the level of the thyroid cartilage and placed, prone, in a head stand. A wedge of bone from the occipital region was removed before the cerebellum and brainstem were elevated to visualize the cranial nerves associated with the medulla oblongata, cerebellopontine angle and mesencephalic-pontine junction prior to cutting them as close to the skull as possible. Five brains were successfully removed from the skull, each having a full complement of cranial nerves of good length attached to them. This approach significantly increases the length and number of cranial nerves remaining attached to the brain, which supports student education. For integration into head and neck dissection courses, careful consideration will be required to ensure the necks are suitably dissected and to decide whether the cranial nerves are best left attached to the skull base or brain. Copyright © 2013 Wiley Periodicals, Inc.

Association of lunate morphology, sex, and lunotriquetral interosseous ligament injury with radiologic measurement of the capitate-triquetrum joint

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Borgese, Marissa; Boutin, Robert D.; Chaudhari, Abhijit J. [University of California - Davis, Department of Radiology, Sacramento, CA (United States); Bayne, Christopher O.; Szabo, Robert M. [University of California - Davis, Department of Orthopaedic Surgery, Sacramento, CA (United States)

2017-12-15

Radiologic presentation of carpal instability at the radial side of the carpus, e.g. scapholunate diastasis following scapholunate interosseous ligament injury, has been studied extensively. By comparison, presentation at the ulnar-sided carpus has not. The purpose of this study was to assess the effects of lunate morphology, sex, and lunotriquetral interosseous ligament (LTIL) status on the radiologic measurement of the capitate-triquetrum joint (C-T distance). Further, we sought to evaluate the diagnostic accuracy of C-T distance for assessing LTIL injuries. We retrospectively identified 223 wrists with wrist radiographs and MR arthrograms with contrast injection. Data collected included sex, lunate morphology and LTIL status from MR arthrography, and C-T distance from radiography. The effects of lunate morphology, sex, and LTIL injury status on C-T distance were evaluated using generalized linear models. Diagnostic performance of C-T distance was assessed by the area under receiver-operator characteristic curve (AUROC). Lunate morphology, sex, and LTIL injury status all had significant effects on C-T distance; wrists with type II lunates, men, and wrists with LTIL injuries had greater C-T distances than wrists with type I lunates, women, and wrists without LTIL injuries, respectively (p < 0.01). The diagnostic value of the C-T distance for identifying patients with full-thickness LTIL tears was sufficient for women with type I (AUROC = 0.67) and type II lunates (0.60) and good for men with type I (0.72) and type II lunates (0.77). The demonstrated influence of LTIL status on C-T distance supports the use of C-T distance as a tool in assessing for full-thickness LTIL tears. (orig.)

Association of lunate morphology, sex, and lunotriquetral interosseous ligament injury with radiologic measurement of the capitate-triquetrum joint

International Nuclear Information System (INIS)

Borgese, Marissa; Boutin, Robert D.; Chaudhari, Abhijit J.; Bayne, Christopher O.; Szabo, Robert M.

2017-01-01

Radiologic presentation of carpal instability at the radial side of the carpus, e.g. scapholunate diastasis following scapholunate interosseous ligament injury, has been studied extensively. By comparison, presentation at the ulnar-sided carpus has not. The purpose of this study was to assess the effects of lunate morphology, sex, and lunotriquetral interosseous ligament (LTIL) status on the radiologic measurement of the capitate-triquetrum joint (C-T distance). Further, we sought to evaluate the diagnostic accuracy of C-T distance for assessing LTIL injuries. We retrospectively identified 223 wrists with wrist radiographs and MR arthrograms with contrast injection. Data collected included sex, lunate morphology and LTIL status from MR arthrography, and C-T distance from radiography. The effects of lunate morphology, sex, and LTIL injury status on C-T distance were evaluated using generalized linear models. Diagnostic performance of C-T distance was assessed by the area under receiver-operator characteristic curve (AUROC). Lunate morphology, sex, and LTIL injury status all had significant effects on C-T distance; wrists with type II lunates, men, and wrists with LTIL injuries had greater C-T distances than wrists with type I lunates, women, and wrists without LTIL injuries, respectively (p < 0.01). The diagnostic value of the C-T distance for identifying patients with full-thickness LTIL tears was sufficient for women with type I (AUROC = 0.67) and type II lunates (0.60) and good for men with type I (0.72) and type II lunates (0.77). The demonstrated influence of LTIL status on C-T distance supports the use of C-T distance as a tool in assessing for full-thickness LTIL tears. (orig.)

Reactive histiocytosis of the orbit and posterior segment in a dog.

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Pumphrey, Stephanie A; Pizzirani, Stefano; Pirie, Christopher G; Sato, Amy F; Buckley, Faith I

2013-05-01

We present a case of reactive histiocytic disease involving the orbit, optic nerve, retina, and choroid in a Border Collie dog initially presenting for vision loss. Long-term partial return of vision has been achieved with systemic immunosuppression. Anterior segment and ocular surface manifestations of reactive histiocytic disease in dogs are relatively common. Posterior segment and orbital involvement, however, are minimally documented in the existing literature. To the authors' knowledge, this is the first report of disease confined to the orbit and posterior segment as well as the first report of vision loss as a presenting complaint for reactive histiocytic disease. Clinical, magnetic resonance imaging, cytologic, and histopathologic findings are reviewed. © 2012 American College of Veterinary Ophthalmologists.

The Relationship of the Facial Nerve to the Condylar Process: A Cadaveric Study with Implications for Open Reduction Internal Fixation

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H. P. Barham

2015-01-01

Full Text Available Introduction. The mandibular condyle is the most common site of mandibular fracture. Surgical treatment of condylar fractures by open reduction and internal fixation (ORIF demands direct visualization of the fracture. This project aimed to investigate the anatomic relationship of the tragus to the facial nerve and condylar process. Materials and Methods. Twelve fresh hemicadavers heads were used. An extended retromandibular/preauricular approach was utilized, with the incision being based parallel to the posterior edge of the ramus. Measurements were obtained from the tragus to the facial nerve and condylar process. Results. The temporozygomatic division of the facial nerve was encountered during each approach, crossing the mandible at the condylar neck. The mean tissue depth separating the facial nerve from the condylar neck was 5.5 mm (range: 3.5 mm–7 mm, SD 1.2 mm. The upper division of the facial nerve crossed the posterior border of the condylar process on average 2.31 cm (SD 0.10 cm anterior to the tragus. Conclusions. This study suggests that the temporozygomatic division of the facial nerve will be encountered in most approaches to the condylar process. As visualization of the relationship of the facial nerve to condyle is often limited, recognition that, on average, 5.5 mm of tissue separates condylar process from nerve should help reduce the incidence of facial nerve injury during this procedure.

Morphometric characteristics of caudal cranial nerves at petroclival region in fetuses.

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Ozdogmus, Omer; Saban, Enis; Ozkan, Mazhar; Yildiz, Sercan Dogukan; Verimli, Ural; Cakmak, Ozgur; Arifoglu, Yasin; Sehirli, Umit

2016-06-01

Morphometric measurements of cranial nerves in posterior cranial fossa of fetus cadavers were carried out in an attempt to identify any asymmetry in their openings into the cranium. Twenty-two fetus cadavers (8 females, 14 males) with gestational age ranging between 22 and 38 weeks (mean 30 weeks) were included in this study. The calvaria were removed, the brains were lifted, and the cranial nerves were identified. The distance of each cranial nerve opening to midline and the distances between different cranial nerve openings were measured on the left and right side and compared. The mean clivus length and width were 21.2 ± 4.4 and 13.2 ± 1.5 mm, respectively. The distance of the twelfth cranial nerve opening from midline was shorter on the right side when compared with the left side (6.6 ± 1.1 versus 7.1 ± 0.8 mm, p = 0.038). Openings of other cranial nerves did not show such asymmetry with regard to their distance from midline, and the distances between different cranial nerves were similar on the left and right side. Cranial nerves at petroclival region seem to show minimal asymmetry in fetuses.

A modified straight leg raise test to differentiate between sural nerve pathology and Achilles tendinopathy. A cross-sectional cadaver study

NARCIS (Netherlands)

Coppieters, M.W.J.; Crooke, J.L.; Lawrenson, P.R.; Khoo, S.J.; Skulstad, T.; Bet-Or, Y.

2015-01-01

Background: A modified straight leg raise test for the sural nerve (SLRSURAL) has been proposed to assist in the differential diagnosis of sural nerve pathology in people with posterior calf or ankle pain, or lateral foot pain. The biomechanical rationale is that strain in the

Anatomic and pathologic features of third cranial nerve disorders according to magnetic resonance studies

International Nuclear Information System (INIS)

Ruiz, Y.; Torres, J.; Ramos, M.; Caniego, J.L.; Manzanares, R.; Fresno, L.F.

1998-01-01

The objective of this report is to demonstrate the utility of magnetic resonance (MR) in the diagnosis of disorders involving the third cranial nerves. We have selected MR studies corresponding to patients with an anomaly affecting the third cranial nerves, whether alone or in combination with other cranial nerves. In order to better study the pathology of these cranial nerves, we considered four different segments of the nerves: mesencephalic, cisternal, cavernous and orbital. We present the MR features of the anatomy of the third cranial nerves and the most representative lesions affecting the different intracranial segments: infraction, multiple sclerosis, glioma and cavernoma in the mesencephalon; posterior communicating artery aneurysm, neuritis, neurinomas and meningioma in the cisternal segment; aneurysm of the internal carotid artery, cavernous carotid fistula, metastasis and meningioma in the cavernous sinus and Tolosa-Hunt syndrome in the orbital apex. (Author) 11 refs

Evaluation of the Predictive Value of Intraoperative Changes in Motor-Evoked Potentials of Caudal Cranial Nerves for the Postoperative Functional Outcome.

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Kullmann, Marcel; Tatagiba, Marcos; Liebsch, Marina; Feigl, Guenther C

2016-11-01

The predictive value of changes in intraoperatively acquired motor-evoked potentials (MEPs) of the lower cranial nerves (LCN) IX-X (glossopharyngeal-vagus nerve) and CN XII (hypoglossal nerve) on operative outcomes was investigated. MEPs of CN IX-X and CN XII were recorded intraoperatively in 63 patients undergoing surgery of the posterior cranial fossa. We correlated the changes of the MEPs with postoperative nerve function. For CN IX-X, we found a correlation between the amplitude of the MEP ratio and uvula deviation (P = 0.028) and the amplitude duration of the MEP and gag reflex function (P = 0.027). Patients with an MEP ratio of the glossopharyngeal-vagus amplitude ≤1.47 μV had a 3.4 times increased risk of developing a uvula deviation. Patients with a final MEP duration of the CN IX-X ≤11.6 milliseconds had a 3.6 times increased risk for their gag reflex to become extinct. Our study greatly contributes to the current knowledge of intraoperative MEPs as a predictor for postoperative cranial nerve function. We were able to extent previous findings on MEP values of the facial nerve on postoperative nerve function to 3 additional cranial nerves. Finding reliable predictors for postoperative nerve function is of great importance to the overall quality of life for a patient undergoing surgery of the posterior cranial fossa. Copyright © 2016 Elsevier Inc. All rights reserved.

Posterior pelvic exenteration and retrograde total hysterectomy in patients with locally advanced ovarian cancer: Clinical and functional outcome

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Roberto Berretta

2016-06-01

Conclusion: Our study confirmed that pelvic posterior exenteration associated with retrograde radical hysterectomy represents the safest radical surgical approach to advanced ovarian cancer, which permits preservation of the pelvic autonomic nerve plexus and, therefore, bladder and colorectal functions.

Ultrasound imaging accurately identifies the intercostobrachial nerve

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Ahmed K. Thallaj

2015-10-01

Full Text Available Objectives: To test the hypothesis that identification and blockade of the intercostobrachial nerve (ICBN can be achieved under ultrasound (US guidance using a small volume of local anesthetic. Methods: Twenty-eight adult male volunteers were examined at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia from November 2012 to September 2013. Intercostobrachial nerve blockade was performed using one ml of 2% lidocaine under US guidance. A sensory map of the blocked area was developed relative to the medial aspect of the humeral head. Results: The ICBN appears as a hyper-echoic structure. The nerve diameter was 2.3±0.28 mm, and the depth was 9±0.28 mm. The measurements of the sensory-blocked area relative to the medial aspect of the humeral head were as follows: 6.3±1.6 cm anteriorly; 6.2±2.9 cm posteriorly; 9.4±2.9 cm proximally; and 9.2±4.4 cm distally. Intercostobrachial nerve blockade using one ml of local anesthetic was successful in all cases. Conclusion: The present study described the sonographic anatomical details of the ICBN and its sensory distribution to successfully perform selective US-guided ICBN blockade.

Posterior subscapular dissection: An improved approach to the brachial plexus for human anatomy students.

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Hager, Shaun; Backus, Timothy Charles; Futterman, Bennett; Solounias, Nikos; Mihlbachler, Matthew C

2014-05-01

Students of human anatomy are required to understand the brachial plexus, from the proximal roots extending from spinal nerves C5 through T1, to the distal-most branches that innervate the shoulder and upper limb. However, in human cadaver dissection labs, students are often instructed to dissect the brachial plexus using an antero-axillary approach that incompletely exposes the brachial plexus. This approach readily exposes the distal segments of the brachial plexus but exposure of proximal and posterior segments require extensive dissection of neck and shoulder structures. Therefore, the proximal and posterior segments of the brachial plexus, including the roots, trunks, divisions, posterior cord and proximally branching peripheral nerves often remain unobserved during study of the cadaveric shoulder and brachial plexus. Here we introduce a subscapular approach that exposes the entire brachial plexus, with minimal amount of dissection or destruction of surrounding structures. Lateral retraction of the scapula reveals the entire length of the brachial plexus in the subscapular space, exposing the brachial plexus roots and other proximal segments. Combining the subscapular approach with the traditional antero-axillary approach allows students to observe the cadaveric brachial plexus in its entirety. Exposure of the brachial dissection in the subscapular space requires little time and is easily incorporated into a preexisting anatomy lab curriculum without scheduling additional time for dissection. Copyright © 2014 Elsevier GmbH. All rights reserved.

[Evaluation of iatrogenic accessory nerve injury in forensic medical practice].

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Somogyi, E; Irányi, J

1996-04-14

The authors give a survey of the clinical and medical-legal characteristics of the accessory nerve injury. In the past two decades the conception of the successfulness of the surgical treatment of the accessory nerve injury became prevailing. About the medical-legal aspects of the iatrogenic injury of the nerve reported in connection of the reconstructive surgery chiefly also departments of neurosurgery, orthopedics and traumatology. In the case of the authors a 70 year old patient suffered 10 years ago a iatrogenic accessory nerve injury. The mild trapezius palsy recovered spontaneously practically with cosmetic disadvantage. In connection with the development of extreme dorso-lumbal scoliosis associated with torsion the trapezius atrophy worsened. Physical therapy was partly successful. But the patient became unfit for manual work. Their observations sustain the data of authors who established that in the case of accessory nerve injury not only the surgical but also conservative treatment is usually successful. In opposite to certain data of the literature the authors establish that the iatrogenic injuries of the accessory nerve may lead to significant lifelong disability. The diagnosis is not always made in time with consequent delay in repair. This may be regarded as an unfavorable issue during medical-legal discussions. The authors recommend in interest to prevent nerve injury in the posterior triangle of the neck to perform operation in special department.

Ultrasound-Guided Interscalene Catheter Complicated by Persistent Phrenic Nerve Palsy

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Andrew T. Koogler

2018-01-01

Full Text Available A 76-year-old male presented for reverse total shoulder arthroplasty (TSA in the beach chair position. A preoperative interscalene nerve catheter was placed under direct ultrasound-guidance utilizing a posterior in-plane approach. On POD 2, the catheter was removed. Three weeks postoperatively, the patient reported worsening dyspnea with a subsequent chest X-ray demonstrating an elevated right hemidiaphragm. Pulmonary function testing revealed worsening deficit from presurgical values consistent with phrenic nerve palsy. The patient decided to continue conservative management and declined further invasive testing or treatment. He was followed for one year postoperatively with moderate improvement of his exertional dyspnea over that period of time. The close proximity of the phrenic nerve to the brachial plexus in combination with its frequent anatomical variation can lead to unintentional mechanical trauma, intraneural injection, or chemical injury during performance of ISB. The only previously identified risk factor for PPNP is cervical degenerative disc disease. Although PPNP has been reported following TSA in the beach chair position without the presence of a nerve block, it is typically presumed as a complication of the interscalene block. Previously published case reports and case series of PPNP complicating ISBs all describe nerve blocks performed with either paresthesia technique or localization with nerve stimulation. We report a case of a patient experiencing PPNP following an ultrasound-guided placement of an interscalene nerve catheter.

Occurrence of phrenic nerve stimulation in cardiac resynchronization therapy patients: the role of left ventricular lead type and placement site.

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Biffi, Mauro; Exner, Derek V; Crossley, George H; Ramza, Brian; Coutu, Benoit; Tomassoni, Gery; Kranig, Wolfgang; Li, Shelby; Kristiansen, Nina; Voss, Frederik

2013-01-01

Unwanted phrenic nerve stimulation (PNS) has been reported in ∼1 in 4 patients undergoing left ventricular (LV) pacing. The occurrence of PNS over mid-term follow-up and the significance of PNS are less certain. Data from 1307 patients enrolled in pre-market studies of LV leads manufactured by Medtronic (models 4193 and 4195 unipolar, 4194, 4196, 4296, and 4396 bipolar) were pooled. Left ventricular lead location was recorded at implant using a common classification scheme. Phrenic nerve stimulation symptoms were either spontaneously reported or identified at scheduled follow-up visits. A PNS-related complication was defined as PNS resulting in invasive intervention or the termination of LV pacing. Average follow-up was 14.9 months (range 0.0-46.6). Phrenic nerve stimulation symptoms occurred in 169 patients (12.9%). Phrenic nerve stimulation-related complications occurred in 21 of 1307 patients (1.6%); 16 of 738 (2.2%) in the unipolar lead studies, and 5 of 569 (0.9%) in the bipolar lead studies (P = 0.08). Phrenic nerve stimulation was more frequent at middle-lateral/posterior, and apical LV sites (139/1010) vs. basal-posterior/lateral/anterior, and middle-anterior sites (20/297; P= 0.01). As compared with an anterior LV lead position, a lateral LV pacing site was associated with over a four-fold higher risk of PNS (P= 0.005) and an apical LV pacing site was associated with over six-fold higher risk of PNS (P= 0.001). Phrenic nerve stimulation occurred in 13% of patients undergoing LV lead placement and was more common at mid-lateral/posterior, and LV apical sites. Most cases (123/139; 88%) of PNS were mitigated via electrical reprogramming, without the need for invasive intervention.

Clinical and imaging characteristics of foraminal nerve root disorders of the lumbar spine

International Nuclear Information System (INIS)

Nishi, Tomio; Tani, Takayuki; Suzuki, Norio; Aonuma, Hiroshi

2009-01-01

We analyzed cases of lumbar nerve root compression at intervertebral foramina, by comparing 19 cases of foraminal stenosis (FS), and 38 cases of foraminal hernia (FH) with 21 cases of lumbar canal stenosis (LCS). Japan Orthopedic Association (JOA) scores, intervertebral disc degeneration, anatomical measurements of the nerve root foramina and the MRI findings were reviewed. The scores for pain in the lower extremities, and walking ability were both lowest in the FS group. The scores for low back pain, lower extremities, and sensory disturbances were lowest in the FH group. Anterior-posterior diameters of the nerve root foramina were smaller in the FS group and FH group than in the LCS group. More degenerated discs and short length of upper part of the nerve root foramina were seen in FS group than in the other groups. The MRI images of so-called black out nerve root foramina were positive in 63.6% of FS cases, 75% of FH cases. (author)

Carotid artery and lower cranial nerve exposure with increasing surgical complexity to the parapharyngeal space.

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Lemos-Rodriguez, Ana M; Sreenath, Satyan B; Rawal, Rounak B; Overton, Lewis J; Farzal, Zainab; Zanation, Adam M

2017-03-01

To investigate the extent of carotid artery exposure attained, including the identification of the external carotid branches and lower cranial nerves in five sequential external approaches to the parapharyngeal space, and to provide an anatomical algorithm. Anatomical study. Six latex-injected adult cadaver heads were dissected in five consecutive approaches: transcervical approach with submandibular gland removal, posterior extension of the transcervical approach, transcervical approach with parotidectomy, parotidectomy with lateral mandibulotomy, and parotidectomy with mandibulectomy. The degree of carotid artery exposure attained, external carotid branches, and lower cranial nerves visualized was documented. The transcervical approach exposed 1.5 cm (Standard Deviation (SD) 0.5) of internal carotid artery (ICA) and 1.25 cm (SD 0.25) of external carotid artery (ECA). The superior thyroid and facial arteries and cranial nerve XII and XI were identified. The posterior extension exposed 2.9 cm (SD 0.7) of ICA and 2.7 cm (SD 1.0) of ECA. Occipital and ascending pharyngeal arteries were visualized. The transparotid approach exposed 4.0 cm (SD 1.1) of ICA and 3.98 cm (SD 1.8) of ECA. Lateral mandibulotomy exposed the internal maxillary artery, cranial nerve X, the sympathetic trunk, and 4.6 cm (SD 2.4) of ICA. Mandibulectomy allowed for complete ECA exposure, cranial nerve IX, lingual nerve, and 6.9 cm (SD 1.3) of ICA. Approaches for the parapharyngeal space must be based on anatomic and biological patient factors. This study provides a guide for the skull base surgeon for an extended approach based on the desired anatomic exposure. N/A. Laryngoscope, 127:585-591, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

MR findings of facial nerve on oblique sagittal MRI using TMJ surface coil: normal vs peripheral facial nerve palsy

International Nuclear Information System (INIS)

Park, Yong Ok; Lee, Myeong Jun; Lee, Chang Joon; Yoo, Jeong Hyun

2000-01-01

To evaluate the findings of normal facial nerve, as seen on oblique sagittal MRI using a TMJ (temporomandibular joint) surface coil, and then to evaluate abnormal findings of peripheral facial nerve palsy. We retrospectively reviewed the MR findings of 20 patients with peripheral facial palsy and 50 normal facial nerves of 36 patients without facial palsy. All underwent oblique sagittal MRI using a T MJ surface coil. We analyzed the course, signal intensity, thickness, location, and degree of enhancement of the facial nerve. According to the angle made by the proximal parotid segment on the axis of the mastoid segment, course was classified as anterior angulation (obtuse and acute, or buckling), straight and posterior angulation. Among 50 normal facial nerves, 24 (48%) were straight, and 23 (46%) demonstrated anterior angulation; 34 (68%) showed iso signal intensity on T1W1. In the group of patients, course on the affected side was either straight (40%) or showed anterior angulation (55%), and signal intensity in 80% of cases was isointense. These findings were similar to those in the normal group, but in patients with post-traumatic or post-operative facial palsy, buckling, of course, appeared. In 12 of 18 facial palsy cases (66.6%) in which contrast materials were administered, a normal facial nerve of the opposite facial canal showed mild enhancement on more than one segment, but on the affected side the facial nerve showed diffuse enhancement in all 14 patients with acute facial palsy. Eleven of these (79%) showed fair or marked enhancement on more than one segment, and in 12 (86%), mild enhancement of the proximal parotid segment was noted. Four of six chronic facial palsy cases (66.6%) showed atrophy of the facial nerve. When oblique sagittal MR images are obtained using a TMJ surface coil, enhancement of the proximal parotid segment of the facial nerve and fair or marked enhancement of at least one segment within the facial canal always suggests pathology of

α-Synuclein pathology in the cranial and spinal nerves in Lewy body disease.

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Nakamura, Keiko; Mori, Fumiaki; Tanji, Kunikazu; Miki, Yasuo; Toyoshima, Yasuko; Kakita, Akiyoshi; Takahashi, Hitoshi; Yamada, Masahito; Wakabayashi, Koichi

2016-06-01

Accumulation of phosphorylated α-synuclein in neurons and glial cells is a histological hallmark of Lewy body disease (LBD) and multiple system atrophy (MSA). Recently, filamentous aggregations of phosphorylated α-synuclein have been reported in the cytoplasm of Schwann cells, but not in axons, in the peripheral nervous system in MSA, mainly in the cranial and spinal nerve roots. Here we conducted an immunohistochemical investigation of the cranial and spinal nerves and dorsal root ganglia of patients with LBD. Lewy axons were found in the oculomotor, trigeminal and glossopharyngeal-vagus nerves, but not in the hypoglossal nerve. The glossopharyngeal-vagus nerves were most frequently affected, with involvement in all of 20 subjects. In the spinal nerve roots, Lewy axons were found in all of the cases examined. Lewy axons in the anterior nerves were more frequent and numerous in the thoracic and sacral segments than in the cervical and lumbar segments. On the other hand, axonal lesions in the posterior spinal nerve roots appeared to increase along a cervical-to-sacral gradient. Although Schwann cell cytoplasmic inclusions were found in the spinal nerves, they were only minimal. In the dorsal root ganglia, axonal lesions were seldom evident. These findings indicate that α-synuclein pathology in the peripheral nerves is axonal-predominant in LBD, whereas it is restricted to glial cells in MSA. © 2015 Japanese Society of Neuropathology.

Tibial nerve stimulation for overactive bladder syndrome unresponsive to medical therapy.

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Ridout, A E; Yoong, W

2010-02-01

Overactive bladder syndrome is defined as a symptom syndrome which includes urinary urgency, with or without urge incontinence, usually accompanied by frequency (>8 micturitions/24 h) and nocturia. Conservative treatment usually comprises behavioural techniques, bladder retraining, pelvic floor re-education and pharmacotherapy but up to 30% of patients will remain refractory to treatment. Although second-line treatment options such as sacral nerve stimulation and intravesical botulinum A injections are valuable additions to the therapeutic arsenal, they are relatively invasive and can have serious side-effects. Inhibition of detrusor activity by peripheral neuromodulation of the posterior tibial nerve was first described in 1983, with recent authors further confirming a 60-80% positive response rate. This review was undertaken to examine published literature on percutaneous tibial nerve stimulation and to discuss outcome measures, maintenance therapy and prognostic factors of this technique.

The analysis of the effective of preserving sacral nerve root during surgical treatment of chordoma

International Nuclear Information System (INIS)

Ji Yiming; Chen Kangwu; Yang Huilin; Zhu Lifan

2010-01-01

Objective: To analyze the effective of preserving sacral nerve root during surgical treatment of sacral chordoma. Methods: This retrospective study included 30 cases of sacral chordomas. All the cases were operated with posterior approach. The blood loss and blood transfusion during operation, the drainged blood after operation were reviewed. The sphincter muscle function of bladder and bowl were observed. Results: Tremendous reduction of blood loss during surgery was found in all cases, the blood loss was 1280 ml in average, the blood transfusion was 1080 ml in average, the drainged blood after ope-ration was 650 ml. Nine patients whose sacral nerve roots had been reserved bilaterally at and above S 3 level, the sphincter muscle function of bladder and bowl was good, whereas the function of sphincter muscle impaired in the other 21 patients and in one case colostomy and ureterocutaneostomy were used. Conclusion: Preoperative arterial embolization is effective method and can lead to excellent results. Even if the tumor is relatively huge and the upper resection margin is as high as at S 1 or S 2 level, the tumor can be removed successfully by posterior approach. Sacral nerve should be preserved as possible. (authors)

Extraosseous Ewing's sarcoma / primitive neuroectodermal tumor of the sacral nerve plexus

International Nuclear Information System (INIS)

Narula, MK; Gupta, Nishant; Anand, Rama; Kapoor, Sudhir

2009-01-01

We report an unusual case of Ewing's sarcoma / primitive neuroectodermal tumor (PNET) of the sacral nerve plexus in a 9-year-old boy who presented with a soft tissue swelling and severe piercing pain in the lower back region. MRI of the lumbosacral spine showed a lobulated soft tissue mass with clubbed finger-like projections along the path of the sacral nerves, which had caused widening of the spinal canal and the sacral foramina (S2–S4 level). There was presacral extension and posterior scalloping of the sacral vertebrae. Histopathology of the lesion confirmed Ewing's sarcoma / PNET of the sacral spinal nerve plexus. The patient responded favorably to chemotherapy and radiotherapy, showing clinical and radiological improvement

Cranial nerves in the Australian lungfish, Neoceratodus forsteri, and in fossil relatives (Osteichthyes: Dipnoi).

Science.gov (United States)

Kemp, A

2017-02-01

Three systems, two sensory and one protective, are present in the skin of the living Australian lungfish, Neoceratodus forsteri, and in fossil lungfish, and the arrangement and innervation of the sense organs is peculiar to lungfish. Peripheral branches of nerves that innervate the sense organs are slender and unprotected, and form before any skeletal structures appear. When the olfactory capsule develops, it traps some of the anterior branches of cranial nerve V, which emerged from the chondrocranium from the lateral sphenotic foramen. Cranial nerve I innervates the olfactory organ enclosed within the olfactory capsule and cranial nerve II innervates the eye. Cranial nerve V innervates the sense organs of the snout and upper lip, and, in conjunction with nerve IX and X, the sense organs of the posterior and lateral head. Cranial nerve VII is primarily a motor nerve, and a single branch innervates sense organs in the mandible. There are no connections between nerves V and VII, although both emerge from the brain close to each other. The third associated system consists of lymphatic vessels covered by an extracellular matrix of collagen, mineralised as tubules in fossils. Innervation of the sensory organs is separate from the lymphatic system and from the tubule system of fossil lungfish. Copyright © 2016 Elsevier Ltd. All rights reserved.

Morphology of nerve endings in vocal fold of human newborn.

Science.gov (United States)

Gonçalves da Silva Leite, Janaina; Costa Cavalcante, Maria Luzete; Fechine-Jamacaru, Francisco Vagnaldo; de Lima Pompeu, Margarida Maria; Leite, José Alberto Dias; Nascimento Coelho, Dulce Maria; Rabelo de Freitas, Marcos

2016-10-01

Sensory receptors are distributed throughout the oral cavity, pharynx, and larynx. Laryngeal sensitivity is crucial for maintaining safe swallowing, thus avoiding silent aspiration. Morphologic description of different receptor types present in larynx vary because of the study of many different species, from mouse to humans. The most commonly sensory structures described in laryngeal mucosa are free nerve endings, taste buds, muscle spindles, glomerular and corpuscular receptors. This study aimed at describing the morphology and the distribution of nerve endings in premature newborn glottic region. Transversal serial frozen sections of the whole vocal folds of three newborns were analyzed using an immuno-histochemical process with a pan-neuronal marker anti-protein gene product 9.5 (PGP 9.5). Imaging was done using a confocal laser microscope. Nerve fiber density in vocal cord was calculated using panoramic images in software Morphometric Analysis System v1.0. Some sensory structures, i.e. glomerular endings and intraepithelial free nerve endings were found in the vocal cord mucosa. Muscle spindles, complex nerve endings (Meissner-like, spherical, rectangular and growing) spiral-wharves nerve structures were identified in larynx intrinsic muscles. Nervous total mean density in vocal cord was similar in the three newborns, although they had different gestational age. The mean nerve fiber density was higher in the posterior region than anterior region of vocal cord. The present results demonstrate the occurrence of different morphotypes of sensory corpuscles and nerve endings premature newborn glottic region and provide information on their sensory systems. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Primary oculomotor nerve palsy due to mild head injury. Report of two cases

International Nuclear Information System (INIS)

Katsuno, Makoto; Kobayashi, Shiro; Yokota, Hiroyuki; Teramoto, Akira

2008-01-01

Two patients with primary oculomotor nerve palsy due to direct mild head injury are reported. They presented with internal ophthalmoplegia, dilated nonreactive pupils, and very mild disturbance in consciousness. Except for the persistent oculomotor nerve palsy, both the patients recovered fully within one week. Neither demonstrated a history that was suggestive of a cause for their oculomotor nerve palsy. Initial CT scans demonstrated localized subarachnoid hemorrhage around the brain stem. One of the patients had sustained a fracture of the anterior clinoid process. As the underlying pathophysiologic mechanism underlying the oculomotor nerve palsy we suspected mild injury to the pupillomotor fibers at the anterior petroclinoidal ligament and that of the pupillary fibers at the posterior petroclinoidal ligament. We speculate that these perforating fibers at the anterior petroclinoidal ligament acted as a fulcrum due to downward displacement of the brainstem at the time of impact. (author)

Inferior Alveolar Nerve Lateralization and Transposition for Dental Implant Placement. Part I: a Systematic Review of Surgical Techniques

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Boris Abayev

2015-03-01

Full Text Available Objectives: The purpose of this first part of a two-part series was to review the literature concerning the indications, contraindications, advantages, disadvantages and surgical techniques of the lateralization and transposition of the inferior alveolar nerve, followed by the placement of an implant in an edentulous atrophic posterior mandible. Material and Methods: A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed and PMC database, academic sites and books. The articles were searched from January 1997 to July 2014 and comprised English-language articles that included adult patients between 18 and 80 years old with minimal residual bone above the mandibular canal who had undergone inferior alveolar nerve (IAN repositioning with a minimum 6 months of follow-up. Results: A total of 16 studies were included in this review. Nine were related to IAN transposition, 4 to IAN lateralization and 3 to both transposition and lateralization. Implant treatment results and complications were presented. Conclusions: Inferior alveolar nerve lateralization and transposition in combination with the installation of dental implants is sometimes the only possible procedure to help patients to obtain a fixed prosthesis, in edentulous atrophic posterior mandibles. With careful pre-operative surgical and prosthetic planning, imaging, and extremely precise surgical technique, this procedure can be successfully used for implant placement in edentulous posterior mandibular segments.

EFFECT OF UNIPOLAR ACU-STIM ON MUSCLE RE-EDUCATION FOLLOWING TENDON TRANSFER - A CASE STUDY

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Prof. Srikanth R

2015-02-01

Full Text Available Background: Tendon transfer surgery is usually done to improve function, following damage to either major nerve trunks or peripheral nerves. Re-education of the muscle is of utmost importance to gain functional activity.To achieve this, along with re-education exercises, faradic stimulation is usually used. Unipolar Acu-Stim (UAS, is an innovative technique where an acupuncture needle is used to stimulate the transferred tendon with Surged Faradic Currents (SFC. The objective of the study is to identify if the application of SFC using UAS method, is effective to re-educate a transferred muscle. Case Description: The subject was a 24 year old male who had a loss of finger and thumb extension following Posterior Interosseous Nerve (PIN palsy, for which Flexor Carpi Radialis (FCR was transferred to Extensor Digitorum Communis (EDC and Palmaris Longus (PL was transferred to Extensor Pollicis Longus (EPL. Following removal of the POP, UAS with surged faradic current was applied for 4 weeks along with re-education exercises. Prognosis of finger extension was assessed by goniometry and video recordings. Outcome: At the end of 8th week, as observed on goniometry and video recordings, complete finger extension was achieved. Discussion: UAS with SFC, is useful in re-education of a transferred muscle, as desired movement can be achieved with low intensity.

Neurophysiologic intraoperative monitoring of the vestibulocochlear nerve.

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Simon, Mirela V

2011-12-01

Neurosurgical procedures involving the skull base and structures within can pose a significant risk of damage to the brain stem and cranial nerves. This can have life-threatening consequences and/or result in devastating neurologic deficits. Over the past decade, intraoperative neurophysiology has significantly evolved and currently offers a great tool for live monitoring of the integrity of nervous structures. Thus, dysfunction can be identified early and prompt modification of the surgical management or operating conditions, leads to avoidance of permanent structural damage.Along these lines, the vestibulocochlear nerve (CN VIII) and, to a greater extent, the auditory pathways as they pass through the brain stem are especially at risk during cerebelopontine angle (CPA), posterior/middle fossa, or brain stem surgery. CN VIII can be damaged by several mechanisms, from vascular compromise to mechanical injury by stretch, compression, dissection, and heat injury. Additionally, cochlea itself can be significantly damaged during temporal bone drilling, by noise, mechanical destruction, or infarction, and because of rupture, occlusion, or vasospasm of the internal auditory artery.CN VIII monitoring can be successfully achieved by live recording of the function of one of its parts, the cochlear or auditory nerve (AN), using the brain stem auditory evoked potentials (BAEPs), electrocochleography (ECochG), and compound nerve action potentials (CNAPs) of the cochlear nerve.This is a review of these techniques, their principle, applications, methodology, interpretation of the evoked responses, and their change from baseline, within the context of surgical and anesthesia environments, and finally the appropriate management of these changes.

[Motor nerves of the face. Surgical and radiologic anatomy of facial paralysis and their surgical repair].

Science.gov (United States)

Vacher, C; Cyna-Gorse, F

2015-10-01

Motor innervation of the face depends on the facial nerve for the mobility of the face, on the mandibular nerve, third branch of the trigeminal nerve, which gives the motor innervation of the masticator muscles, and the hypoglossal nerve for the tongue. In case of facial paralysis, the most common palliative surgical techniques are the lengthening temporalis myoplasty (the temporal is innervated by the mandibular nerve) and the hypoglossal-facial anastomosis. The aim of this work is to describe the surgical anatomy of these three nerves and the radiologic anatomy of the facial nerve inside the temporal bone. Then the facial nerve penetrates inside the parotid gland giving a plexus. Four branches of the facial nerve leave the parotid gland: they are called temporal, zygomatic, buccal and marginal which give innervation to the cutaneous muscles of the face. Mandibular nerve gives three branches to the temporal muscles: the anterior, intermediate and posterior deep temporal nerves which penetrate inside the deep aspect of the temporal muscle in front of the infratemporal line. The hypoglossal nerve is only the motor nerve to the tongue. The ansa cervicalis, which is coming from the superficial cervical plexus and joins the hypoglossal nerve in the submandibular area is giving the motor innervation to subhyoid muscles and to the geniohyoid muscle. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Role of motor-evoked potential monitoring in conjunction with temporary clipping of spinal nerve roots in posterior thoracic spine tumor surgery.

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Eleraky, Mohammed A; Setzer, Matthias; Papanastassiou, Ioannis D; Baaj, Ali A; Tran, Nam D; Katsares, Kiesha M; Vrionis, Frank D

2010-05-01

The vascular supply of the thoracic spinal cord depends on the thoracolumbar segmental arteries. Because of the small size and ventral course of these arteries in relation to the dorsal root ganglion and ventral root, they cannot be reliably identified during surgery by anatomic or morphologic criteria. Sacrificing them will most likely result in paraplegia. The goal of this study was to evaluate a novel method of intraoperative testing of a nerve root's contribution to the blood supply of the thoracic spinal cord. This is a clinical retrospective study of 49 patients diagnosed with thoracic spine tumors. Temporary nerve root clipping combined with motor-evoked potential (MEP) and somatosensory-evoked potential (SSEP) monitoring was performed; additionally, postoperative clinical evaluation was done and reported in all cases. All cases were monitored by SSEP and MEPs. The nerve root to be sacrificed was temporarily clipped using standard aneurysm clips, and SSEP/MEP were assessed before and after clipping. Four nerve roots were sacrificed in four cases, three nerve roots in eight cases, and two nerve roots in 22 cases. Nerve roots were sacrificed bilaterally in 12 cases. Most patients (47/49) had no changes in MEP/SSEP and had no neurological deficit postoperatively. One case of a spinal sarcoma demonstrated changes in MEP after temporary clipping of the left T11 nerve root. The nerve was not sacrificed, and the patient was neurologically intact after surgery. In another case of a sarcoma, MEPs changed in the lower limbs after ligation of left T9 nerve root. It was felt that it was a global event because of anesthesia. Postoperatively, the patient had complete paraplegia but recovered almost completely after 6 months. Temporary nerve root clipping combined with MEP and SSEP monitoring may enhance the impact of neuromonitoring in the intraoperative management of patients with thoracic spine tumors and favorably influence neurological outcome. Copyright 2010 Elsevier

Hand weakness in Charcot-Marie-Tooth disease 1X.

LENUS (Irish Health Repository)

Arthur-Farraj, P J

2012-07-01

There have been suggestions from previous studies that patients with Charcot-Marie-Tooth disease (CMT) have weaker dominant hand muscles. Since all studies to date have included a heterogeneous group of CMT patients we decided to analyse hand strength in 43 patients with CMT1X. We recorded handedness and the MRC scores for the first dorsal interosseous and abductor pollicis brevis muscles, median and ulnar nerve compound motor action potentials and conduction velocities in dominant and non-dominant hands. Twenty-two CMT1X patients (51%) had a weaker dominant hand; none had a stronger dominant hand. Mean MRC scores were significantly higher for first dorsal interosseous and abductor pollicis brevis in non-dominant hands compared to dominant hands. Median nerve compound motor action potentials were significantly reduced in dominant compared to non-dominant hands. We conclude that the dominant hand is weaker than the non-dominant hand in patients with CMT1X.

Posterior epidural disc fragment masquerading as spinal tumor: Review of the literature.

Science.gov (United States)

Park, Taejune; Lee, Ho Jun; Kim, Jae Seong; Nam, Kiyeun

2018-03-09

Posterior epidural lumbar disc fragment is infrequent because of anatomical barriers, and it is difficult to diagnose posterior epidural lumbar disc fragment because of its rare incidence and the ambiguity of radiologic evaluations. And it is difficult to differentiate it from other diseases such as spinal tumors. Differential diagnosis of posterior epidural lumbar disc fragment is clinically important because its diagnosis can affect treatment and prognosis. To investigate the incidence, anatomical concern, etiology, symptom, diagnostic tool, management and prognosis of posterior epidural lumbar disc fragment, we reviewed articles including case report. We performed a search of all clinical studies of posterior epidural lumbar disc fragment published to date. The following keywords were searched: Posterior epidural lumbar disc fragment, disc migration, posterior epidural disc, extradural migration, dorsal epidural migration, sequestrated disc, and disc fragment. We identified 40 patients of posterior epidural lumbar disc fragment from 28 studies. The most common presentation of posterior epidural lumbar disc fragment was sudden onset radiculopathy (70.0%), followed by cauda equina syndrome (27.5%). The most frequently used diagnostic modality was magnetic resonance imaging (MRI), conducted in 36 cases (90.0%), and followed by computed tomography in 14 cases (35.0%). After the imaging studies, the preoperative diagnoses were 45.0% masses, 20.0% lesions, and 12.5% tumors. Characteristic MRI findings in posterior epidural lumbar disc fragment are helpful for diagnosis; it typically displays low signals on T1-weighted images and high signals on T2-weighted images with respect to the parent disc. In addition, most of the disc fragments show peripheral rim enhancement on MRI with gadolinium administration. Electrodiagnostic testing is useful for verifying nerve damage. Surgical treatment was performed in all cases, and neurologic complications were observed in 12.5%. As

Biomechanics of the Optic Nerve Sheath in VIIP Syndrome

Science.gov (United States)

Ethier, C. Ross; Raykin, Julia; Gleason, Rudy; Mulugeta, Lealem; Myers, Jerry; Nelson, Emily; Samuels, Brian C.

2014-01-01

Long-duration space flight carries the risk of developing Visual Impairment and Intracranial Pressure (VIIP) syndrome, a spectrum of ophthalmic changes including posterior globe flattening, choroidal folds, distension of the optic nerve sheath (ONS), optic nerve kinking and potentially permanent degradation of visual function. The slow onset of VIIP, its chronic nature, and certain clinical features strongly suggest that biomechanical factors acting on the ONS play a role in VIIP. Here we measure several relevant ONS properties needed to model VIIP biomechanics. The ONS (meninges) of fresh porcine eyes (n7) was reflected, the nerve proper was truncated near the sclera, and the meninges were repositioned to create a hollow cylinder of meningeal connective tissue attached to the posterior sclera. The distal end was cannulated, sealed, and pressure clamped (mimicking cerebrospinal fluid [CSF] pressure), while the eye was also cannulated for independent control of intraocular pressure (IOP). The meninges were inflated (CSF pressure cycling 7-50 mmHg) while ONS outer diameter was imaged. In another set of experiments (n4), fluid permeation rate across the meninges was recorded by observing the drainage of an elevated fluid reservoir (30 mmHg) connected to the meninges. The ONS showed behavior typical of soft tissues: viscoelasticity, with hysteresis in early preconditioning cycles and repeatable behavior after 4 cycles, and nonlinear stiffening, particularly at CSF pressures 15 mmHg (Figure). Tangent moduli measured from the loading curve were 372 101, 1199 358, and 2050 379 kPa (mean SEM) at CSF pressures of 7, 15 and 30 mmHg, respectively. Flow rate measurements through the intact meninges at 30mmHg gave a permeability of 1.34 0.46 lmincm2mmHg (mean SEM). The ONS is a tough, strain-stiffening connective tissue that is surprisingly permeable. The latter observation suggests that there could be significant CSF drainage through the ONS into the orbit, likely important

Optic Nerve Sheath Mechanics and Permeability in VIIP Syndrome

Science.gov (United States)

Raykin, Julia; Best, Lauren; Gleason, Rudy; Mulugeta, Lealem; Myers, Jerry; Nelson, Emily; Samuels, Brian C.; Ethier, C. R.

2014-01-01

Long-duration space flight carries the risk of developing Visual Impairment and Intracranial Pressure (VIIP) syndrome, a spectrum of ophthalmic changes including posterior globe flattening, choroidal folds, distension of the optic nerve sheath (ONS), optic nerve kinking and potentially permanent degradation of visual function. The slow onset of VIIP, its chronic nature, and certain clinical features strongly suggest that biomechanical factors acting on the ONS play a role in VIIP. Here we measure several relevant ONS properties needed to model VIIP biomechanics. The ONS (meninges) of fresh porcine eyes (n7) was reflected, the nerve proper was truncated near the sclera, and the meninges were repositioned to create a hollow cylinder of meningeal connective tissue attached to the posterior sclera. The distal end was cannulated, sealed, and pressure clamped (mimicking cerebrospinal fluid [CSF] pressure), while the eye was also cannulated for independent control of intraocular pressure (IOP). The meninges were inflated (CSF pressure cycling 7-50 mmHg) while ONS outer diameter was imaged. In another set of experiments (n4), fluid permeation rate across the meninges was recorded by observing the drainage of an elevated fluid reservoir (30 mmHg) connected to the meninges. The ONS showed behavior typical of soft tissues: viscoelasticity, with hysteresis in early preconditioning cycles and repeatable behavior after 4 cycles, and nonlinear stiffening, particularly at CSF pressures 15 mmHg (Figure). Tangent moduli measured from the loading curve were 372 101, 1199 358, and 2050 379 kPa (mean SEM) at CSF pressures of 7, 15 and 30 mmHg, respectively. Flow rate measurements through the intact meninges at 30mmHg gave a permeability of 1.34 0.46 lmincm2mmHg (mean SEM). The ONS is a tough, strain-stiffening connective tissue that is surprisingly permeable. The latter observation suggests that there could be significant CSF drainage through the ONS into the orbit, likely important

Guillain-Barre syndrome with posterior reversible encephalopathy syndrome

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Basavaraj F Banakar

2014-01-01

Full Text Available Posterior reversible encephalopathy syndrome (PRES is a clinicoradiologic entity commonly associated with eclampsia, septicemia, chemotherapeutic drugs etc. Concurrent occurrence of Guillain-Barre syndrome (GBS with PRES is a rare entity. Dysautonomia is a proposed mechanism for such occurrence. Here we present a non-diabetic, non-hypertensive 63-year-old male patient, who came with acute onset flaccid quadriparesis, developing generalized seizures, altered sensorium and raised blood pressure on fifth day of illness. Magnetic resonance imaging (MRI of brain showed altered signal intensities involving the parieto-occipital areas suggestive of posterior reversible encephalopathy. Cerebrospinal fluid analysis showed albuminocytological dissociation, nerve conduction studies revealed demyelinating type of polyneuropathy. The patient was treated with antihypertensives and antiepileptics. After resolution of the encephalopathy, intravenous immunoglobulin (IVIg was given. The patient recovered gradually over few months. Our case concludes GBS as independent risk factor, for PRES may be secondary to dysautonomia and physicians should be aware of such rare coexistence so that early treatment can be done to reduce the mortality and morbidity.

Absence of the musculocutaneous nerve with innervation of coracobrachialis, biceps brachii, brachialis and the lateral border of the forearm by branches from the lateral cord of the brachial plexus

Science.gov (United States)

NAKATANI, TOSHIO; TANAKA, SHIGENORI; MIZUKAMI, SHIGEKI

1997-01-01

Anomalies of the brachial plexus and its terminal branches are not uncommon. Variations in the course and branches of the musculocutaneous nerve have been noted (Clemente, 1985; Bergman et al. 1988) and its absence was reported by Le Minor (1990). Several anomalies were present in the left plexus of a 59-y-old Japanese man (Fig.). There were no anterior and posterior divisions of the middle trunk, although there were communications between the posterior, medial and lateral cords. The musculocutaneous nerve was absent (Le Minor, 1990) and the medial and lateral roots of the median nerve did not unite in the axillary fossa but in the upper arm about 5 cm distal to the lower border of latissimus dorsi (Adachi, 1928; Buch-Hansen, 1955). The hitherto unreported findings were branches arising directly from the lateral cord to supply coracobrachialis, both heads of biceps brachii and brachialis. The lateral cutaneous nerve of the forearm was derived from the lateral cord with a small contribution from the medial root of the median nerve. Since there were communications between the posterior cord (a continuation of the middle trunk) and the medial and lateral cords, it is theoretically possibly, but not proven, that the root values of branches innervating the flexor muscles of the arm and forearm and the skin of lateral border of the forearm were normal. PMID:9419004

Detection of posterior vortex veins in eyes with pathologic myopia by ultra-widefield indocyanine green angiography.

Science.gov (United States)

Moriyama, Muka; Cao, Kejia; Ogata, Satoko; Ohno-Matsui, Kyoko

2017-09-01

To analyse the characteristics of posterior vortex veins detected in highly myopic eyes by wide-field indocyanine green angiography (ICGA). One hundred and fifty-eight consecutive patients (302 eyes) with high myopia (myopic refractive error >8.0 dioptres (D) or axial length ≥26.5 mm) were studied. Wide-field ICGA was performed with the Spectralis HRA module. Posterior vortex veins were found in 80 eyes (26%). The prevalence of posterior staphyloma was significantly higher in eyes in which posterior vortex vein was detected than in eyes without posterior vortex vein. The posterior vortex veins were classified into five types according to the site of exit from the eye; around the optic nerve in 28%, in the macular area in 17%, along the border of staphyloma in 6%, along the margin of macular atrophy or large peripapillary conus in 21%, and elsewhere in 28%. In one eye, two posterior vortex veins collected the choroidal venous blood from the entire fundus. Wide-field ICGA can analyse the characteristic features of choroidal blood outflow system through posterior vortex veins in highly myopic eyes. They may play an important role as routes of choroidal outflow in highly myopic eyes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation

International Nuclear Information System (INIS)

Kotnis, Nikhil A.; Chiavaras, Mary M.; Harish, Srinivasan

2012-01-01

The diagnosis of lateral epicondylitis is often straightforward and can be made on the basis of clinical findings. However, radiological assessment is valuable where the clinical picture is less clear or where symptoms are refractory to treatment. Demographics, aspects of clinical history, or certain physical signs may suggest an alternate diagnosis. Knowledge of the typical clinical presentation and imaging findings of lateral epicondylitis, in addition to other potential causes of lateral elbow pain, is necessary. These include entrapment of the posterior interosseous and lateral antebrachial cutaneous nerves, posterolateral rotatory instability, posterolateral plica syndrome, Panner's disease, osteochondritis dissecans of the capitellum, radiocapitellar overload syndrome, occult fractures and chondral-osseous impaction injuries, and radiocapitellar arthritis. Knowledge of these potential masquerades of lateral epicondylitis and their characteristic clinical and imaging features is essential for accurate diagnosis. The goal of this review is to provide an approach to the imaging of lateral elbow pain, discussing the relevant anatomy, various causes, and discriminating factors, which will allow for an accurate diagnosis. (orig.)

Prevalence of saphenous nerve injury after adductor-canal-blockade in patients receiving total knee arthroplasty

DEFF Research Database (Denmark)

Henningsen, Maja; Jæger, Pia; Hilsted, K L

2013-01-01

, 76 patients could not discriminate between blunt and sharp stimulation with a needle, 81 patients could not discriminate between cold and warmth, and 82 patients displayed an altered sensation to light brush. CONCLUSION: We found no indications of saphenous nerve injury caused by the adductor...... of the saphenous nerve), as well as the anterior, posterior, lateral and infrapatellar part of the affected and contralateral lower leg. Sensory function was tested with pinprick (sharp and blunt needle), temperature discrimination (cold disinfectant swabs) and light brush. RESULTS: We included 97 patients. None...

A comparison of optic nerve dosimetry in craniospinal radiotherapy planned and treated with conventional and intensity modulated techniques

International Nuclear Information System (INIS)

Rene, Nicholas J.; Brodeur, Marylene; Parker, William; Roberge, David; Freeman, Carolyn

2010-01-01

Background and purpose: Some CNS tumours present leptomeningeal dissemination. Craniospinal radiotherapy is complex and recurrences may occur at sites of target volume underdosage. IMRT, being highly conformal to the target, could theoretically underdose the optic nerves if they are not specifically targeted leading to optic nerve recurrences. We analyzed optic nerve dosimetry when they are not specifically targeted. Materials and methods: We designed 3D-conformal and tomotherapy plans for our last five patients treated to the craniospinal axis, not including the optic nerves in the target volume. We analyzed the dose delivered to the optic nerves, to the anterior and posterior half of the optic nerves, and to a theoretical optic nerve-PTV. Results: The dose delivered to the optic nerves was similar for both plans in all patients (V95% close to 100%) except one in whom tomotherapy considerably underdosed the anterior optic nerves. The dose to the optic nerve-PTV was lower with tomotherapy in all patients. Conclusion: Despite not intentionally targeting the optic nerves, the dose to the optic nerves with IMRT was similar to 3D-conformal plans in most cases but left no margin for setup error. In individual cases the anterior half of the optic nerves could be significantly underdosed.

[Treatment of bilateral vocal cord paralysis by hemi-phrenic nerve transfer].

Science.gov (United States)

Song, W; Li, M; Zheng, H L; Sun, L; Chen, S C; Chen, D H; Liu, F; Zhu, M H; Zhang, C Y; Wang, W

2017-04-07

Objective: To investigate the surgical effect of reinnervation of bilateral posterior cricoarytenoid muscles(PCA) with left hemi-phrenic nerve and endoscopic laser arytenoid resection in bilateral vocal cord fold paralysis(BVFP) and to analyze the pros and cons of the two methods. Methods: One hundred and seventeen BVFP patients who underwent reinnervation of bilateral PCA using the left hemi-phrenic nerve approach (nerve group, n =52) or laser arytenoidectomy(laser group, n =65) were enrolled in this study from Jan.2009 to Dec.2015.Vocal perception evaluation, video stroboscopy, pulmonary function test and laryngeal electromyography were preformed in all patients both preoperatively and postoperative1y.Extubution rate was calculated postoperative1y. Results: Most of the vocal function parameters in nerve group were improved postoperatively compared with preoperative parameters, albeit without a significant difference( P >0.05), while laser group showed a significant deterioration in voice quality postoperative1y( P nerve group was larger than that in laser group ( P nerve group were inhale physiological vocal cord abductions. Postoperative glottal closure showed no significant difference in nerve group ( P >0.05), while showed various increment in laser group( P nerve group and laser group respectively. In both groups, patients presented aspiration symptoms postoperatively, and rdieved soon, except 2 patients in laser group suffered repeated aspiration. Conclusions: Reinnervation of bilateral PCA muscles using left hemi-phrenic nerve can restore inspiratory vocal fold abduction to a satisfactory extent while preserving phonatory function at the preoperative level without evident morbidity, and do not affect swallowing function, greatly improving the quality of life of the patients.

A reminder about the trigeminocardiac reflex in surgeries at the posterior third of the falx cerebri

Directory of Open Access Journals (Sweden)

Koji Takano

2014-09-01

Full Text Available The trigeminocardiac reflex (TCR is defined as a reproducible hypotension and bradycardia coinciding with the manipulation around the trigeminal nerve. Here, we report a case of sudden bradycardia with falcine manipulation. As the falx cerebri is innervated by the nervus tentorii, which is a recurrent branch of the ophthalmic nerve, the observed asystole is highly possible to be caused by TCR. Anesthesiologists and neurosurgeons should be fully aware of the anatomical innervation of the falx cerebri and that the posterior third of the falx cerebri is one of the highest risk structures for TCR induction for safe operation around this region.

Brain imaging signatures of the relationship between epidermal nerve fibers and heat pain perception.

Science.gov (United States)

Tseng, Ming-Tsung; Kong, Yazhuo; Chiang, Ming-Chang; Chao, Chi-Chao; Tseng, Wen-Yih I; Hsieh, Sung-Tsang

2015-11-15

Although the small-diameter primary afferent fibers in the skin promptly respond to nociceptive stimuli and convey sensory inputs to the central nervous system, the neural signatures that underpin the relationship between cutaneous afferent fibers and pain perception remain elusive. We combined skin biopsy at the lateral aspect of the distal leg, which is used to quantify cutaneous afferent fibers, with fMRI, which is used to assess brain responses and functional connectivity, to investigate the relationship between cutaneous sensory nerves and the corresponding pain perception in the brain after applying heat pain stimulation to the dorsum of the right foot in healthy subjects. During painful stimulation, the degree of cutaneous innervation, as measured by epidermal nerve fiber density, was correlated with individual blood oxygen level-dependent (BOLD) signals of the posterior insular cortex and of the thalamus, periaqueductal gray, and rostral ventromedial medulla. Pain perception was associated with the activation of the anterior insular cortex and with the functional connectivity from the anterior insular cortex to the primary somatosensory cortex during painful stimulation. Most importantly, both epidermal nerve fiber density and activity in the posterior insular cortex showed a positive correlation with the strength of coupling under pain between the anterior insular cortex and the primary somatosensory cortex. Thus, our findings support the notion that the neural circuitry subserving pain perception interacts with the cerebral correlates of peripheral nociceptive fibers, which implicates an indirect role for skin nerves in human pain perception. Copyright © 2015 Elsevier Inc. All rights reserved.

Anesthetic Efficacy of 4 % Articaine During Extraction of the Mandibular Posterior Teeth by Using Inferior Alveolar Nerve Block and Buccal Infiltration Techniques.

Science.gov (United States)

El-Kholey, Khalid E

2017-03-01

The study was designed to evaluate the anesthetic efficacy of 4 % articaine with 1:100,000 epinephrine (A100) in infiltration and inferior alveolar nerve block (IANB) anesthetic techniques for the pain control during extraction of the mandibular posterior teeth. This prospective randomized single-blind clinical trial included 100 patients needing extraction of at least two mandibular molars. Patients received either infiltration in the buccal vestibule opposite to the first molar supplemented with lingual infiltration or standard IANB with A100. For assessment of depth of anesthesia obtained by the two anaethetic techniques, presence or absence of pain during the extraction were rated using the visual analog scale. Fifty patients received infiltration anesthesia and fifty patients were anesthetized by IANB. The success rate of pain-free extraction after buccal infiltration was 94 %, whereas by using IANB with the same anesthetic it was 92 %. No statistical differences were detected in the success rates between the two anesthetic techniques ( P  = 0.15). Buccal Infiltration can be considered a good option during extraction of the mandibular molar and premolar teeth of course, with supplemental lingual anesthesia.

Terminal nerve: cranial nerve zero

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Jorge Eduardo Duque Parra

2006-12-01

Full Text Available It has been stated, in different types of texts, that there are only twelve pairs of cranial nerves. Such texts exclude the existence of another cranial pair, the terminal nerve or even cranial zero. This paper considers the mentioned nerve like a cranial pair, specifying both its connections and its functional role in the migration of liberating neurons of the gonadotropic hormone (Gn RH. In this paper is also stated the hypothesis of the phylogenetic existence of a cerebral sector and a common nerve that integrates the terminal nerve with the olfactory nerves and the vomeronasals nerves which seem to carry out the odors detection function as well as in the food search, pheromone detection and nasal vascular regulation.

Lingual nerve injury following surgical removal of mandibular third molar

Directory of Open Access Journals (Sweden)

Abduljaleel Azad Samad

2017-12-01

Full Text Available Background and objective: The close proximity of lingual nerve in relation to the lingual cortical bone of the posterior mandibular third molar is clinically important because lingual nerve may be subjected to trauma during surgical removal of the impacted lower third molar. This prospective study aimed to evaluate the incidence of lingual nerve paresthesia following surgical removal of mandibular third molar in College of Dentistry, Hawler Medical University. Methods: A total of 116 third molars surgery were carried out under local anesthesia for 116 patients for removal of lower mandibular teeth Using Terence Ward's incision made in all cases, and after that, the buccal flap was reflected, lingual tissues had been retracted during bone removal with a periosteal elevator. The sensory disturbance was evaluated on the 7th postoperative day by standard questioning the patients: “Do you have any unusual feeling in your tongue, lingual gingiva and mucosa of the floor of the mouth?" Results: One patient experienced sensory disturbance, the lingual nerve paresthesia incidence was 0.9% as a transient sensory disturbance, while no patient of permanent sensory disturbance. Conclusion: The incidence of injury to the lingual nerve can be minimized by careful clinical evaluation, surgeon’s experience, surgical approach and knowledge about anatomical landmarks during surgical removal of an impacted lower third molar tooth.

Attention modulates specific motor cortical circuits recruited by transcranial magnetic stimulation.

Science.gov (United States)

Mirdamadi, J L; Suzuki, L Y; Meehan, S K

2017-09-17

Skilled performance and acquisition is dependent upon afferent input to motor cortex. The present study used short-latency afferent inhibition (SAI) to probe how manipulation of sensory afference by attention affects different circuits projecting to pyramidal tract neurons in motor cortex. SAI was assessed in the first dorsal interosseous muscle while participants performed a low or high attention-demanding visual detection task. SAI was evoked by preceding a suprathreshold transcranial magnetic stimulus with electrical stimulation of the median nerve at the wrist. To isolate different afferent intracortical circuits in motor cortex SAI was evoked using either posterior-anterior (PA) or anterior-posterior (PA) monophasic current. In an independent sample, somatosensory processing during the same attention-demanding visual detection tasks was assessed using somatosensory-evoked potentials (SEP) elicited by median nerve stimulation. SAI elicited by AP TMS was reduced under high compared to low visual attention demands. SAI elicited by PA TMS was not affected by visual attention demands. SEPs revealed that the high visual attention load reduced the fronto-central P20-N30 but not the contralateral parietal N20-P25 SEP component. P20-N30 reduction confirmed that the visual attention task altered sensory afference. The current results offer further support that PA and AP TMS recruit different neuronal circuits. AP circuits may be one substrate by which cognitive strategies shape sensorimotor processing during skilled movement by altering sensory processing in premotor areas. Copyright © 2017 IBRO. Published by Elsevier Ltd. All rights reserved.

A Case Study Of Dietary Deficiency On Peripheral Nerve Functions In Chronic Alcoholic Patient

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Arbind Kumar Choudhary

2015-08-01

Full Text Available Abstract Alcoholic neuropathy is most likely result of dietary deficiency rather than direct neurotoxic effect of alcohol. A male alcoholic patient aged 34- years old with clear clinical sign of peripheral neuropathy was examined after his habit of six years chronic alcoholic drinking. Conduction velocities latencies and nerve action potential amplitudes was measured from median radial common peroneal and sural nerves on respective upper and lower limb and the results showed that there was decrease in conduction velocity of common peroneal and posterior tibial in lower limbs. However sensory nerve conduction SNCV of sural nerve right and left was normal in lower limb. Based on the results observed in our study we conclude that the combination of vitamin B12 uridine and cytidine can be safe and effective in the treatment of patients presenting alcoholic polyneuropathy. So the prognosis of alcoholic peripheral neuropathy is good and independent of age provided that intake of alcohol is withdrawn completely.

Peroneal nerve injury in three patients with knee trauma: MR imaging and correlation with anatomic findings in volunteers and anatomic specimens

Energy Technology Data Exchange (ETDEWEB)

Trappeniers, Laurence; Osteaux, Michel [Department of Radiology, Vrije Universiteit Brussels, Brussels (Belgium); De Maeseneer, Michel [Department of Radiology, Vrije Universiteit Brussels, Brussels (Belgium); Department of Radiology, AZ VUB, Laarbeeklaan 101, 1090, Jette (Belgium); Van Roy, Peter [Department of Experimental Anatomy, Vrije Universiteit Brussels, Brussels (Belgium); Chaskis, Christo [Department of Neurosurgery, Vrije Universiteit Brussels, Brussels (Belgium)

2003-07-01

The aim of this article is to report on three patients with injuries of the peroneal nerve along the posterolateral aspect of the knee. Injuries in this area are less common than the injuries occurring at the level of the fibular head. In this article we report on three patients with posterolateral knee trauma who had peroneal nerve dysfunction. To better understand the precise location of the nerve on MR images, we performed MR imaging in five volunteers, and studied the position of the nerve on anatomic dissection (n=1) and anatomic slices (n=1). The common peroneal nerve is easily depicted on MR images and has a typical location along the posterior margin of the biceps tendon. Non-visualisation of the peroneal nerve at the posterolateral aspect of the knee, as seen on MR images, is consistent with nerve injury. Scar tissue at the posterolateral aspect of the knee indicates injury of this specific area, and involvement of the peroneal nerve is likely. (orig.)

Age-related differences in twitch properties and muscle activation of the first dorsal interosseous.

Science.gov (United States)

Miller, Jonathan D; Herda, Trent J; Trevino, Michael A; Sterczala, Adam J; Ciccone, Anthony B; Nicoll, Justin X

2017-06-01

To examine twitch force potentiation and twitch contraction duration, as well as electromyographic amplitude (EMG RMS ) and motor unit mean firing rates (MFR) at targeted forces between young and old individuals in the first dorsal interosseous (FDI). Ultrasonography was used to assess muscle quality. Twenty-two young (YG) (age=22.6±2.7years) and 14 older (OD) (age=62.1±4.7years) individuals completed conditioning contractions at 10% and 50% maximal voluntary contraction, (MVC) during which EMG RMS and MFRs were assessed. Evoked twitches preceded and followed the conditioning contractions. Ultrasound images were taken to quantify muscle quality (cross-sectional area [CSA] and echo intensity [EI]). No differences were found between young and old for CSA, pre-conditioning contraction twitch force, or MFRs (P>0.05). However, OD individuals exhibited greater EI and contraction duration (PMFRs. Ultrasonography suggested age-related changes in muscle structure contributed to altered contractile properties in the OD. Greater muscle activation requirements can have negative implications on fatigue resistance at low to moderate intensities in older individuals. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

[Morphology research of the rat sciatic nerve bridged by collage-heparin sulfate scaffold].

Science.gov (United States)

Wang, Shu-sen; Hu, Yun-yu; Luo, Zhuo-jing; Chen, Liang-wei; Liu, Hui-ling; Meng, Guo-lin; Lü, Rong; Xu, Xin-zhi

2005-04-15

To observe the treating effect of collage-heparin sulfate after the 10 mm rat sciatic nerve defect was bridged by it. A new kind of nervous tissue engineering scaffold was produced by freeze-drying technique from collagen-heparin sulfate. Thirty-two SD rats were randomly divided into A, B, C and D groups. Sciatic nerve defect in group A was bridged by collagen-heparin sulfate. In group B, sciatic nerve was bridged by auto-nerve transplantation. Group C was the blank control group. Animals in group D were normal. And 10 mm sciatic nerve defect was bridged in the experiment. Thirty-six weeks after the operation, the experimental animals were detected by HRP labeled retrograde trace, HE staining, toluidine staining, silvering staining, S100, GAP-43 and NF immunohistological staining, MBP immunofluorescence staining and transmission electron microscope to observe the nerve regeneration inducing effect of this new scaffold. Nine months after operation, the collage-heparin sulfate scaffold was replaced by newly regenerated nerve. The number of HRP labeled spinal cord anterior horn cells and the area of sensation nerve fiber at the posterior horn were similar with that was repaired by auto-nerve. GAP-43, NF and S100 labeled regenerated nerve fiber had passed the total scaffold and entered the distal terminal. The regenerated nerve fibers were paralleled, lineage arranged, coincide with the prearranged regenerating "channel" in the collagen-heparin sulfate scaffold. MBP immunofluorescence staining also proved that the newly regenerated nerve fiber could be ensheathed. In the experimental group, the area of myelinated nerve fiber and the thickness of the myelin sheath had no obvious difference with that of the group repaired by auto-nerve, except that the density of the regenerated myelinated sheath fiber was lower than that of the control group. Nervous tissue engineering scaffold produced by collagen-heparin sulfate can guide the regeneration of nerve fibers. The nerve

End-to-side neurorrhaphy repairs peripheral nerve injury: sensory nerve induces motor nerve regeneration.

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Yu, Qing; Zhang, She-Hong; Wang, Tao; Peng, Feng; Han, Dong; Gu, Yu-Dong

2017-10-01

End-to-side neurorrhaphy is an option in the treatment of the long segment defects of a nerve. It involves suturing the distal stump of the disconnected nerve (recipient nerve) to the side of the intimate adjacent nerve (donor nerve). However, the motor-sensory specificity after end-to-side neurorrhaphy remains unclear. This study sought to evaluate whether cutaneous sensory nerve regeneration induces motor nerves after end-to-side neurorrhaphy. Thirty rats were randomized into three groups: (1) end-to-side neurorrhaphy using the ulnar nerve (mixed sensory and motor) as the donor nerve and the cutaneous antebrachii medialis nerve as the recipient nerve; (2) the sham group: ulnar nerve and cutaneous antebrachii medialis nerve were just exposed; and (3) the transected nerve group: cutaneous antebrachii medialis nerve was transected and the stumps were turned over and tied. At 5 months, acetylcholinesterase staining results showed that 34% ± 16% of the myelinated axons were stained in the end-to-side group, and none of the myelinated axons were stained in either the sham or transected nerve groups. Retrograde fluorescent tracing of spinal motor neurons and dorsal root ganglion showed the proportion of motor neurons from the cutaneous antebrachii medialis nerve of the end-to-side group was 21% ± 5%. In contrast, no motor neurons from the cutaneous antebrachii medialis nerve of the sham group and transected nerve group were found in the spinal cord segment. These results confirmed that motor neuron regeneration occurred after cutaneous nerve end-to-side neurorrhaphy.

Anatomically based lower limb nerve model for electrical stimulation

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Soboleva Tanya K

2007-12-01

Full Text Available Abstract Background Functional Electrical Stimulation (FES is a technique that aims to rehabilitate or restore functionality of skeletal muscles using external electrical stimulation. Despite the success achieved within the field of FES, there are still a number of questions that remain unanswered. One way of providing input to the answers is through the use of computational models. Methods This paper describes the development of an anatomically based computer model of the motor neurons in the lower limb of the human leg and shows how it can be used to simulate electrical signal propagation from the beginning of the sciatic nerve to a skeletal muscle. One-dimensional cubic Hermite finite elements were used to represent the major portions of the lower limb nerves. These elements were fit to data that had been digitised using images from the Visible Man project. Nerves smaller than approximately 1 mm could not be seen in the images, and thus a tree-branching algorithm was used to connect the ends of the fitted nerve model to the respective skeletal muscle. To simulate electrical propagation, a previously published mammalian nerve model was implemented and solved on the anatomically based nerve mesh using a finite difference method. The grid points for the finite difference method were derived from the fitted finite element mesh. By adjusting the tree-branching algorithm, it is possible to represent different levels of motor-unit recruitment. Results To illustrate the process of a propagating nerve stimulus to a muscle in detail, the above method was applied to the nerve tree that connects to the human semitendinosus muscle. A conduction velocity of 89.8 m/s was obtained for a 15 μm diameter nerve fibre. This signal was successfully propagated down the motor neurons to a selected group of motor units in the muscle. Conclusion An anatomically and physiologically based model of the posterior motor neurons in the human lower limb was developed. This

Restoration of quinine-stimulated Fos-immunoreactive neurons in the central nucleus of the amygdala and gustatory cortex following reinnervation or cross-reinnervation of the lingual taste nerves in rats.

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King, Camille Tessitore; Garcea, Mircea; Spector, Alan C

2014-08-01

Remarkably, when lingual gustatory nerves are surgically rerouted to inappropriate taste fields in the tongue, some taste functions recover. We previously demonstrated that quinine-stimulated oromotor rejection reflexes and neural activity (assessed by Fos immunoreactivity) in subregions of hindbrain gustatory nuclei were restored if the posterior tongue, which contains receptor cells that respond strongly to bitter compounds, was cross-reinnervated by the chorda tympani nerve. Such functional recovery was not seen if instead, the anterior tongue, where receptor cells are less responsive to bitter compounds, was cross-reinnervated by the glossopharyngeal nerve, even though this nerve typically responds robustly to bitter substances. Thus, recovery depended more on the taste field being reinnervated than on the nerve itself. Here, the distribution of quinine-stimulated Fos-immunoreactive neurons in two taste-associated forebrain areas was examined in these same rats. In the central nucleus of the amygdala (CeA), a rostrocaudal gradient characterized the normal quinine-stimulated Fos response, with the greatest number of labeled cells situated rostrally. Quinine-stimulated neurons were found throughout the gustatory cortex, but a "hot spot" was observed in its anterior-posterior center in subregions approximating the dysgranular/agranular layers. Fos neurons here and in the rostral CeA were highly correlated with quinine-elicited gapes. Denervation of the posterior tongue eliminated, and its reinnervation by either nerve restored, numbers of quinine-stimulated labeled cells in the rostralmost CeA and in the subregion approximating the dysgranular gustatory cortex. These results underscore the remarkable plasticity of the gustatory system and also help clarify the functional anatomy of neural circuits activated by bitter taste stimulation. © 2014 Wiley Periodicals, Inc.

Innervation pattern of the suprascapular nerve within supraspinatus: a three-dimensional computer modeling study.

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Hermenegildo, J A; Roberts, S L; Kim, S Y

2014-05-01

The relationship between the innervation pattern of the suprascapular nerve (SSN) and the muscle architecture of supraspinatus has not been thoroughly investigated. The supraspinatus is composed of two architecturally distinct regions: anterior and posterior. Each of these regions is further subdivided into three parts: superficial, middle and deep. The purpose of this study was to investigate the course of the SSN throughout the volume of supraspinatus and to relate the intramuscular branches to the distinct regions and parts of the supraspinatus. The SSN was dissected in thirty formalin embalmed cadaveric specimens and digitized throughout the muscle volume in six of those specimens. The digitized data were modeled using Autodesk(®) Maya(®) 2011. The three-dimensional (3D) models were used to relate the intramuscular innervation pattern to the muscle and tendon architecture defined by Kim et al. (2007, Clin Anat 20:648-655). The SSN bifurcated into two main trunks: medial and lateral. All parts of the anterior region were predominantly innervated by the medial trunk and its proximal and medial branches, whereas all parts of the posterior region predominantly by the lateral trunk and its posterolateral and/or posteromedial branches. The posterior region also received innervation from the proximal branch of the medial trunk in half of the specimens. These findings provide evidence that the anterior and posterior regions are distinct with respect to their innervation. The 3D map of the innervation pattern will aid in planning future clinical studies investigating muscle activation patterns and provide insight into possible injury of the nerve with supraspinatus pathology and surgical techniques. Copyright © 2013 Wiley Periodicals, Inc.

Sacral Fracture Nonunion Treated by Bone Grafting through a Posterior Approach

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Sang Yang Lee

2013-01-01

Full Text Available Nonunion of a sacral fracture is a rare but serious clinical condition which can cause severe chronic pain, discomfort while sitting, and significant restriction of the level of activities. Fracture nonunions reportedly occur most often after nonoperative initial treatment or inappropriate operative treatment. We report a case of fracture nonunion of the sacrum and pubic rami that resulted from non-operative initial treatment, which was treated successfully using bone grafting through a posterior approach and CT-guided percutaneous iliosacral screw fixation combined with anterior external fixation. Although autologous bone grafting has been the gold standard for the treatment of pelvic fracture nonunions, little has been written describing the approach. We utilized a posterior approach for bone grafting, which could allow direct visualization of the nonunion site and preclude nerve root injury. By this procedure, we were able to obtain the healing of fracture nonunion, leading to pain relief and functional recovery.

Integrated Model of the Eye/Optic Nerve Head Biomechanical Environment

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Ethier, C. R.; Feola, A.; Myers, J. G.; Nelson, E.; Raykin, J.; Samuels, B.

2017-01-01

Visual Impairment and Intracranial Pressure (VIIP) syndrome is a concern for long-duration space flight. Previously, it has been suggested that ocular changes observed in VIIP syndrome are related to the cephalad fluid shift that results in altered fluid pressures [1]. We are investigating the impact of changes in intracranial pressure (ICP) using a combination of numerical models, which simulate the effects of various environment conditions, including finite element (FE) models of the posterior eye. The specific interest is to understand how altered pressures due to gravitational changes affect the biomechanical environment of tissues of the posterior eye and optic nerve sheath. METHODS: Additional description of the numerical modeling is provided in the IWS abstract by Nelson et al. In brief, to simulate the effects of a cephalad fluid shift on the cardiovascular and ocular systems, we utilized a lumped-parameter compartment model of these systems. The outputs of this lumped-parameter model then inform boundary conditions (pressures) for a finite element model of the optic nerve head (Figure 1). As an example, we show here a simulation of postural change from supine to 15 degree head-down tilt (HDT), with primary outcomes being the predicted change in strains at the optic nerve head (ONH) region, specifically in the lamina cribrosa (LC), retrolaminar optic nerve, and prelaminar neural tissue (PLNT). The strain field can be decomposed into three orthogonal components, denoted as the first, second and third principal strains. We compare the peak tensile (first principal) and compressive (third principal) strains, since elevated strain alters cell phenotype and induces tissue remodeling. RESULTS AND CONCLUSIONS: Our lumped-parameter model predicted an IOP increase of c. 7 mmHg after 21 minutes of 15 degree HDT, which agreed with previous reports of IOP in HDT [1]. The corresponding FEM simulations predicted a relative increase in the magnitudes of the peak tensile

Sacral nerve stimulation increases activation of the primary somatosensory cortex by anal canal stimulation in an experimental model.

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Griffin, K M

2011-08-01

Sacral and posterior tibial nerve stimulation may be used to treat faecal incontinence; however, the mechanism of action is unknown. The aim of this study was to establish whether sensory activation of the cerebral cortex by anal canal stimulation was increased by peripheral neuromodulation.

Examination of muscle composition and motor unit behavior of the first dorsal interosseous of normal and overweight children.

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Miller, Jonathan D; Sterczala, Adam J; Trevino, Michael A; Herda, Trent J

2018-05-01

We examined differences between normal weight (NW) and overweight (OW) children aged 8-10 yr in strength, muscle composition, and motor unit (MU) behavior of the first dorsal interosseous. Ultrasonography was used to determine muscle cross-sectional area (CSA), subcutaneous fat (sFAT), and echo intensity (EI). MU behavior was assessed during isometric muscle actions at 20% and 50% of maximal voluntary contraction (MVC) by analyzing electromyography amplitude (EMG RMS ) and relationships between mean firing rates (MFR), recruitment thresholds (RT), and MU action potential amplitudes (MUAP size ) and durations (MUAP time ). The OW group had significantly greater EI than the NW group ( P = 0.002; NW, 47.99 ± 6.01 AU; OW, 58.90 ± 10.63 AU, where AU is arbitrary units) with no differences between groups for CSA ( P = 0.688) or MVC force ( P = 0.790). MUAP size was larger for NW than OW in relation to RT ( P = 0.002) and for MUs expressing similar MFRs ( P = 0.011). There were no significant differences ( P = 0.279-0.969) between groups for slopes or y-intercepts from the MFR vs. RT relationships. MUAP time was larger in OW ( P = 0.015) and EMG RMS was attenuated in OW compared with NW ( P = 0.034); however, there were no significant correlations ( P = 0.133-0.164, r = 0.270-0.291) between sFAT and EMG RMS . In a muscle that does not support body mass, the OW children had smaller MUAP size as well as greater EI, although anatomical CSA was similar. This contradicts previous studies examining larger limb muscles. Despite evidence of smaller MUs, the OW children had similar isometric strength compared with NW children. NEW & NOTEWORTHY Ultrasound data and motor unit action potential sizes suggest that overweight children have poorer muscle composition and smaller motor units in the first dorsal interosseous than normal weight children. Evidence is presented that suggests differences in action potential size cannot be explained

Non-formation of the main trunk of the sciatic nerve and unusual relationships to the piriformis muscle

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J. Stoyanov

2017-09-01

Full Text Available Background: The sciatic nerve is the largest branch of the sacral plexus. Variations of its origin, exit from the pelvis, emergence and branching in the posterior region of the thigh, especially in regards to the piriformis muscle, are an object of interest due to the possibility to be involved in the pathogenensis of clinically significant non-discogenic sciatica or piriformis syndrome. Case report: We present a case of variant anatomy of the sciatic nerve, discovered during routine dissection of the left gluteal region of an adult female cadaver. We observed a non-formation of the main trunk of the nerve; rather, the tibial nerve passed inferiorly to the piriformis muscle, while the common peroneal nerve went through the body of the bifid piriformis muscle, immediately next to its tendon. The two branches continued their course in the thigh without joining and forming a proper sciatic nerve. The medical records of the body donor did not reveal any neurological impairment which could be linked to this anatomical peculiarity. Conclusion: The anatomy of the sciatic nerve could be considered to be a factor of clinical significance. The high prevalence of similar anatomical variations should be kept in mind during the diagnostic process of clinical entities involving the sciatic nerve.

Evaluation of nerve transfer options for treating total brachial plexus avulsion injury: A retrospective study of 73 participants.

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Gao, Kai-Ming; Hu, Jing-Jing; Lao, Jie; Zhao, Xin

2018-03-01

Despite recent great progress in diagnosis and microsurgical repair, the prognosis in total brachial plexus-avulsion injury remains unfavorable. Insufficient number of donors and unreasonable use of donor nerves might be key factors. To identify an optimal treatment strategy for this condition, we conducted a retrospective review. Seventy-three patients with total brachial plexus avulsion injury were followed up for an average of 7.3 years. Our analysis demonstrated no significant difference in elbow-flexion recovery between phrenic nerve-transfer (25 cases), phrenic nerve-graft (19 cases), intercostal nerve (17 cases), or contralateral C 7 -transfer (12 cases) groups. Restoration of shoulder function was attempted through anterior accessory nerve (27 cases), posterior accessory nerve (10 cases), intercostal nerve (5 cases), or accessory + intercostal nerve transfer (31 cases). Accessory nerve + intercostal nerve transfer was the most effective method. A significantly greater amount of elbow extension was observed in patients with intercostal nerve transfer (25 cases) than in those with contralateral C 7 transfer (10 cases). Recovery of median nerve function was noticeably better for those who received entire contralateral C 7 transfer (33 cases) than for those who received partial contralateral C 7 transfer (40 cases). Wrist and finger extension were reconstructed by intercostal nerve transfer (31 cases). Overall, the recommended surgical treatment for total brachial plexus-avulsion injury is phrenic nerve transfer for elbow flexion, accessory nerve + intercostal nerve transfer for shoulder function, intercostal nerves transfer for elbow extension, entire contralateral C 7 transfer for median nerve function, and intercostal nerve transfer for finger extension. The trial was registered at ClinicalTrials.gov (identifier: NCT03166033).

Evaluation of nerve transfer options for treating total brachial plexus avulsion injury: a retrospective study of 73 participants

Science.gov (United States)

Gao, Kai-ming; Hu, Jing-jing; Lao, Jie; Zhao, Xin

2018-01-01

Despite recent great progress in diagnosis and microsurgical repair, the prognosis in total brachial plexus-avulsion injury remains unfavorable. Insufficient number of donors and unreasonable use of donor nerves might be key factors. To identify an optimal treatment strategy for this condition, we conducted a retrospective review. Seventy-three patients with total brachial plexus avulsion injury were followed up for an average of 7.3 years. Our analysis demonstrated no significant difference in elbow-flexion recovery between phrenic nerve-transfer (25 cases), phrenic nerve-graft (19 cases), intercostal nerve (17 cases), or contralateral C7-transfer (12 cases) groups. Restoration of shoulder function was attempted through anterior accessory nerve (27 cases), posterior accessory nerve (10 cases), intercostal nerve (5 cases), or accessory + intercostal nerve transfer (31 cases). Accessory nerve + intercostal nerve transfer was the most effective method. A significantly greater amount of elbow extension was observed in patients with intercostal nerve transfer (25 cases) than in those with contralateral C7 transfer (10 cases). Recovery of median nerve function was noticeably better for those who received entire contralateral C7 transfer (33 cases) than for those who received partial contralateral C7 transfer (40 cases). Wrist and finger extension were reconstructed by intercostal nerve transfer (31 cases). Overall, the recommended surgical treatment for total brachial plexus-avulsion injury is phrenic nerve transfer for elbow flexion, accessory nerve + intercostal nerve transfer for shoulder function, intercostal nerves transfer for elbow extension, entire contralateral C7 transfer for median nerve function, and intercostal nerve transfer for finger extension. The trial was registered at ClinicalTrials.gov (identifier: NCT03166033). PMID:29623932

The soleal line: a cause of tibial pseudoperiostitis.

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Levine, A H; Pais, M J; Berinson, H; Amenta, P S

1976-04-01

An unusually prominent soleal line (a normal anatomic variant) may mimic periosteal reaction along the posterior margin of the proximal tibial shaft. This area of pseudoperiostitis is differentiated from hyperostoses arising from the anterior tibial tubercle and the interosseous membrane. It is always associated with normal, undisturbed architecture of the underlying bone.

Radioanatomy of the singular nerve canal

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Muren, C. [Dept. of Diagnostic Radiology, Sabbatsbergs Hospital, Stockholm (Sweden); Wadin, K. [University Hospital, Uppsala (Sweden); Dimopoulos, P. [University Hospital, Uppsala (Sweden)

1991-08-01

The singular canal conveys vestibular nerve fibers from the ampulla of the posterior semicircular canal to the posteroinferior border of the internal auditory meatus. Radiographic identification of this anatomic structure helps to distinguish it from a fracture. It is also a landmark in certain surgical procedures. Computed tomography (CT) examinations of deep-frozen temporal bone specimens were compared with subsequently prepared plastic casts of these bones, showing good correlation between the anatomy and the images. The singular canal and its variable anatomy were studied in CT examinations of 107 patients. The singular canal could be identified, in both the axial and in the coronal planes. Its point of entry into the internal auditory meatus varied considerably. (orig.)

Peripapillary retinal nerve fiber layer and choroidal thickness in cirrhosis patients

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M.Orcun Akdemir

2015-12-01

Full Text Available ABSTRACT Purpose: To evaluate the effect of cirrhosis on peripapillary retinal nerve fiber layer and choroidal thickness with enhanced depth imaging optical coherence tomography. Methods: This cross sectional, single center study was undertaken at Bulent Ecevit University Ophthalmology department with the participation of internal medicine, Gastroenterology department. Patients who were treated with the diagnosis of cirrhosis (n=75 were examined in the ophthalmology clinic. Age and sex matched patients (n=50 who were healthy and met the inclusion, exclusion criteria were included in the study. Complete ophthalmological examination included visual acuity with Snellen chart, intraocular pressure measurement with applanation tonometry, biomicroscopy of anterior and posterior segments, gonioscopy, axial length measurement, visual field examination, peripapillary retinal nerve fiber layer, central macular and subfoveal choroidal thickness measurements. Results: The difference between intraocular pressure values was not statistically significant between cirrhosis and control group (p=0.843. However, mean peripapillary retinal nerve fiber layer thickness was significantly thinner in cirrhosis group in all regions (p<0.001 and subfoveal choroidal thickness was significantly thinner in cirrhosis group also (p<0.001. Moreover, central macular thickness of cirrhosis group was significantly thicker than the control group (p=0.001. Conclusion: Peripapillary retinal nerve fiber layer and subfoveal choroidal thickness was significantly thinner in cirrhosis patients.

A simple and successful sonographic technique to identify the sciatic nerve in the parasacral area.

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Taha, Ahmad Muhammad

2012-03-01

The purpose of this study was to describe detailed sonographic anatomy of the parasacral area for rapid and successful identification of the sciatic nerve. Fifty patients scheduled for knee surgery were included in this observational study. An ultrasound-guided parasacral sciatic nerve block was performed in all patients. The ultrasound probe was placed on an axial plane 8 cm lateral to the uppermost point of the gluteal cleft. Usually, at this level the posterior border of the ischium (PBI), a characteristically curved hyperechoic line, could be identified. The sciatic nerve appeared as a hyperechoic structure just medial to the PBI. The nerve lies deep to the piriformis muscle lateral to the inferior gluteal vessels, and if followed caudally, it rests directly on the back of the ischium. After confirmation with electrical stimulation, a 20-mL mixture of 1% ropivacaine and 1% lidocaine with epinephrine was injected. The sciatic nerve was identified successfully in 48 patients (96%). In those patients, the median time required for its ultrasonographic identification was ten seconds [interquartile range, 8-13.7 sec], and the block success rate was 100%. The described sonographic details of the parasacral area allowed for rapid and successful identification of the sciatic nerve.

Anatomical approach for surgery of the male posterior urethra.

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Dalpiaz, Orietta; Mitterberger, Michael; Kerschbaumer, Andrea; Pinggera, Germar M; Bartsch, Georg; Strasser, Hannes

2008-11-01

To investigate, in a morphological study, the anatomy of the male rhabdosphincter and the relation between the membranous urethra, the rhabdosphincter and the neurovascular bundles (NVBs) to provide the anatomical basis for surgical approach of the posterior urethra as successful outcomes in urethral reconstructive surgery still remain a challenging issue. In all, 11 complete pelves and four tissue blocks of prostate, rectum, membranous urethra and the rhabdosphincter were studied. Besides anatomical preparations, the posterior urethra and their relationship were studied by means of serial histological sections. In the histological cross-sections, the rhabdosphincter forms an omega-shaped loop around the anterior and lateral aspects of the membranous urethra. Ventrally and laterally, it is separated from the membranous urethra by a delicate sheath of connective tissue. Through a midline approach displacing the nerves and vessels laterally, injuries to the NVBs can be avoided. With meticulous dissection of the delicate ventral connective tissue sheath between the ventral wall of the membranous urethra and the rhabdosphincter, the two structures can be separated without damage to either of them. This anatomical approach can be used for dissection of the anterior urethral wall in urethral surgery. Based on precise anatomical knowledge, the ventral wall of the posterior urethra can be dissected and exposed without injuring the rhabdosphincter and the NVBs. This approach provides the basis for sparing of the rhabdosphincter and for successful outcomes in urethral surgery for the treatment of bulbo-membranous urethral strictures.

Cranial nerve monitoring during subpial dissection in temporomesial surgery.

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Ortler, Martin; Fiegele, Thomas; Walser, Gerald; Trinka, Eugen; Eisner, Wilhelm

2011-06-01

Cranial nerves (CNs) crossing between the brainstem and skull base at the level of the tentorial hiatus may be at risk in temporomesial surgery involving subpial dissection and/or tumorous growth leading to distorted anatomy. We aimed to identify the surgical steps most likely to result in CN damage in this type of surgery. Electromyographic responses obtained with standard neuromonitoring techniques and a continuous free-running EMG were graded as either contact activity or pathological spontaneous activity (PSA) during subpial resection of temporomesial structures in 16 selective amygdalohippocampectomy cases. Integrity of peripheral motor axons was tested by transpial/transarachnoidal electrical stimulation while recording compound muscle action potentials from distal muscle(s). Continuous EMG showed pathological activity in five (31.2%) patients. Nine events with PSA (slight activity, n = 8; strong temporary activity, n = 1) were recorded. The oculomotor nerve was involved three times, the trochlear nerve twice, the facial nerve once, and all monitored nerves on three occasions. Surgical maneuvers associated with PSA were the resection of deep parts of the hippocampus and parahippocampal gyrus (CN IV, twice; CN III, once), lining with or removing cotton patties from the resection cavity (III, twice; all channels, once) and indirect exertion of tension on the intact pia/arachnoid of the uncal region while mobilizing the hippocampus and parahippocampal gyrus en bloc (all channels, once; III, once). CMAPs were observed at 0.3 mA in two patients and at 0.6 mA in one patient, and without registering the exact amount of intensity in three patients. The most dangerous steps leading to cranial nerve damage during mesial temporal lobe surgery are the final stages of the intervention while the resection is being completed in the deep posterior part and the resection cavity is being lined with patties. Distant traction may act on nerves crossing the tentorial

The Impact of Ocular Pressures, Material Properties and Geometry on Optic Nerve Head Deformation

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Feola, Andrew J.; Myers, Jerry G.; Raykin, Julia; Nelson, Emily S.; Samuels, Brian C.; Ethier C. Ross

2017-01-01

Alteration in intracranial pressure (ICP) has been associated with various diseases that cause visual impairment, including glaucoma, idiopathic intracranial hypertension and Visual Impairment and Intracranial Pressure (VIIP) syndrome. However, how changes in ICP lead to vision loss is unclear, although it is hypothesized to involve deformations of the tissues in the optic nerve head (ONH). Recently, understanding the effect of ICP alterations on ocular tissues has become a major concern for NASA, where 42 of astronauts that partake in long duration space missions suffer from VIIP syndrome. Astronauts with VIIP syndrome suffer from visual impairment and changes in ocular anatomy that persist after returning to earth (1). It is hypothesized that the cephalad fluid shift that occurs upon entering microgravity increases ICP, which leads to an altered biomechanical environment in the posterior globe and optic nerve sheath, and subsequently VIIP syndrome. Our goal was to develop a finite element (FE) model to simulate the acute effects of elevated ICP on the posterior eye. Here, we simulated how inter-individual differences affect the deformation of ONH tissues. Further, we examined how several different geometries influenced deformations when exposed to elevated ICP.

Does the presence of the nerve root sedimentation sign on MRI correlate with the operative level in patients undergoing posterior lumbar decompression for lumbar stenosis?

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Fazal, Akil; Yoo, Andrew; Bendo, John A

2013-08-01

Recent research describes the use of a nerve root sedimentation sign to diagnose lumbar spinal stenosis (LSS). The lack of sedimentation of the nerve roots (positive sedimentation sign) to the dorsal part of the dural sac is the characteristic feature of this new radiological parameter. To demonstrate how the nerve root sedimentation sign compares with other more traditional radiological parameters in patients who have been operated for LSS. A retrospective chart and image review. Preoperative magnetic resonance images (MRIs) were reviewed from 71 consecutive operative patients who presented with LSS and received spinal decompression surgery from 2006 to 2010. Preoperative T2-weighted MRIs were reviewed for each patient. One hundred thirty-four vertebral levels from L1 to L5 were measured for: sedimentation sign, cross-sectional area (CSA) and anterior/posterior (A/P) diameter of the dural sac, thickness of the ligamentum flavum, and Fujiwara grade of facet hypertrophy. Radiological measurements were made using Surgimap 1.1.2.169 software (Nemaris, Inc., New York, NY, USA). Statistical analyses were performed using the SPSS 17.0 statistical software (SPSS Inc., Chicago, IL, USA). Significance was demonstrated using unpaired t tests and chi-squared tests. Study funding was departmental. There were no study-specific conflicts of interest-associated biases. A positive sedimentation sign was determined in 120 operated levels (89.5%), whereas 14 levels (10.5%) had no sign (negative sedimentation sign). The mean CSA and A/P diameter were 140.62 mm(2) (standard deviation [SD]=53) and 11.76 mm (SD=3), respectively, for the no-sign group; the mean CSA and A/P diameter were 81.87 mm(2) (SD=35) and 8.76 mm (SD=2.2), respectively, for the sedimentation sign group (p<.001). We found that 60% of levels with Fujiwara Grade A facet hypertrophy did not have a sedimentation sign, whereas 86.3% of levels with Grade B, 93.2% of levels with Grade C, and 100.0% of levels with Grade D

Anatomical study of middle cluneal nerve entrapment

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Konno T

2017-06-01

Full Text Available Tomoyuki Konno,1 Yoichi Aota,2 Tomoyuki Saito,1 Ning Qu,3 Shogo Hayashi,3 Shinichi Kawata,3 Masahiro Itoh3 1Department of Orthopaedic Surgery, Yokohama City University, 2Department of Spine and Spinal Cord, Yokohama Brain and Spine Center, Yokohama City, 3Department of Anatomy, Tokyo Medical University, Tokyo, Japan Object: Entrapment of the middle cluneal nerve (MCN under the long posterior sacroiliac ligament (LPSL is a possible, and underdiagnosed, cause of low-back and/or leg symptoms. To date, detailed anatomical studies of MCN entrapment are few. The purpose of this study was to ascertain, using cadavers, the relationship between the MCN and LPSL and to investigate MCN entrapment. Methods: A total of 30 hemipelves from 20 cadaveric donors (15 female, 5 male designated for education or research, were studied by gross anatomical dissection. The age range of the donors at death was 71–101 years with a mean of 88 years. Branches of the MCN were identified under or over the gluteus maximus fascia caudal to the posterior superior iliac spine (PSIS and traced laterally as far as their finest ramification. Special attention was paid to the relationship between the MCN and LPSL. The distance from the branch of the MCN to the PSIS and to the midline and the diameter of the MCN were measured. Results: A total of 64 MCN branches were identified in the 30 hemipelves. Of 64 branches, 10 (16% penetrated the LPSL. The average cephalocaudal distance from the PSIS to where the MCN penetrated the LPSL was 28.5±11.2 mm (9.1–53.7 mm. The distance from the midline was 36.0±6.4 mm (23.5–45.2 mm. The diameter of the MCN branch traversing the LPSL averaged 1.6±0.5 mm (0.5–3.1 mm. Four of the 10 branches penetrating the LPSL had obvious constriction under the ligament. Conclusion: This is the first anatomical study illustrating MCN entrapment. It is likely that MCN entrapment is not a rare clinical entity. Keywords: middle cluneal nerve, sacroiliac joint

Variations in reciprocal distances between the ethmoidal sinus, sphenoidal sinus and posterior orbit. Measurement on CTscans

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Hayakawa, Kimiko; Yoshikawa, Hiroshi; Suzuki, Miyako; Yokoi, Hidenori; Hosokawa, Akira; Hagiwara, Akiko; Ichikawa, Ginichirou [Juntendo Univ., Tokyo (Japan). School of Medicine

2003-05-01

In concluding surgery of the paranasal sinuses (anterior and posterior) and the sphenoidal sinus, caution is demanded because intraorbital complications may develop in the skull. It is well-known that there is substantial variation in the form of the internal wall of the orbit, and the anterior and posterior walls of the sphenoidal sinus. In the present study, we measured the size of the structure around the paranasal sinus on patient CTscans to be used in surgery on the paranasal sinuses. A total of 387 people (184 males and 203 females) with no destructive bone lesions who visited the Juntendo University Hospital between 1999 and June 2002 were investigated. A plane was selected 14 mm above a line drawn between the medial angle and the external acoustic orifice on CTscans performed using axial projection. This framework was used to conduct the measurements. We employed this method because we consider it ideal for rendering the ethmoidal sinuses, the internal wall of the orbit, medial rectus muscle, optic nerve, and the anterior and posterior walls of the sphenoidal sinus most clearly visible. We measured the length between these anatomically important regions. We measured 1) the length of a line drawn between the opening of the nose and the line drawn between the right and left optic canals, 2) the length between the nasal opening and the posterior wall of the sphenoidal sinus, on the same horizontal line drawn between the posterior end of the eyeball and the nasal septum, 3) the length of a line from the site where the optic nerve adheres to the nasal septum, 4) the length between the lateral wall of the ethmoidal sinus, 5) the length between the nasal septum and the medial side of the medial rectus muscle, 6) the length between the medial side of the medial rectus muscle and the medial side of the optic nerve. The measurements were performed on both sides. We analyzed the above results statistically according to gender and age. The results of the analysis

Nerve Blocks

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... News Physician Resources Professions Site Index A-Z Nerve Blocks A nerve block is an injection to ... the limitations of Nerve Block? What is a Nerve Block? A nerve block is an anesthetic and/ ...

OUR EXPERINCE WITH USE OF POSTERIOR MESH RECTOPEXY IN COMPLETE RECTAL PROLAPSE

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Sudhansu Sekhar Mohanty

2017-12-01

Full Text Available BACKGROUND Mesh rectopexy is one of the accepted treatment options for rectal prolapse. We used polypropylene posterior mesh rectopexy for prolapse rectum. The aim of the study was to see demographic, clinical and functional outcome of posterior mesh rectopexy in our setup. MATERIALS AND METHODS The case report of 33 patients under gone posterior abdominal mesh rectopexy in MKCG medical college and hospital from 1st July 2012 to 1st July 2017 were reviewed retrospectively and the patients were followed up in surgical OPD/telephonic questionnaire. All patients had undergone standard posterior abdominal mesh rectopexy without the division of lateral ligaments with utmost care for prevention of bleeding and nerve damage. RESULTS Out of 33 cases of abdominal rectopexy, 12 (36% were males and 21 (64% were females. 27 (82% were within 61-80 years of age group. The most common symptoms were mass per annum (100% followed by incontinence for liquid stool and flatus 24 (72%. There was no operative mortality. The average hospital stay 7.8 days (5-11 days. The constipation (p=0.019 and incontinence (p=0.0165 were better postoperatively. There was 1 (3% partial recurrence of rectal prolapse in 91-year-old lady in 2 years follow up. CONCLUSION The recurrence rate as well as clinical and functional outcome of open abdominal mesh rectopexy seems to be satisfactory, however, long-term effect has to be seen.

Sonoanatomical Change of Phrenic Nerve According to Posture During Ultrasound-Guided Stellate Ganglion Block.

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Joeng, Eui Soo; Jeong, Young Cheol; Park, Bum Jun; Kang, Seok; Yang, Seung Nam; Yoon, Joon Shik

2016-04-01

To evaluate the risk of phrenic nerve injury during ultrasound-guided stellate ganglion block (US-SGB) according to sonoanatomy of the phrenic nerve, and determine a safer posture for needle insertion by assessing its relationship with surrounding structure according to positional change. Twenty-nine healthy volunteers were recruited and underwent ultrasound in two postures, i.e., supine position with the neck extension and head rotation, and lateral decubitus position. The transducer was placed at the anterior tubercle of the C6 level to identify phrenic nerve. The cross-sectional area (CSA), depth from skin, distance between phrenic nerve and anterior tubercle of C6 transverse process, and the angle formed by anterior tubercle, posterior tubercle and phrenic nerve were measured. The phrenic nerve was clearly identified in the intermuscular fascia layer between the anterior scalene and sternocleidomastoid muscles. The distance between the phrenic nerve and anterior tubercle was 10.33±3.20 mm with the supine position and 9.20±3.31 mm with the lateral decubitus position, respectively. The mean CSA and skin depth of phrenic nerve were not statistically different between the two positions. The angle with the supine position was 48.37°±27.43°, and 58.89°±30.02° with the lateral decubitus position. The difference of angle between the two positions was statistically significant. Ultrasound is a useful tool for assessing the phrenic nerve and its anatomical relation with other cervical structures. In addition, lateral decubitus position seems to be safer by providing wider angle for needle insertion than the supine position in US-SGB.

Posterior glenoid rim deficiency in recurrent (atraumatic) posterior shoulder instability

International Nuclear Information System (INIS)

Weishaupt, D.; Zanetti, M.; Hodler, J.; Nyffeler, R.W.; Gerber, C.

2000-01-01

Objective. To assess the shape of the posterior glenoid rim in patients with recurrent (atraumatic) posterior instability.Design and patients. CT examinations of 15 shoulders with recurrent (atraumatic) posterior instability were reviewed in masked fashion with regard to abnormalities of the glenoid shape, specifically of its posterior rim. The glenoid version was also assessed. The findings were compared with the findings in 15 shoulders with recurrent anterior shoulder instability and 15 shoulders without instability. For all patients, surgical correlation was available.Results. Fourteen of the 15 (93%) shoulders with recurrent (atraumatic) posterior shoulder instability had a deficiency of the posteroinferior glenoid rim. In patients with recurrent anterior instability or stable shoulders such deficiencies were less common (60% and 73%, respectively). The craniocaudal length of the deficiencies was largest in patients with posterior instability. When a posteroinferior deficiency with a craniocaudal length of 12 mm or more was defined as abnormal, sensitivity and specificity for diagnosing recurrent (atraumatic) posterior instability were 86.7% and 83.3%, respectively. There was a statistically significant difference in glenoid version between shoulders with posterior instability and stable shoulders (P=0.01).Conclusion. Recurrent (atraumatic) posterior shoulder instability should be considered in patients with a bony deficiency of the posteroinferior glenoid rim with a craniocaudal length of more than 12 mm. (orig.)

Ultrasound-guided continuous suprascapular nerve block for adhesive capsulitis: one case and a short topical review

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Neimann, Jens Dupont Børglum; Bartholdy, Anne; Hautopp, H

2011-01-01

We present a case with an ultrasound-guided (USG) placement of a perineural catheter beneath the transverse scapular ligament in the scapular notch to provide a continuous block of the suprascapular nerve (SSN). The patient suffered from a severe and very painful adhesive capsulitis of the left...... shoulder secondary to an operation in the same shoulder conducted 20 weeks previously for impingement syndrome and a superior labral anterior-posterior tear. Following a new operation with capsular release, the placement of a continuous nerve block catheter subsequently allowed for nearly pain-free low...... impact passive and guided active mobilization by the performing physiotherapist for three consecutive weeks. This case and a short topical review on the use of SSN block in painful shoulder conditions highlight the possibility of a USG continuous nerve block of the SSN as sufficient pain management...

Extraction of mandibular premolars and molars: comparison between local infiltration via pressure syringe and inferior alveolar nerve block anesthesia.

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Thiem, Daniel G E; Schnaith, Florian; Van Aken, Caroline M E; Köntges, Anne; Kumar, Vinay V; Al-Nawas, Bilal; Kämmerer, Peer W

2018-04-01

The purpose of this study was to evaluate the anesthetic efficiency of local infiltration anesthesia administered with a pressure syringe (P-INF) via a special technique versus direct block anesthesia of the inferior alveolar nerve (IANB) for tooth extraction in the posterior mandible. In a prospective randomized study, 101 teeth in 101 patients were extracted in the posterior mandible under local anesthesia whereby two different administration techniques were used (P-INF n = 48; IANB n = 53). Primary objectives were comparisons of anesthetic success rate (yes/no) and efficacy (full/sufficient vs. insufficient). Secondary objectives were patients' pain perception during treatment, pain of injection (numerical rating scale), need for second injections (always IANB), time until onset of anesthetic action (min), and duration of local numbness (min). IANB was successful in all cases, whereas initial P-INF achieved 35% of success only. Furthermore, IANB reached significant higher values of anesthetic efficacy compared to P-INF (P block anesthesia of the inferior alveolar nerve (IANB) turned out to be more proficient to local infiltration via special delivering system with a special technique. Infiltration, even when performed with 4% articaine and a pressure syringe system, is not a suitable method of anesthesia in the posterior mandible.

[Dumbbell malignant dorsal schwannoma embolized and operated by single posterior approach].

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Zabalo, Gorka; de Frutos, Daniel; García, Juan Carlos; Ortega, Rodrigo; Guelbenzu, Juan José; Zazpe, Idoya

2018-02-19

We report a case of a 41 years old patient complaining of chronic dorsalgia. MRI showed a well defined intradural extramedular dumbbell-shaped lesion, associated to a left paravertebral tumor at D5-D6 level. The tumor was embolizated prior to surgery. Following she underwent a D4-D6 laminotomy, left D5-D6 costotransversectomy and resection of the intracanal extradural part of the lesion with section of the left D5 nerve. Posteriorly, complete resection of the extracanal portion of the tumor was performed by a postero-lateral approach. The anatomopathologic diagnosis was a malignant schwannoma. After the surgery, the patient required adyuvant radiotherapic treatment. Malignant schwannoma is a very uncommon tumor which belongs to the malignant peripheral nerve sheath tumors (MPNST). It develops from Schwann cells. It is frequently associated with type 1 neurofibromatosis. MPNST usually present local recurrence and can metastatize. Copyright © 2018 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

Multiple roles for apoptosis facilitating condensation of the Drosophila ventral nerve cord.

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Page, Damon T; Olofsson, Birgitta

2008-02-01

At the end of embryogenesis, the ventral nerve cord (VNC) of Drosophila undergoes a shape change, termed condensation. During condensation the length of the VNC shortens by 25%, a process dependent on extracellular matrix deposited by hemocytes, an intact cytoskeleton of glia and neurons and neural activity. Here we show that cell death contributes to nerve cord shortening. Firstly, apoptosis occurs at the interface of the epidermis and the nerve cord where it plays a role in the separation of these two tissues. Separation precedes condensation and in conditions where separation is prevented, condensation fails. Secondly, many cells undergo apoptosis within VNC during condensation. This cell death is localized mainly to the posterior part of the nerve cord where more than half of all cell death occurs. Preventing apoptosis either in neurons or glia partially inhibits VNC shortening during condensation. Despite the importance of midline glia in axon tract development, preventing midline glia cell death results in normal hatching and adult formation. We find that undead midline glia are eliminated from the midline and become mispositioned or expelled from the nervous system. We suggest that this represent a form of pattern repair that operates to reduce the impact of the additional cells. (c) 2008 Wiley-Liss, Inc.

Dangerous extracranial-intracranial anastomoses and supply to the cranial nerves: vessels the neurointerventionalist needs to know.

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Geibprasert, S; Pongpech, S; Armstrong, D; Krings, T

2009-09-01

Transarterial embolization in the external carotid artery (ECA) territory has a major role in the endovascular management of epistaxis, skull base tumors, and dural arteriovenous fistulas. Knowledge of the potential anastomotic routes, identification of the cranial nerve supply from the ECA, and the proper choice of embolic material are crucial to help the interventionalist avoid neurologic complications during the procedure. Three regions along the skull base constitute potential anastomotic routes between the extracranial and intracranial arteries: the orbital, the petrocavernous, and the upper cervical regions. Branches of the internal maxillary artery have anastomoses with the ophthalmic artery and petrocavernous internal carotid artery (ICA), whereas the branches of the ascending pharyngeal artery are connected to the petrocavernous ICA. Branches of both the ascending pharyngeal artery and the occipital artery have anastomoses with the vertebral artery. To avoid cranial nerve palsy, one must have knowledge of the supply to the lower cranial nerves: The petrous branch of the middle meningeal artery and the stylomastoid branch of the posterior auricular artery form the facial arcade as the major supply to the facial nerve, and the neuromeningeal trunk of the ascending pharyngeal artery supplies the lower cranial nerves (CN IX-XII).

Raman spectroscopic detection of peripheral nerves towards nerve-sparing surgery

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Minamikawa, Takeo; Harada, Yoshinori; Takamatsu, Tetsuro

2017-02-01

The peripheral nervous system plays an important role in motility, sensory, and autonomic functions of the human body. Preservation of peripheral nerves in surgery, namely nerve-sparing surgery, is now promising technique to avoid functional deficits of the limbs and organs following surgery as an aspect of the improvement of quality of life of patients. Detection of peripheral nerves including myelinated and unmyelinated nerves is required for the nerve-sparing surgery; however, conventional nerve identification scheme is sometimes difficult to identify peripheral nerves due to similarity of shape and color to non-nerve tissues or its limited application to only motor peripheral nerves. To overcome these issues, we proposed a label-free detection technique of peripheral nerves by means of Raman spectroscopy. We found several fingerprints of peripheral myelinated and unmyelinated nerves by employing a modified principal component analysis of typical spectra including myelinated nerve, unmyelinated nerve, and adjacent tissues. We finally realized the sensitivity of 94.2% and the selectivity of 92.0% for peripheral nerves including myelinated and unmyelinated nerves against adjacent tissues. Although further development of an intraoperative Raman spectroscopy system is required for clinical use, our proposed approach will serve as a unique and powerful tool for peripheral nerve detection for nerve-sparing surgery in the future.

[Foster Modification of Full Tendon Transposition of Vertical Rectus Muscles for Sixth Nerve Palsy].

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Heede, Santa

2018-04-11

Since 1907 a variety of muscle transposition procedures for the treatment of abducens nerve palsy has been established internationally. Full tendon transposition of the vertical rectus muscle was initially described by O'Connor 1935 and then augmented by Foster 1997 with addition of posterior fixation sutures on the vertical rectus muscle. Full tendon transposition augmented by Foster belongs to the group of the most powerful surgical techniques to improve the abduction. Purpose of this study was to evaluate the results of full tendon vertical rectus transposition augmented with lateral fixation suture for patients with abducens nerve palsy. Full tendon transpositions of vertical rectus muscles augmented with posterior fixation suture was performed in 2014 on five patients with abducens nerve palsy. Two of the patients received Botox injections in the medial rectus muscle: one of them three months after the surgery and another during the surgery. One of the patients had a combined surgery of the horizontal muscles one year before. On three of the patients, who received a pure transposition surgery, the preoperative deviation at the distance (mean: + 56.6 pd; range: + 40 to + 80 pd) was reduced by a mean of 39.6 pd (range 34 to 50 pd), the abduction was improved by a mean of 3 mm (range 2 to 4 mm). The other two patients, who received besides the transposition procedure additional surgeries of the horizontal muscles, the preoperative deviation at the distance (+ 25 and + 126 pd respectively) was reduced by 20 and 81 pd respectively. The abduction was improved by 4 and 8 mm respectively. After surgery two patients developed a vertical deviation with a maximum of 4 pd. None of the patients had complications or signs of anterior segment ischemia. The elevation and/or depression was only marginally affected. There was no diplopia in up- or downgaze. Full tendon transposition of vertical rectus muscles, augmented with lateral posterior fixation suture is

Median artery of the forearm in human fetuses in northeastern Brazil: anatomical study and review of the literature.

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Aragão, José Aderval; da Silva, Ana Caroline Ferreira; Anunciação, Caio Barretto; Reis, Francisco Prado

2017-01-01

A persistent median artery is a rare anomaly. It accompanies the median nerve along its course in the forearm and is of variable origin. It is associated with other local anatomical variations and may contribute significantly towards formation of the superficial palmar arch. In embryos, it is responsible mainly for the blood supply to the hand. The objective of this study was to research the frequency, type (forearm or palmar) and origin of the median artery in fetuses, correlating its presence with sex and body side. Red-colored latex was injected into 32 brachial arteries of human fetuses until its arrival in the hand could be seen. Twenty-four hours after the injection, the median arteries were dissected without the aid of optical instruments. Among the 32 forearms dissected, the median artery was present in 81.25 % (26) of the cases, and it was found more frequently in females and on the left side. Regarding origin, most of the median arteries originated in the common interosseous artery (38.5 %) and anterior interosseous artery (34.6 %). The mean length of the median arteries was 21.1 mm for the palmar type and 19.8 mm for the forearm type. The median artery has a high rate of persistence. It is important to be aware of this anatomical variation, since its presence may give rise to difficulties during routine surgical procedures on the wrist. Its presence may cause serious functional complications in the carpal tunnel, anterior interosseous nerve, round pronator syndromes, and ischemia of the hand.

Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation

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Kotnis, Nikhil A. [McMaster University, Departments of Radiology, Hamilton, ON (Canada); Sheffield Teaching Hospitals, Department of Medical Physics and Medical Imaging, Sheffield (United Kingdom); Chiavaras, Mary M. [McMaster University, Departments of Radiology, Hamilton, ON (Canada); Harish, Srinivasan [McMaster University, Departments of Radiology, Hamilton, ON (Canada); St. Joseph' s Healthcare, Department of Diagnostic Imaging, Hamilton, ON (Canada)

2012-04-15

The diagnosis of lateral epicondylitis is often straightforward and can be made on the basis of clinical findings. However, radiological assessment is valuable where the clinical picture is less clear or where symptoms are refractory to treatment. Demographics, aspects of clinical history, or certain physical signs may suggest an alternate diagnosis. Knowledge of the typical clinical presentation and imaging findings of lateral epicondylitis, in addition to other potential causes of lateral elbow pain, is necessary. These include entrapment of the posterior interosseous and lateral antebrachial cutaneous nerves, posterolateral rotatory instability, posterolateral plica syndrome, Panner's disease, osteochondritis dissecans of the capitellum, radiocapitellar overload syndrome, occult fractures and chondral-osseous impaction injuries, and radiocapitellar arthritis. Knowledge of these potential masquerades of lateral epicondylitis and their characteristic clinical and imaging features is essential for accurate diagnosis. The goal of this review is to provide an approach to the imaging of lateral elbow pain, discussing the relevant anatomy, various causes, and discriminating factors, which will allow for an accurate diagnosis. (orig.)

Combined Ipsilateral Oculomotor Nerve Palsy and Contralateral Downbeat Nystagmus in a Case of Cerebral Infarction

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Kosuke Matsuzono

2014-04-01

Full Text Available We report a patient with acute cerebral infarction of the left paramedian thalamus, upper mesencephalon and cerebellum who exhibited ipsilateral oculomotor nerve palsy and contralateral downbeat nystagmus. The site of the infarction was considered to be the paramedian thalamopeduncular and cerebellar regions, which are supplied by the superior cerebellar artery containing direct perforating branches or both the superior cerebellar artery and the superior mesencephalic and posterior thalamosubthalamic arteries. Contralateral and monocular downbeat nystagmus is very rare. Our case suggests that the present downbeat nystagmus was due to dysfunction of cerebellar-modulated crossed oculovestibular fibers of the superior cerebellar peduncle or bilateral downbeat nystagmus with one-sided oculomotor nerve palsy.

Acellular Nerve Allografts in Peripheral Nerve Regeneration: A Comparative Study

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Moore, Amy M.; MacEwan, Matthew; Santosa, Katherine B.; Chenard, Kristofer E.; Ray, Wilson Z.; Hunter, Daniel A.; Mackinnon, Susan E.; Johnson, Philip J.

2011-01-01

Background Processed nerve allografts offer a promising alternative to nerve autografts in the surgical management of peripheral nerve injuries where short deficits exist. Methods Three established models of acellular nerve allograft (cold-preserved, detergent-processed, and AxoGen® -processed nerve allografts) were compared to nerve isografts and silicone nerve guidance conduits in a 14 mm rat sciatic nerve defect. Results All acellular nerve grafts were superior to silicone nerve conduits in support of nerve regeneration. Detergent-processed allografts were similar to isografts at 6 weeks post-operatively, while AxoGen®-processed and cold-preserved allografts supported significantly fewer regenerating nerve fibers. Measurement of muscle force confirmed that detergent-processed allografts promoted isograft-equivalent levels of motor recovery 16 weeks post-operatively. All acellular allografts promoted greater amounts of motor recovery compared to silicone conduits. Conclusions These findings provide evidence that differential processing for removal of cellular constituents in preparing acellular nerve allografts affects recovery in vivo. PMID:21660979

Subtemporal approach to basilar tip aneurysm with division of posterior communicating artery: Technical note

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Shunsuke Kakino

2008-08-01

Full Text Available Shunsuke Kakino, Kuniaki Ogasawara, Yoshitaka Kubo, Hideaki Nishimoto, Akira OgawaDepartment of Neurosurgery, Iwate Medical University School of Medicine, Morioka, Iwate, JapanAbstract: The subtemporal approach with division of the posterior communicating artery (PcomA is described for treating aneurysms of the basilar tip. When the ipsilateral posterior cerebral artery (PCA interferes with visibility and manipulation around the aneurysm neck and the artery is tethered by the PcomA and not mobilized, the PcomA can be divided near the junction with the PCA. The procedure permits PCA mobilization and exposes the neck of the aneurysm. We applied this procedure to a patient with a ruptured aneurysm of the basilar tip. The postoperative course was uneventful except for transient left oculomotor nerve palsy. Postoperative cerebral angiography and magnetic resonance imaging confirmed the respective disappearance of the aneurysm and no new ischemic lesions. The subtemporal approach allows safer and easier division of the PcomA near the junction to the PCA compared with the pterional approach, and the present procedure is more suitable for the subtemporal approach.Keywords: basilar tip aneurysm, subtemporal approach, posterior communicating artery

Transcutaneous electrical nerve stimulation and transcutaneous spinal electroanalgesia: a preliminary efficacy and mechanisms-based investigation.

Science.gov (United States)

Palmer, Shea; Cramp, Fiona; Propert, Kate; Godfrey, Helen

2009-09-01

To determine the effects of transcutaneous electrical nerve stimulation (TENS) and transcutaneous spinal electroanalgesia (TSE) on mechanical pain threshold (MPT) and vibration threshold (VT). A prospective, single-blind, randomised, placebo-controlled trial. Laboratory based. Thirty-four healthy volunteers (12 men and 22 women; mean age+/-standard deviation 30+/-8 years). Exclusion criteria were conditions affecting upper limb sensation and contraindications to electrical stimulation. Participants were allocated at random to receive TENS (n=8), TSE (n=8), placebo (n=9) or control (n=9). Electrical stimulation was applied for 30 minutes (from time 18 minutes to 48 minutes) via electrodes (5 cmx5 cm) placed centrally above and below the space between the C6 and C7 spinous processes, with 5 cm between electrodes. MPT (using an algometer) and VT (using a vibrameter) were recorded on seven occasions from the first dorsal interosseous muscle of the right hand - at baseline (0 minutes) and then at 10-minute intervals until the end of the 60-minute testing period. There were no statistically significant group differences in MPT (all p>0.05). Significant group differences in VT were found at 20, 30 and 40 minutes (all ptests showed that the TENS group had significantly greater VT than both the placebo [median difference 0.30 microm, 95% confidence interval (CI) -0.05 to 0.66] and control (0.51 microm, 95% CI 0.05 to 0.97) groups at 20 minutes, and significantly greater VT than the control group (0.69 microm, 95% CI 0.20 to 1.17) at 30 minutes (all p<0.008). Electrical stimulation did not alter MPT. The increase in VT during TENS may be due to distraction or antidromic block of large-diameter nerve fibres. TSE failed to alter either outcome measure significantly.

Nerve Cross-Bridging to Enhance Nerve Regeneration in a Rat Model of Delayed Nerve Repair

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2015-01-01

There are currently no available options to promote nerve regeneration through chronically denervated distal nerve stumps. Here we used a rat model of delayed nerve repair asking of prior insertion of side-to-side cross-bridges between a donor tibial (TIB) nerve and a recipient denervated common peroneal (CP) nerve stump ameliorates poor nerve regeneration. First, numbers of retrogradely-labelled TIB neurons that grew axons into the nerve stump within three months, increased with the size of the perineurial windows opened in the TIB and CP nerves. Equal numbers of donor TIB axons regenerated into CP stumps either side of the cross-bridges, not being affected by target neurotrophic effects, or by removing the perineurium to insert 5-9 cross-bridges. Second, CP nerve stumps were coapted three months after inserting 0-9 cross-bridges and the number of 1) CP neurons that regenerated their axons within three months or 2) CP motor nerves that reinnervated the extensor digitorum longus (EDL) muscle within five months was determined by counting and motor unit number estimation (MUNE), respectively. We found that three but not more cross-bridges promoted the regeneration of axons and reinnervation of EDL muscle by all the CP motoneurons as compared to only 33% regenerating their axons when no cross-bridges were inserted. The same 3-fold increase in sensory nerve regeneration was found. In conclusion, side-to-side cross-bridges ameliorate poor regeneration after delayed nerve repair possibly by sustaining the growth-permissive state of denervated nerve stumps. Such autografts may be used in human repair surgery to improve outcomes after unavoidable delays. PMID:26016986

Nerve conduction and excitability studies in peripheral nerve disorders

DEFF Research Database (Denmark)

Krarup, Christian; Moldovan, Mihai

2009-01-01

counterparts in the peripheral nervous system, in some instances without peripheral nervous system symptoms. Both hereditary and acquired demyelinating neuropathies have been studied and the effects on nerve pathophysiology have been compared with degeneration and regeneration of axons. SUMMARY: Excitability......PURPOSE OF REVIEW: The review is aimed at providing information about the role of nerve excitability studies in peripheral nerve disorders. It has been known for many years that the insight into peripheral nerve pathophysiology provided by conventional nerve conduction studies is limited. Nerve...... excitability studies are relatively novel but are acquiring an increasingly important role in the study of peripheral nerves. RECENT FINDINGS: By measuring responses in nerve that are related to nodal function (strength-duration time constant, rheobase and recovery cycle) and internodal function (threshold...

Complications of wrist arthroscopy.

Science.gov (United States)

Ahsan, Zahab S; Yao, Jeffrey

2012-06-01

The purpose of this systematic review was to address the incidence of complications associated with wrist arthroscopy. Given the paucity of information published on this topic, an all-inclusive review of published wrist arthroscopy complications was sought. Two independent reviewers performed a literature search using PubMed, Google Scholar, EBSCO, and Academic Megasearch using the terms "wrist arthroscopy complications," "complications of wrist arthroscopy," "wrist arthroscopy injury," and "wrist arthroscopy." Inclusion criteria were (1) Levels I to V evidence, (2) "complication" defined as an adverse outcome directly related to the operative procedure, and (3) explicit description of operative complications in the study. Eleven multiple-patient studies addressing complications of wrist arthroscopy from 1994 to 2010 were identified, with 42 complications reported from 895 wrist arthroscopy procedures, a 4.7% complication rate. Four case reports were also found, identifying injury to the dorsal sensory branch of the ulnar nerve, injury to the posterior interosseous nerve, and extensor tendon sheath fistula formation. This systematic review suggests that the previously documented rate of wrist arthroscopy complications may be underestimating the true incidence. The report of various complications provides insight to surgeons for improving future surgical techniques. Level IV, systematic review of Levels I-V studies. Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

External laryngeal nerve in thyroid surgery: is the nerve stimulator necessary?

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Aina, E N; Hisham, A N

2001-09-01

To find out the incidence and type of external laryngeal nerves during operations on the thyroid, and to assess the role of a nerve stimulator in detecting them. Prospective, non-randomised study. Teaching hospital, Malaysia. 317 patients who had 447 dissections between early January 1998 and late November 1999. Number and type of nerves crossing the cricothyroid space, and the usefulness of the nerve stimulator in finding them. The nerve stimulator was used in 206/447 dissections (46%). 392 external laryngeal nerves were seen (88%), of which 196/206 (95%) were detected with the stimulator. However, without the stimulator 196 nerves were detected out of 241 dissections (81%). The stimulator detected 47 (23%) Type I nerves (nerve > 1 cm from the upper edge of superior pole); 86 (42%) Type IIa nerves (nerve edge of superior pole); and 63 (31%) Type IIb nerves (nerve below upper edge of superior pole). 10 nerves were not detected. When the stimulator was not used the corresponding figures were 32 (13%), 113 (47%), and 51 (21%), and 45 nerves were not seen. If the nerve cannot be found we recommend dissection of capsule close to the medial border of the upper pole of the thyroid to avoid injury to the nerve. Although the use of the nerve stimulator seems desirable, it confers no added advantage in finding the nerve. In the event of uncertainty about whether a structure is the nerve, the stimulator may help to confirm it. However, exposure of the cricothyroid space is most important for good exposure in searching for the external laryngeal nerve.

Prognostic Value of Facial Nerve Antidromic Evoked Potentials in Bell Palsy: A Preliminary Study

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Zhang WenHao

2012-01-01

Full Text Available To analyze the value of facial nerve antidromic evoked potentials (FNAEPs in predicting recovery from Bell palsy. Study Design. Retrospective study using electrodiagnostic data and medical chart review. Methods. A series of 46 patients with unilateral Bell palsy treated were included. According to taste test, 26 cases were associated with taste disorder (Group 1 and 20 cases were not (Group 2. Facial function was established clinically by the Stennert system after monthly follow-up. The result was evaluated with clinical recovery rate (CRR and FNAEP. FNAEPs were recorded at the posterior wall of the external auditory meatus of both sides. Results. Mean CRR of Group 1 and Group 2 was 61.63% and 75.50%. We discovered a statistical difference between two groups and also in the amplitude difference (AD of FNAEP. Mean ± SD of AD was −6.96% ± 12.66% in patients with excellent result, −27.67% ± 27.70% with good result, and −66.05% ± 31.76% with poor result. Conclusions. FNAEP should be monitored in patients with intratemporal facial palsy at the early stage. FNAEP at posterior wall of external auditory meatus was sensitive to detect signs of taste disorder. There was close relativity between FNAEPs and facial nerve recovery.

Prognostic Value of Facial Nerve Antidromic Evoked Potentials in Bell Palsy: A Preliminary Study

Science.gov (United States)

WenHao, Zhang; Minjie, Chen; Chi, Yang; Weijie, Zhang

2012-01-01

To analyze the value of facial nerve antidromic evoked potentials (FNAEPs) in predicting recovery from Bell palsy. Study Design. Retrospective study using electrodiagnostic data and medical chart review. Methods. A series of 46 patients with unilateral Bell palsy treated were included. According to taste test, 26 cases were associated with taste disorder (Group 1) and 20 cases were not (Group 2). Facial function was established clinically by the Stennert system after monthly follow-up. The result was evaluated with clinical recovery rate (CRR) and FNAEP. FNAEPs were recorded at the posterior wall of the external auditory meatus of both sides. Results. Mean CRR of Group 1 and Group 2 was 61.63% and 75.50%. We discovered a statistical difference between two groups and also in the amplitude difference (AD) of FNAEP. Mean ± SD of AD was −6.96% ± 12.66% in patients with excellent result, −27.67% ± 27.70% with good result, and −66.05% ± 31.76% with poor result. Conclusions. FNAEP should be monitored in patients with intratemporal facial palsy at the early stage. FNAEP at posterior wall of external auditory meatus was sensitive to detect signs of taste disorder. There was close relativity between FNAEPs and facial nerve recovery. PMID:22164176

Anterior Inferior Cerebellar Arteries Juxtaposed with the Internal Acoustic Meatus and Their Relationship to the Cranial Nerve VII/VIII Complex.

Science.gov (United States)

Alonso, Fernando; Kassem, Mohammad W; Iwanaga, Joe; Oskouian, Rod J; Loukas, Marios; Demerdash, Amin; Tubbs, R Shane

2017-08-16

Vascular loops in the cerebellopontine angle (CPA) and their relationship to cranial nerves have been used to explain neurological symptoms. The anterior inferior cerebellar artery (AICA) has variable branches producing vascular loops that can compress the facial cranial nerve (CN) VII and vestibulocochlear (CN VIII) nerves. AICA compression of the facial-vestibulocochlear nerve complex can lead to various clinical presentations, including hemifacial spasm (HFS), tinnitus, and hemiataxia. The formation of arterial loops inside or outside of the internal auditory meatus (IAM) can cause abutment or compression of CN VII and CN VIII. Twenty-five (50 sides) fresh adult cadavers underwent dissection of the cerebellopontine angle in the supine position. In regard to relationships between the AICA and the nerves of the facial/vestibulocochlear complex, 33 arteries (66%) traveled in a plane between the facial/nervus intermedius nerves and the cochlear and vestibular nerves. Five arteries (10%) traveled below the CN VII/VIII complex, six (12%) traveled posterior to the nerve complex, four (8%) formed a semi-circle around the upper half of the nerve complex, and two (4%) traveled between and partially separated the nervus intermedius and facial nerve proper. Our study found that the majority of AICA will travel in a plane between the facial/nervus intermedius nerves and the cochlear and vestibular nerves. Although the relationship between the AICA and porus acusticus and AICA and the nerves of the CN VII/VIII complex are variable, based on our findings, some themes exist. Surgeons should consider these with approaches to the cerebellopontine angle.

Chitin biological absorbable catheters bridging sural nerve grafts transplanted into sciatic nerve defects promote nerve regeneration.

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Wang, Zhi-Yong; Wang, Jian-Wei; Qin, Li-Hua; Zhang, Wei-Guang; Zhang, Pei-Xun; Jiang, Bao-Guo

2018-06-01

To investigate the efficacy of chitin biological absorbable catheters in a rat model of autologous nerve transplantation. A segment of sciatic nerve was removed to produce a sciatic nerve defect, and the sural nerve was cut from the ipsilateral leg and used as a graft to bridge the defect, with or without use of a chitin biological absorbable catheter surrounding the graft. The number and morphology of regenerating myelinated fibers, nerve conduction velocity, nerve function index, triceps surae muscle morphology, and sensory function were evaluated at 9 and 12 months after surgery. All of the above parameters were improved in rats in which the nerve graft was bridged with chitin biological absorbable catheters compared with rats without catheters. The results of this study indicate that use of chitin biological absorbable catheters to surround sural nerve grafts bridging sciatic nerve defects promotes recovery of structural, motor, and sensory function and improves muscle fiber morphology. © 2018 John Wiley & Sons Ltd.

Endoscopic resection of acetabular screw tip to decompress sciatic nerve following total hip arthroplasty.

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Yoon, Sun-Jung; Park, Myung-Sik; Matsuda, Dean K; Choi, Yun Ho

2018-06-04

Sciatic nerve injuries following total hip arthroplasty are disabling complications. Although degrees of injury are variable from neuropraxia to neurotmesis, mechanical irritation of sciatic nerve might be occurred by protruding hardware. This case shows endoscopic decompression for protruded acetabular screw irritating sciatic nerve, the techniques described herein may permit broader arthroscopic/endoscopic applications for management of complications after reconstructive hip surgery. An 80-year-old man complained of severe pain and paresthesias following acetabular component revision surgery. Physical findings included right buttock pain with radiating pain to lower extremity. Radiographs and computed tomography imaging showed that the sharp end of protruded screw invaded greater sciatic foramen anterior to posterior and distal to proximal direction at sciatic notch level. A protruding tip of the acetabular screw at the sciatic notch was decompressed by use of techniques gained from experience performing endoscopic sciatic nerve decompression. The pre-operative pain and paresthesias resolved post-operatively after recovering from anesthesia. This case report describes the first documented endoscopic resection of the tip of the acetabular screw irritating sciatic nerve after total hip arthroplasty. If endoscopic resection of an offending acetabular screw can be performed in a safe and minimally invasive manner, one can envision a future expansion of the role of hip arthroscopic surgery in several complications management after total hip arthroplasty.

CT-clinical approach to patients with symptoms related to the V, VII, IX-XII cranial nerves and cervical sympathetics

International Nuclear Information System (INIS)

Kalovidouris, A.; Mancuso, A.A.; Dillon, W.

1984-01-01

Forty-three patients who had signs and symptoms possibly related to the extracranial course of cranial nerves V, VII, IX, X-XII, and the cervical sympathetics were examined prospectively using high resolution CT to obtain images of thin sections during rapid drip infusion of contrast material. Anatomic areas in the scan protocols included the posterior fossa, cavernous and paranasal sinuses, skull base, temporal bone, nasopharynx, parotid gland, tongue base, and neck. Nine of the 23 patients with possible fifth nerve deficits had extracranial structural lesions that explained the symptoms; none of these nine, however, had typical trigeminal neuralgia. Of eight patients with peripheral seventh nerve abnormalities, two had positive findings on scans. Of five patients presenting with referred ear pain, three had carcinoma of the upper aerodigestive tract. The authors' experience suggests that patients at high risk for structural lesions responsible for cranial nerve deficits can be selected by clinical criteria. Protocols for each clinical setting are presented

Variations in reciprocal distances between the ethmoidal sinus, sphenoidal sinus and posterior orbit. Measurement on CTscans

International Nuclear Information System (INIS)

Hayakawa, Kimiko; Yoshikawa, Hiroshi; Suzuki, Miyako; Yokoi, Hidenori; Hosokawa, Akira; Hagiwara, Akiko; Ichikawa, Ginichirou

2003-01-01

In concluding surgery of the paranasal sinuses (anterior and posterior) and the sphenoidal sinus, caution is demanded because intraorbital complications may develop in the skull. It is well-known that there is substantial variation in the form of the internal wall of the orbit, and the anterior and posterior walls of the sphenoidal sinus. In the present study, we measured the size of the structure around the paranasal sinus on patient CTscans to be used in surgery on the paranasal sinuses. A total of 387 people (184 males and 203 females) with no destructive bone lesions who visited the Juntendo University Hospital between 1999 and June 2002 were investigated. A plane was selected 14 mm above a line drawn between the medial angle and the external acoustic orifice on CTscans performed using axial projection. This framework was used to conduct the measurements. We employed this method because we consider it ideal for rendering the ethmoidal sinuses, the internal wall of the orbit, medial rectus muscle, optic nerve, and the anterior and posterior walls of the sphenoidal sinus most clearly visible. We measured the length between these anatomically important regions. We measured 1) the length of a line drawn between the opening of the nose and the line drawn between the right and left optic canals, 2) the length between the nasal opening and the posterior wall of the sphenoidal sinus, on the same horizontal line drawn between the posterior end of the eyeball and the nasal septum, 3) the length of a line from the site where the optic nerve adheres to the nasal septum, 4) the length between the lateral wall of the ethmoidal sinus, 5) the length between the nasal septum and the medial side of the medial rectus muscle, 6) the length between the medial side of the medial rectus muscle and the medial side of the optic nerve. The measurements were performed on both sides. We analyzed the above results statistically according to gender and age. The results of the analysis

Unilateral duplicated abducens nerve coursing through both the sphenopetroclival venous gulf and cavernous sinus: a case report.

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Coquet, Thomas; Lefranc, Michel; Chenin, Louis; Foulon, Pascal; Havet, Éric; Peltier, Johann

2018-03-15

In this anatomy report, we describe the first case of abducens nerve duplication limited to the sphenopetroclival venous gulf and the cavernous sinus. The objective point of division of the two duplicated roots was localized at the gulfar face of the dural porus, just distal to the unique cisternal trunk of the abducens nerve, as it pierced the petroclival dural mater. In the gulfar segment, both roots traveled through a variant of Dorello's canal called the "petrosphenoidal canal" and remained separated through the posterior half of the cavernous sinus. Both roots finally fused in the anterior half of the cavernous sinus to innervate the lateral rectus muscle as a single trunk. Although many variants of the abducens nerve have been reported over the recent decades, this anatomic variation has never been previously described and enriches the continuum of abducens nerve variations reported in the literature data. Awareness of this variation is crucial for neurosurgeons, especially during clival or petrosal surgical approaches used for resection of skull base chordomas.

Nanofiber Nerve Guide for Peripheral Nerve Repair and Regeneration

Science.gov (United States)

2016-04-01

1 Award Number: W81XWH-11-2-0047 TITLE: Nanofiber Nerve Guide for Peripheral Nerve Repair and Regeneration PRINCIPAL INVESTIGATOR: Ahmet Höke...TITLE AND SUBTITLE 5a. CONTRACT NUMBER W81XWH-11-2-0047 Nanofiber nerve guide for peripheral nerve repair and regeneration 5b. GRANT NUMBER...goal of this collaborative research project was to develop next generation engineered nerve guide conduits (NGCs) with aligned nanofibers and

Posterior malleolar fracture: technique and clinical ex-perience of the posterolateral approach

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HUANG Ruo-kun

2012-04-01

Full Text Available 【Abstract】Objective: To introduce the postero-lateral surgical approach to the posterior malleolar fracture and report its clinical outcomes in 32 cases. Methods: This study consisted of 32 cases, 22 males and 10 females with the mean age of 48 years (range, 21-63 years, suffering from posterior malleolar fracture. All cases were treated with the posterolateral surgical approach to the ankle. The average follow-up period was 28 months (range, 24-35 months. The clinical outcomes of these cases were evaluated on the basis of the Olerud-Molander Ankle (OMA score and plain radiographs. Results: All cases showed radiological evidence of bony union at follow-up. The average OMA score was 82 points; 21 cases had excellent scores (90-100 points, 9 good (61-90 points, and 2 fair (31-60 points. The excellent-to-good rate was 93.8%. Although most cases did not show any wound dehiscence or necrosis, one patient had a su-perficial infection which healed after using antibiotic dress-ing and one had sural cutaneous nerve injury that under-went spontaneous remission without any treatment after three months. In addition, one presented with mild symp-toms of peroneal tendonitis that disappeared after plate removal. Conclusion: The posterolateral approach offers an effective technique for fracture reduction and fixation of large posterior malleolar fragments. Key words: Ankle injuries; Dislocations; Fracture fixation, internal

Radial nerve dysfunction

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Neuropathy - radial nerve; Radial nerve palsy; Mononeuropathy ... Damage to one nerve group, such as the radial nerve, is called mononeuropathy . Mononeuropathy means there is damage to a single nerve. Both ...

Radiation therapy in and about the retina, optic nerve, and anterior visual pathway: psychophysical assessment

International Nuclear Information System (INIS)

Fitzgerald, C.R.; Enoch, J.M.; Temme, L.A.

1981-01-01

Visual changes may develop in patients receiving radiation therapy for malignant neoplasms in and about the optic nerve and anterior visual pathway. Cases have been studied using a series of psychophysical tests, including kinetic perimetry, increment threshold determinations, Flashing Repeat Static Test, and sustained- and transient-like functions. A characteristic time-dependent reduction in sensitivity has been identified in these patients. This finding, in addition to the presence of nerve fiber bundle defects, appears to place the pathologic changes in the axon of the ganglion cell posterior to the lamina cribrosa. Any change in the sustained- and transient-like functions, the organization of which appears to be in the neural retina, was seen only if a concomitant radiation retinopathy was identified

Radiation therapy in and about the retina, optic nerve, and anterior visual pathway. Psychophysical assessment

International Nuclear Information System (INIS)

Fitzgerald, C.R.; Enoch, J.M.; Temme, L.A.

1981-01-01

Visual changes may develop in patients receiving radiation therapy for malignant neoplasms in and about the optic nerve and anterior visual pathway. Cases have been studied using a series of psychophysical tests, including kinetic perimetry, increment threshold determinations, Flashing Repeat Static Test, and sustained- and transient-like functions. A characteristic time-dependent reduction in sensitivity has been identified in these patients. This finding, in addition to the presence of nerve fiber bundle defects, appears to place the pathologic changes in the axon of the ganglion cell posterior to the lamina cribrosa. Any change in the sustained- and transient-like functions, the organization of which appears to be in the neural retina, was seen only if a concomitant radiation retinopathy was identified

Preventing lower cranial nerve injuries during fourth ventricle tumor resection by utilizing intraoperative neurophysiological monitoring.

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Jahangiri, Faisal R; Minhas, Mazhar; Jane, John

2012-12-01

We present two cases illustrating the benefit of utilizing intraoperative neurophysiological monitoring (IONM) for prevention of injuries to the lower cranial nerves during fourth ventricle tumor resection surgeries. Multiple cranial nerve nuclei are located on the floor of the fourth ventricle with a high risk of permanent damage. Two male patients (ages 8 and 10 years) presented to the emergency department and had brain magnetic resonance imaging (MRI) scans showing brainstem/fourth ventricle tumors. During surgery, bilateral posterior tibial and median nerve somatosensory evoked potentials (SSEPs); four-limb and cranial nerves transcranial electrical motor evoked potentials (TCeMEPs); brainstem auditory evoked responses (BAERs); and spontaneous electromyography (s-EMG) were recorded. Electromyography (EMG) was monitored bilaterally from cranial nerves V VII, IX, X, XI, and XII. Total intravenous anesthesia was used. Neuromuscular blockade was used only for initial intubation. Pre-incision baselines were obtained with good morphology of waveforms. After exposure the floor of the fourth ventricle was mapped by triggered-EMG (t-EMG) using 0.4 to 1.0 mA. In both patients the tumor was entangled with cranial nerves VII to XII on the floor of the fourth ventricle. The surgeon made the decision not to resect the tumor in one case and limited the resection to 70% of the tumor in the second case on the basis of neurophysiological monitoring. This decision was made to minimize any post-operative neurological deficits due to surgical manipulation of the tumor involving the lower cranial nerves. Intraoperative spontaneous and triggered EMG was effectively utilized in preventing injuries to cranial nerves during surgical procedures. All signals remained stable during the surgical procedure. Postoperatively both patients were well with no additional cranial nerve weakness. At three months follow-up, the patients continued to have no deficits.

Serratus muscle stimulation effectively treats notalgia paresthetica caused by long thoracic nerve dysfunction: a case series

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Barad Meredith

2009-09-01

Full Text Available Abstract Currently, notalgia paresthetica (NP is a poorly-understood condition diagnosed on the basis of pruritus, pain, or both, in the area medial to the scapula and lateral to the thoracic spine. It has been proposed that NP is caused by degenerative changes to the T2-T6 vertebrae, genetic disposition, or nerve entrapment of the posterior rami of spinal nerves arising at T2-T6. Despite considerable research, the etiology of NP remains unclear, and a multitude of different treatment modalities have correspondingly met with varying degrees of success. Here we demonstrate that NP can be caused by long thoracic nerve injury leading to serratus anterior dysfunction, and that electrical muscle stimulation (EMS of the serratus anterior can successfully and conservatively treat NP. In four cases of NP with known injury to the long thoracic nerve we performed transcutaneous EMS to the serratus anterior in an area far lateral to the site of pain and pruritus, resulting in significant and rapid pain relief. These findings are the first to identify long thoracic nerve injury as a cause for notalgia paresthetica and electrical muscle stimulation of the serratus anterior as a possible treatment, and we discuss the implications of these findings on better diagnosing and treating notalgia paresthetica.

Malignant peripheral nerve sheath tumor of the oculomotor nerve

DEFF Research Database (Denmark)

Kozic, D; Nagulic, M; Ostojic, J

2006-01-01

We present the short-term follow-up magnetic resonance (MR) studies and 1H-MR spectroscopy in a child with malignant peripheral nerve sheath tumor of the oculomotor nerve associated with other less aggressive cranial nerve schwannomas. The tumor revealed perineural extension and diffuse nerve...

Scaffoldless tissue-engineered nerve conduit promotes peripheral nerve regeneration and functional recovery after tibial nerve injury in rats

Institute of Scientific and Technical Information of China (English)

Aaron M. Adams; Keith W. VanDusen; Tatiana Y. Kostrominova; Jacob P. Mertens; Lisa M. Larkin

2017-01-01

Damage to peripheral nerve tissue may cause loss of function in both the nerve and the targeted muscles it innervates. This study compared the repair capability of engineered nerve conduit (ENC), engineered fibroblast conduit (EFC), and autograft in a 10-mm tibial nerve gap. ENCs were fabricated utilizing primary fibroblasts and the nerve cells of rats on embryonic day 15 (E15). EFCs were fabricated utilizing primary fi-broblasts only. Following a 12-week recovery, nerve repair was assessed by measuring contractile properties in the medial gastrocnemius muscle, distal motor nerve conduction velocity in the lateral gastrocnemius, and histology of muscle and nerve. The autografts, ENCs and EFCs reestablished 96%, 87% and 84% of native distal motor nerve conduction velocity in the lateral gastrocnemius, 100%, 44% and 44% of native specific force of medical gastrocnemius, and 63%, 61% and 67% of native medial gastrocnemius mass, re-spectively. Histology of the repaired nerve revealed large axons in the autograft, larger but fewer axons in the ENC repair, and many smaller axons in the EFC repair. Muscle histology revealed similar muscle fiber cross-sectional areas among autograft, ENC and EFC repairs. In conclusion, both ENCs and EFCs promot-ed nerve regeneration in a 10-mm tibial nerve gap repair, suggesting that the E15 rat nerve cells may not be necessary for nerve regeneration, and EFC alone can suffice for peripheral nerve injury repair.

Ulnar nerve dysfunction

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Neuropathy - ulnar nerve; Ulnar nerve palsy; Mononeuropathy; Cubital tunnel syndrome ... Damage to one nerve group, such as the ulnar nerve, is called mononeuropathy . Mononeuropathy means there is damage to a single nerve. Both ...

[Local involvement of the optic nerve by acute lymphoblastic leukemia].

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Bernardczyk-Meller, Jadwiga; Stefańska, Katarzyna

2005-01-01

The leucemias quite commonly involve the eyes and adnexa. In some cases it causes visual complants. Both, the anterior chamber of the eye and the posterior portion of the globe may sites of acute or chronic leukemia and leucemic relapse. We report an unique case of a 14 years old leucemic patient who suffered visual loss and papilloedema, due to a unilateral local involvement within optic nerve, during second relapse of acute lymphocytic leuemia. In spite of typical treatment of main disease, the boy had died. The authors present typical ophthalmic features of the leucemia, too.

Evidence Suggesting that the Buccal and Zygomatic Branches of the Facial Nerve May Contain Parasympathetic Secretomotor Fibers to the Parotid Gland by Means of Communications from the Auriculotemporal Nerve.

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Tansatit, Tanvaa; Apinuntrum, Prawit; Phetudom, Thavorn

2015-12-01

The auriculotemporal nerve is one of the peripheral nerves that communicates with the facial nerve. However, the function of these communications is poorly understood. Details of how these communications form and connect with each other are still unclear. In addition, a reliable anatomical landmark for locating these communications during surgery has not been sufficiently described. Microdissection was performed on 20 lateral hemifaces of 10 soft-embalmed cadavers to investigate facial-auriculotemporal nerve communications with emphasis on determining their function. The auriculotemporal nerve was identified in the retromandibular space and traced towards its terminations. The communicating branches were followed and the anatomical relationships to surrounding structures observed. The auriculotemporal nerve is suspended above the maxillary artery in the dense retromandibular fascia behind the mandibular ramus. It forms a knot and fans out, providing multiple branches in all directions in the sagittal plane. Inferiorly, it connects the maxillary periarterial plexus, while minute branches supply the temporomandibular joint anteriorly. The larger branches mainly communicate with the branches of the temporofacial division of the facial nerve, and the auricular branches enter the fascia of the auricular cartilage posteriorly. The temporal branches and occasionally the zygomatic branches arise superiorly to distribute within the temporoparietal fascia. The auriculotemporal nerve forms the parotid retromandibular plexus through two types of communication. It sends one to three branches to join the zygomatic and buccal branches of the facial nerve at the branching area of the temporofacial division. It also communicates with the periarterial plexus of the superficial temporal and maxillary arteries. This plexus continues anteriorly along the branches of the facial nerve and the periarterial plexus of the transverse facial artery as the parotid periductal autonomic plexus

Clinical value and indication for the dissection of lymph nodes posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma.

Science.gov (United States)

Luo, Ding-Cun; Xu, Xiao-Cheng; Ding, Jin-Wang; Zhang, Yu; Peng, You; Pan, Gang; Zhang, Wo

2017-10-03

Lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) are common sites of nodal recurrence after the resection of papillary thyroid carcinoma (PTC). However, the indication for LN-prRLN dissection remains debatable. We therefore studied the relationships between LN-prRLN metastasis and the clinicopathological characteristics in 306 patients with right or bilateral PTC who underwent LN-prRLN dissection. We found that LN-prRLN metastasis occurred in 16.67% of PTC and was associated with a number of the clinicopathological features. The receiver-operator characteristic (ROC) analysis showed that the areas under the ROC curves for the prediction of LN-prRLN metastasis by the risk factors age right tumor size > 0.85 cm, lymph node (right cervical central VI-1) number > 1.5, metastatic lymph node (right cervical central VI-1) size > 0.45 cm, and lymph node number in the right cervical lateral compartment > 0.5 were 0.601, 0.815, 0.813, 0.725, and 0.743, respectively. In conclusion, the risk factors for LN-prRLN metastasis in patients suffering right thyroid lobe or bilateral PTC include age ≤ 35.5 years, right tumor size ≥ 0.85 cm, capsular invasion, metastatic lymph node (right cervical central VI-1) number ≥ 2, metastatic lymph node (right cervical central VI-1) size ≥ 0.45 cm, and metastatic lymph node number in the right cervical lateral compartment ≥ 1. In patients whose risk factors can be identified pre-operatively or intraoperatively, the dissection of LN-pr-RLN should be considered during right cervical central compartment dissection.

Posterior cricoarytenoid muscle electrophysiologic changes are predictive of vocal cord paralysis with recurrent laryngeal nerve compressive injury in a canine model.

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Puram, Sidharth V; Chow, Harold; Wu, Che-Wei; Heaton, James T; Kamani, Dipti; Gorti, Gautham; Chiang, Feng Yu; Dionigi, Gianlorenzo; Barczynski, Marcin; Schneider, Rick; Dralle, Henning; Lorenz, Kerstin; Randolph, Gregory W

2016-12-01

Injury to the recurrent laryngeal nerve (RLN) is a dreaded complication of endocrine surgery. Intraoperative neural monitoring (IONM) has been increasingly utilized to assess the functional status of the RLN. Although the posterior cricoarytenoid muscle (PCA) is innervated by the RLN as the abductor of the larynx, PCA electromyography (EMG) is infrequently recorded during IONM and PCA activity after RLN compressive injury remains poorly characterized. Single-subject prospective animal study. We employed a canine model to identify postcricoid EMG correlates of postoperative vocal cord paralysis (VCP). Postcricoid electrode recordings were obtained before and after compressive RLN injury associated with VCP. Normative postcricoid recordings revealed mean amplitude of 1288 microvolt (μV) and latency of 8.2 millisecond (ms) with maximum (1 milliamp [mA]) vagal stimulation, and mean amplitude of 1807 μV and latency of 3.5 ms with maximum (1 mA) RLN stimulation. Following injury that was associated with VCP, there was 62.1% decrement in postcricoid EMG amplitude with maximum vagal stimulation and 80% decrement with maximum RLN stimulation. Threshold stimulation of the vagus increased by 23%, and there was a corresponding 42% decrease in amplitude. For RLN stimulation, latency increased by 17.3% following injury, whereas threshold stimulation increased by 61% with 35.5% decrement in EMG amplitude. Thus, if RLN amplitude decreases by ≥ 80%, with absolute amplitude of ≤ 300 μV or less and latency increase of ≥ 10%, RLN injury is likely associated with VCP. Our results predict postoperative VCP based on postcricoid electromyographic IONM and may guide surgical decision making. NA Laryngoscope, 126:2744-2751, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Metabolic Changes in the Visual Cortex Are Linked to Retinal Nerve Fiber Layer Thinning in Multiple Sclerosis

Science.gov (United States)

Schubert, Florian; Bock, Markus; Walaszek, Bernadeta; Waiczies, Helmar; Schwenteck, Thomas; Dörr, Jan; Bellmann-Strobl, Judith; Mohr, Christian; Weinges-Evers, Nicholetta; Ittermann, Bernd; Wuerfel, Jens T.; Paul, Friedemann

2011-01-01

Objective To investigate the damage to the retinal nerve fiber layer as part of the anterior visual pathway as well as an impairment of the neuronal and axonal integrity in the visual cortex as part of the posterior visual pathway with complementary neuroimaging techniques, and to correlate our results to patients' clinical symptoms concerning the visual pathway. Design, Subjects and Methods Survey of 86 patients with relapsing-remitting multiple sclerosis that were subjected to retinal nerve fiber layer thickness (RNFLT) measurement by optical coherence tomography, to a routine MRI scan including the calculation of the brain parenchymal fraction (BPF), and to magnetic resonance spectroscopy at 3 tesla, quantifying N-acetyl aspartate (NAA) concentrations in the visual cortex and normal-appearing white matter. Results RNFLT correlated significantly with BPF and visual cortex NAA, but not with normal-appearing white matter NAA. This was connected with the patients' history of a previous optic neuritis. In a combined model, both BPF and visual cortex NAA were independently associated with RNFLT. Conclusions Our data suggest the existence of functional pathway-specific damage patterns exceeding global neurodegeneration. They suggest a strong interrelationship between damage to the anterior and the posterior visual pathway. PMID:21494672

The pig as preclinical model for laparoscopic vagus nerve stimulation.

Science.gov (United States)

Wolthuis, A M; Stakenborg, N; D'Hoore, A; Boeckxstaens, G E

2016-02-01

Cervical vagus nerve stimulation (VNS) prevents manipulation-induced intestinal inflammation and improves intestinal transit in a mouse model of postoperative ileus (POI). Cervical VNS, however, is accompanied by cardiovascular and respiratory side effects. In view of potential clinical application, we therefore evaluated the safety and feasibility of abdominal VNS via laparoscopic approach in a porcine model. Six pigs were used in a non-survival study for both cervical and abdominal VNS. Two cardiac pacing electrodes were positioned around the right cervical and posterior abdominal vagus nerve and connected to an external stimulator. VNS was performed using four different settings (5 and 20 Hz, 0.5 and 1 ms pulse width) during 2 min with ECG recording. Laparoscopic VNS was timed and videotaped, and technical difficulties were noted. A validated National Aeronautics and Space Administration Task Load Index (NASA-TLX) questionnaire was used to evaluate the task and workload. The procedure was completed in all pigs with 4-port laparoscopic technique. Cervical and abdominal VNS were performed after correct identification and isolation of the nerve, and positioning of the electrodes around the nerve. Median laparoscopic operating time was 16 min (range 8-33 min), and median NASA-TLX was 31 (range 11-74). No major complications were encountered. Reduction of heart rate was between 5.5 and 14% for cervical VNS and undetectable for abdominal VNS. In a porcine model, laparoscopic VNS is feasible and safe with cardiac pacing electrodes and may lead to a similar novel approach in humans in the near future.

One-stage human acellular nerve allograft reconstruction for digital nerve defects

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Xue-yuan Li

2015-01-01

Full Text Available Human acellular nerve allografts have a wide range of donor origin and can effectively avoid nerve injury in the donor area. Very little is known about one-stage reconstruction of digital nerve defects. The present study observed the feasibility and effectiveness of human acellular nerve allograft in the reconstruction of < 5-cm digital nerve defects within 6 hours after injury. A total of 15 cases of nerve injury, combined with nerve defects in 18 digits from the Department of Emergency were enrolled in this study. After debridement, digital nerves were reconstructed using human acellular nerve allografts. The patients were followed up for 6-24 months after reconstruction. Mackinnon-Dellon static two-point discrimination results showed excellent and good rates of 89%. Semmes-Weinstein monofilament test demonstrated that light touch was normal, with an obvious improvement rate of 78%. These findings confirmed that human acellular nerve allograft for one-stage reconstruction of digital nerve defect after hand injury is feasible, which provides a novel trend for peripheral nerve reconstruction.

Origins, distributions, and ramifications of the femoral nerves in giant anteater (Myrmecophaga tridactyla Linnaeus, 1758

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Roseâmely Angélica de Carvalho-Barros

2013-11-01

Full Text Available The study of nerves making up the lumbosacral plexus is extremely important, because it relates the various evolutionary aspects of animals’ posture and locomotion. Taking into account that the femoral nerve is the largest one in the cranial part of the lumbosacral plexus, one aimed to describe the origins, distributions, and ramifications of femoral nerves in giant anteater (Myrmecophaga tridactyla, comparing them to the literature describing domestic and wild animals, in order to establish correlations of morphological similarities and provide the related areas with means. One used three specimens, prepared through an injection of 10% aqueous formaldehyde solution via femoral artery, for their conservation and posterior dissection. The origins in the right and left antimeres took place in the ventral braches of lumbar spinal nerves 1, 2, and 3. The distributions and ramifications were observed for the major and minor psoas, lateral and medial iliac, pectineus, adductor magnus, sartorius, and femoral quadriceps muscles. Having the origins of the M. tridactyla femoral nerves as a basis, a reframing was observed due to the variance in the number of lumbar vertebrae (L1, L2, and L3. However, a partial morphological similarity was kept with regard to the distributions and ramifications, when compared to the domestic and wild animals taken into account in this study.

Nerves and nerve endings in the skin of tropical cattle.

Science.gov (United States)

Amakiri, S F; Ozoya, S E; Ogunnaike, P O

1978-01-01

The nerves and nerve endings in the skin of tropical cattle were studied using histological and histochemical techniques. Many nerve trunks and fibres were present in the reticular and papillary dermis in both hairy and non-hairy skin sites. In non-hairy skin locations such as the muzzle and lower lip, encapsulated endings akin to Krause and Ruffini end bulbs, which arise from myelinated nerve trunks situated lower down the dermis were observed at the upper papillary layer level. Some fibre trunks seen at this level extended upwards to terminate within dermal papillae as bulb-shaped longitudinally lamellated Pacinian-type endings, while other onion-shaped lamellated nerve structures were located either within dermal papillae or near the dermo-epidermal area. Intraepidermal free-ending nerve fibres, appearing non-myelinated were observed in areas with thick epidermis. Intraepidermal free-ending nerve fibres, appearing non-myelinated were observed in areas with thick epidermis. On hairy skin sites, however, organized nerve endings or intraepidermal nerve endings were not readily identifiable.

Diagnostic nerve ultrasonography

International Nuclear Information System (INIS)

Baeumer, T.; Grimm, A.; Schelle, T.

2017-01-01

For the diagnostics of nerve lesions an imaging method is necessary to visualize peripheral nerves and their surrounding structures for an etiological classification. Clinical neurological and electrophysiological investigations provide functional information about nerve lesions. The information provided by a standard magnetic resonance imaging (MRI) examination is inadequate for peripheral nerve diagnostics; however, MRI neurography is suitable but on the other hand a resource and time-consuming method. Using ultrasonography for peripheral nerve diagnostics. With ultrasonography reliable diagnostics of entrapment neuropathies and traumatic nerve lesions are possible. The use of ultrasonography for neuropathies shows that a differentiation between different forms is possible. Nerve ultrasonography is an established diagnostic tool. In addition to the clinical examination and clinical electrophysiology, structural information can be obtained, which results in a clear improvement in the diagnostics. Ultrasonography has become an integral part of the diagnostic work-up of peripheral nerve lesions in neurophysiological departments. Nerve ultrasonography is recommended for the diagnostic work-up of peripheral nerve lesions in addition to clinical and electrophysiological investigations. It should be used in the clinical work-up of entrapment neuropathies, traumatic nerve lesions and spacy-occupying lesions of nerves. (orig.) [de

Nerve ultrasound shows subclinical peripheral nerve involvement in neurofibromatosis type 2.

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Telleman, Johan A; Stellingwerff, Menno D; Brekelmans, Geert J; Visser, Leo H

2018-02-01

Neurofibromatosis type 2 (NF2) is mainly associated with central nervous system (CNS) tumors. Peripheral nerve involvement is described in symptomatic patients, but evidence of subclinical peripheral nerve involvement is scarce. We conducted a cross-sectional pilot study in 2 asymptomatic and 3 minimally symptomatic patients with NF2 to detect subclinical peripheral nerve involvement. Patients underwent clinical examination, nerve conduction studies (NCS), and high-resolution ultrasonography (HRUS). A total of 30 schwannomas were found, divided over 20 nerve segments (33.9% of all investigated nerve segments). All patients had at least 1 schwannoma. Schwannomas were identified with HRUS in 37% of clinically unaffected nerve segments and 50% of nerve segments with normal NCS findings. HRUS shows frequent subclinical peripheral nerve involvement in NF2. Clinicians should consider peripheral nerve involvement as a cause of weakness and sensory loss in the extremities in patients with this disease. Muscle Nerve 57: 312-316, 2018. © 2017 Wiley Periodicals, Inc.

Polymeric Nerve Conduits with Contact Guidance Cues Used in Nerve Repair

Institute of Scientific and Technical Information of China (English)

G DAI; X NIU; J YIN

2016-01-01

In the modern life, the nerve injury frequently happens due to mechanical, chemical or thermal accidents. In the trivial injuries, the peripheral nerves can regenerate on their own; however, in most of the cases the clinical treatments are required, where relatively large nerve injury gaps are formed. Currently, the nerve repair can be accomplished by direct suture when the injury gap is not too large;while the autologous nerve graft working as the gold standard of peripheral nerve injury treatment for nerve injuries with larger gaps. However, the direct suture is limited by heavy tension at the suture sites, and the autologous nerve graft also has the drawbacks of donor site morbidity and insufifcient donor tissue. Recently, artiifcial nerve conduits have been developed as an alternative for clinical nerve repair to overcome the limitations associated with the above treatments. In order to further improve the efifciency of nerve conduits, various guidance cues are incorporated, including physical cues, biochemical signals, as well as support cells. First, this paper reviewed the contact guidance cues applied in nerve conduits, such as lumen ifllers, multi-channels and micro-patterns on the inner surface. Then, the paper focused on the polymeric nerve conduits with micro inner grooves. The polymeric nerve conduits were fabricated using the phase inversion-based ifber spinning techniques. The smart spinneret with grooved die was designed in the spinning platform, while different spinning conditions, including flow rates, air-gap distances, and polymer concentrations, were adjusted to investigate the inlfuence of fabrication conditions on the geometry of nerve conduits. The inner groove size in the nerve conduits can be precisely controlled in our hollow ifber spinning process, which can work as the efifcient contact guidance cue for nerve regeneration.

X-tip intraosseous injection system as a primary anesthesia for irreversible pulpitis of posterior mandibular teeth: A randomized clinical trail

OpenAIRE

Razavian, Hamid; Kazemi, Shantia; Khazaei, Saber; Jahromi, Maryam Zare

2013-01-01

Background: Successful anesthesia during root canal therapy may be difficult to obtain. Intraosseous injection significantly improves anesthesia′s success as a supplemental pulpal anesthesia, particularly in cases of irreversible pulpitis. The aim of this study was to compare the efficacy of X-tip intraosseous injection and inferior alveolar nerve (IAN) block in primary anesthesia for mandibular posterior teeth with irreversible pulpitis. Materials and Methods: Forty emergency patients wi...

Tissue-engineered spiral nerve guidance conduit for peripheral nerve regeneration.

Science.gov (United States)

Chang, Wei; Shah, Munish B; Lee, Paul; Yu, Xiaojun

2018-06-01

Recently in peripheral nerve regeneration, preclinical studies have shown that the use of nerve guidance conduits (NGCs) with multiple longitudinally channels and intra-luminal topography enhance the functional outcomes when bridging a nerve gap caused by traumatic injury. These features not only provide guidance cues for regenerating nerve, but also become the essential approaches for developing a novel NGC. In this study, a novel spiral NGC with aligned nanofibers and wrapped with an outer nanofibrous tube was first developed and investigated. Using the common rat sciatic 10-mm nerve defect model, the in vivo study showed that a novel spiral NGC (with and without inner nanofibers) increased the successful rate of nerve regeneration after 6 weeks recovery. Substantial improvements in nerve regeneration were achieved by combining the spiral NGC with inner nanofibers and outer nanofibrous tube, based on the results of walking track analysis, electrophysiology, nerve histological assessment, and gastrocnemius muscle measurement. This demonstrated that the novel spiral NGC with inner aligned nanofibers and wrapped with an outer nanofibrous tube provided a better environment for peripheral nerve regeneration than standard tubular NGCs. Results from this study will benefit for future NGC design to optimize tissue-engineering strategies for peripheral nerve regeneration. We developed a novel spiral nerve guidance conduit (NGC) with coated aligned nanofibers. The spiral structure increases surface area by 4.5 fold relative to a tubular NGC. Furthermore, the aligned nanofibers was coated on the spiral walls, providing cues for guiding neurite extension. Finally, the outside of spiral NGC was wrapped with randomly nanofibers to enhance mechanical strength that can stabilize the spiral NGC. Our nerve histological data have shown that the spiral NGC had 50% more myelinated axons than a tubular structure for nerve regeneration across a 10 mm gap in a rat sciatic nerve

Transversus Abdominis Plane Versus Ilioinguinal and Iliohypogastric Nerve Blocks for Analgesia Following Open Inguinal Herniorrhaphy

Directory of Open Access Journals (Sweden)

Anatoli Stav

2016-07-01

Full Text Available Objectives We hypothesized that preoperative (pre-op ultrasound (US-guided posterior transversus abdominis plane block (TAP and US-guided ilioinguinal and iliohypogastric nerve block (ILI+IHG will produce a comparable analgesia after Lichtenstein patch tension-free method of open inguinal hernia repair in adult men. The genital branch of the genitofemoral nerve will be blocked separately. Methods This is a prospective, randomized, controlled, and observer-blinded clinical study. A total of 166 adult men were randomly assigned to one of three groups: a pre-op TAP group, a pre-op ILI+IHG group, and a control group. An intraoperative block of the genital branch of the genitofemoral nerve was performed in all patients in all three groups, followed by postoperative patient-controlled intravenous analgesia with morphine. The pain intensity and morphine consumption immediately after surgery and during the 24 hours after surgery were compared between the groups. Results A total of 149 patients completed the study protocol. The intensity of pain immediately after surgery and morphine consumption were similar in the two “block” groups; however, they were significantly decreased compared with the control group. During the 24 hours after surgery, morphine consumption in the ILI+IHG group decreased compared with the TAP group, as well as in each “block” group versus the control group. Twenty-four hours after surgery, all evaluated parameters were similar. Conclusion Ultrasound-guided ILI+IHG provided better pain control than US-guided posterior TAP following the Lichtenstein patch tension-free method of open inguinal hernia repair in men during 24 hours after surgery. (ClinicalTrials.gov number: NCT01429480.

Sensation, mechanoreceptor, and nerve fiber function after nerve regeneration

DEFF Research Database (Denmark)

Krarup, Christian; Rosén, Birgitta; Boeckstyns, Michel

2017-01-01

Objective: Sensation is essential for recovery after peripheral nerve injury. However, the relationship between sensory modalities and function of regenerated fibers is uncertain. We have investigated the relationships between touch threshold, tactile gnosis, and mechanoreceptor and sensory fiber...... function after nerve regeneration. Methods: Twenty-one median or ulnar nerve lesions were repaired by a collagen nerve conduit or direct suture. Quantitative sensory hand function and sensory conduction studies by near-nerve technique, including tactile stimulation of mechanoreceptors, were followed for 2...... years, and results were compared to noninjured hands. Results: At both repair methods, touch thresholds at the finger tips recovered to 81 ± 3% and tactile gnosis only to 20 ± 4% (p nerve action potentials (SNAPs) remained dispersed and areas recovered to 23 ± 2...

Sex differences in the branching position of the nerve to the abductor digiti minimi muscle: an anatomical study of cadavers.

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Mizuno, Daisuke; Naito, Munekazu; Hayashi, Shogo; Ohmichi, Yusuke; Ohmichi, Mika; Nakano, Takashi

2015-01-01

The nerve to the abductor digiti minimi muscle (ADMM nerve) is the first branch of the lateral plantar nerve or originates directly from the posterior tibial nerve. Damage to the ADMM nerve is a cause of heel pain and eventually results in ADMM atrophy. It is known that ADMM atrophy occurs more often in females than in males, and the reason remains unclear. This study aimed to explore sex differences in the branching pattern, position, and angle of the ADMM nerve. Forty-two cadavers (20 males, 22 females) were dissected at Aichi Medical University between 2011 and 2015. Cases of foot deformity or atrophy were excluded and 67 ft (30 male, 37 female) were examined to assess the branching pattern, position, and angle of the ADMM nerve. The branching positions of the ADMM nerve were superior to the malleolar-calcaneal axis (MCA) in 37 ft (55 %), on the MCA in 10 ft (15 %), and inferior to the MCA in 20 ft (30 %). There was no case among male feet in which the ADMM nerve branched inferior to the MCA, whereas this pattern was observed in 19 of 37 female feet (51 %). The branching position of the ADMM nerve was significantly closer to the MCA in female feet than in male feet. There were no significant sex differences in the branching pattern and angle of the ADMM nerve. The ADMM nerve sometimes branches off inferior to the MCA in females, but not in males. This difference may be the reason for the more frequent occurrence of ADMM atrophy in females than in males.

Cranial nerve clock. Part II: functional MR imaging of brain activation during a declarative memory task.

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Weiss, K L; Welsh, R C; Eldevik, P; Bieliauskas, L A; Steinberg, B A

2001-12-01

The authors performed this study to assess brain activation during encoding and successful recall with a declarative memory paradigm that has previously been demonstrated to be effective for teaching students about the cranial nerves. Twenty-four students underwent functional magnetic resonance (MR) imaging during encoding and recall of the name, number, and function of the 12 cranial nerves. The students viewed mnemonic graphic and text slides related to individual nerves, as well as their respective control slides. For the recall paradigm, students were prompted with the numbers 1-12 (test condition) intermixed with the number 14 (control condition). Subjects were tested about their knowledge of cranial nerves outside the MR unit before and after functional MR imaging. Students learned about the cranial nerves while undergoing functional MR imaging (mean post- vs preparadigm score, 8.1 +/- 3.4 [of a possible 12] vs 0.75 +/- 0.94, bilateral prefrontal cortex, left greater than right; P brain activation. Encoding revealed statistically significant activation in the bilateral prefrontal cortex, left greater than right [corrected]; bilateral occipital and parietal associative cortices, parahippocampus region, fusiform gyri, and cerebellum. Successful recall activated the left much more than the right prefrontal, parietal associative, and anterior cingulate cortices; bilateral precuneus and cerebellum; and right more than the left posterior cingulate. A predictable pattern of brain activation at functional MR imaging accompanies the encoding and successful recall of the cranial nerves with this declarative memory paradigm.

The role of great auricular-facial nerve neurorrhaphy in facial nerve damage

OpenAIRE

Sun, Yan; Liu, Limei; Han, Yuechen; Xu, Lei; Zhang, Daogong; Wang, Haibo

2015-01-01

Background: Facial nerve is easy to be damaged, and there are many reconstructive methods for facial nerve reconstructive, such as facial nerve end to end anastomosis, the great auricular nerve graft, the sural nerve graft, or hypoglossal-facial nerve anastomosis. However, there is still little study about great auricular-facial nerve neurorrhaphy. The aim of the present study was to identify the role of great auricular-facial nerve neurorrhaphy and the mechanism. Methods: Rat models of facia...

Neurological complications in thyroid surgery: a surgical point of view on laryngeal nerves.

Directory of Open Access Journals (Sweden)

EMANUELA eVARALDO

2014-07-01

Full Text Available The cervical branches of the vagus nerve that are pertinent to endocrine surgery are the superior and the inferior laryngeal nerves: their anatomical course in the neck places them at risk during thyroid surgery. The external branch of the superior laryngeal nerve (EB is at risk during thyroid surgery because of its close anatomical relationship with the superior thyroid vessels and the superior thyroid pole region. The rate of EB injury (which leads to the paralysis of the cricothyroid muscle varies from 0 to 58%. The identification of the EB during surgery helps avoiding both an accidental transection and an excessive stretching. When the nerve is not identified,the ligation of superior thyroid artery branches close to the thyroid gland is suggested, as well as the abstention from an indiscriminate use of energy-based devices that might damage it. The inferior laryngeal nerve (RLN runs in the tracheoesophageal groove toward the larynx, close to the posterior aspect of the thyroid. It is the main motor nerve of the intrinsic laryngeal muscles, and also provides sensory innervation to the larynx. Its injury finally causes the paralysis of the omolateral vocal cord and various sensory alterations: the symptoms range from mild to severe hoarseness, to acute airway obstruction and swallowing impairment. Permanent lesions of the RNL occur from 0.3 to 7% of cases, according to different factors. The surgeon must be aware of the possible anatomical variations of the nerve which should be actively searched for and identified. Visual control and gentle dissection of RLN are imperative. The use of intraoperative nerve monitoring has been safely applied but, at the moment, its impact in the incidence of RLN injuries has not been clarified. In conclusion, despite a thorough surgical technique and the use of intraoperative neuromonitoring, the incidence of neurological complications after thyroid surgery cannot be suppressed, but should be maintained in a

[Displacement of the posterior part of the eyeball in myopia].

Science.gov (United States)

Akizawa, Yasuko; Masahiro, Ida

2006-12-01

The principal aim of this study was to investigate displacement of the posterior part of the eyeball within the muscle cone in myopic eyes, particularly in moderately myopic subjects as well as in high myopes. Secondly, the correlation of the amount of displacement and the outer axial length of the globe was studied. The direction of displacement was also examined to clarify whether the eyeball tends to shift toward a certain direction. Seven patients with moderate myopia (moderate myopia group), fifteen patients with high myopia without esotropia (high myopia group), five patients with high myopia and esotropia (myopic esotropia group), and twenty-two controls (control group) were examined. Using magnetic resonance imaging, the outer axial length and the displacement of the posterior portion of the eyeball in the muscle cone were measured. In order to eliminate interindividual differences in the facial configuration, the coronal scanning was done perpendicularly to the orbital axis. The displacement was measured in a plane 4 mm anterior to the globe-optic nerve junction. The displacement was represented by the distance and direction of the globe center from the center of the muscle cone. In the moderate myopia group, there was no displacement of the posterior part of the eyeball in the muscle cone. It was the same as in the control group. But among the three groups, the displacement (mean standard deviation) was significantly greater in the myopic esotropia group (1.53 +/- 0.49 mm) and the high myopia group (0.94 +/- 0.52 mm) than in the control group (0.11 +/- 0.18 mm) (one way ANOVA and multiple comparison). The outer axial length and the distance of the displacement in all cases was significantly correlated (r = 0.87, p = 0.01). Moreover, the posterior part of the eyeball of the myopic esotropia group and the high myopia group was displaced superiorly and temporally. The posterior part of the eyeball of myopic eyes was displaced superotemporally in the muscle

Posterior-only approach for lumbar vertebral column resection and expandable cage reconstruction for spinal metastases.

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Jandial, Rahul; Kelly, Brandon; Chen, Mike Yue

2013-07-01

remained paraparetic after the surgery. No patients had lasting intraoperative neuromonitoring changes, and none died. Complications included 2 reoperations, 1 delayed hardware failure (cage subsidence that did not require revision), and 3 incidental durotomies (none of which required reoperation). No postoperative pneumonia, ileus, or deep venous thrombosis developed in any patient. A posterior-only approach for vertebral segment resection with preservation of spinal nerve roots is a viable technique that can be used throughout the entire lumbar spine. Extensive mobilization of the nerve roots is of utmost importance and allows for insertion and expansion of medium-sized, in situ expandable cages in the midline. This approach, although technically challenging, might reduce the morbidity associated with an anterior approach.

The role of great auricular-facial nerve neurorrhaphy in facial nerve damage.

Science.gov (United States)

Sun, Yan; Liu, Limei; Han, Yuechen; Xu, Lei; Zhang, Daogong; Wang, Haibo

2015-01-01

Facial nerve is easy to be damaged, and there are many reconstructive methods for facial nerve reconstructive, such as facial nerve end to end anastomosis, the great auricular nerve graft, the sural nerve graft, or hypoglossal-facial nerve anastomosis. However, there is still little study about great auricular-facial nerve neurorrhaphy. The aim of the present study was to identify the role of great auricular-facial nerve neurorrhaphy and the mechanism. Rat models of facial nerve cut (FC), facial nerve end to end anastomosis (FF), facial-great auricular neurorrhaphy (FG), and control (Ctrl) were established. Apex nasi amesiality observation, electrophysiology and immunofluorescence assays were employed to investigate the function and mechanism. In apex nasi amesiality observation, it was found apex nasi amesiality of FG group was partly recovered. Additionally, electrophysiology and immunofluorescence assays revealed that facial-great auricular neurorrhaphy could transfer nerve impulse and express AChR which was better than facial nerve cut and worse than facial nerve end to end anastomosis. The present study indicated that great auricular-facial nerve neurorrhaphy is a substantial solution for facial lesion repair, as it is efficiently preventing facial muscles atrophy by generating neurotransmitter like ACh.

Pinched Nerve

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... You are here Home » Disorders » All Disorders Pinched Nerve Information Page Pinched Nerve Information Page What research is being done? Within the NINDS research programs, pinched nerves are addressed primarily through studies associated with pain ...

Intraoperative Physical Examination for Diagnosis of Interosseous Ligament Rupture-Cadaveric Study.

Science.gov (United States)

Kachooei, Amir Reza; Rivlin, Michael; Wu, Fei; Faghfouri, Aram; Eberlin, Kyle R; Ring, David

2015-09-01

To study the intraobserver and interobserver reliability of the diagnosis of interosseous ligament (IOL) rupture in a cadaver model. On 12 fresh frozen cadavers, radial heads were cut using an identical incision and osteotomy. After randomization, the soft tissues of the limbs were divided into 4 groups: both IOL and triangular fibrocartilage (TFCC) intact; IOL disruption but TFCC intact; both IOL and TFCC divided; and IOL intact but TFCC divided. All incisions had identical suturing. After standard instruction and demonstration of radius pull-push and radius lateral pull tests, 10 physician evaluators with different levels of experience examined the cadaver limbs in a standardized way (elbow at 90° with the forearm held in both supination and pronation) and were asked to classify them into one of the 4 groups. Next, the same examiners were asked to re-examine the limbs after randomly changing the order of examination. The interobserver reliability of agreement for the diagnosis of IOL injury (groups 2 and 3) was fair in both rounds of examination and the intraobserver reliability was moderate. The intra- and interobserver reliabilities of agreement for the 4 groups of injuries among the examiners were fair in both rounds of examination. The sensitivity, specificity, accuracy, positive, and negative predictive values were all around 70%. The likelihood of a positive test corresponding with the presence of IOL rupture (positive likelihood ratio) was 2.2. The likelihood of a negative test correctly diagnosing an intact IOL was 0.40. In cadavers, intraoperative tests had fair reliability and 70% accuracy for the diagnosis of IOL rupture using the push-pull and lateral pull maneuvers. The level of experience did not have any effect on the correct diagnosis of intact versus disrupted IOL. Although not common, some failure of surgeries for traumatic elbow fracture-dislocations is because of failure in timely diagnosis of IOL disruption. Copyright © 2015 American

Removal of a fractured needle during inferior alveolar nerve block: two case reports.

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You, Jae-Seek; Kim, Su-Gwan; Oh, Ji-Su; Choi, Hae-In; Jih, Myeong-Kwan

2017-09-01

The inferior alveolar nerve block is the most common method of local anesthesia for intraoral surgery at the posterior mandibular region. However, unexpected complications may occur when administering the local anesthesia. One of these uncommon complications is the fracture of the needle. If the injection needle is broken during the surgery, it should be removed immediately. However, this is one of the most difficult procedures. In this report, we present two cases of needle fracture during the procedure, and its successful removal under general/local anesthesia administration.

Computerized tomography-guided neurolytic splanchnic nerve block

International Nuclear Information System (INIS)

Henriquet, Franco; De Martini, Giuseppe; Roy, Maria Teresa; Pretrolesi, Fabio; Martinoli, Carlo; Cariati, Maurizio; Fiorentini, Franco.

1997-01-01

Computerized tomography-guided neurolytic splanchnic nerve block is a technique for relieving abdominal cancer pain; the goal is the alcoholic neurolytic interruption of the sensitive structures in retroperitoneal space. Computerized tomography yields accurate anatomical detailing and the course for needle placement and alcohol spread. January, 1993, to July, 1996, twenty-one bilateral splanchnic nerve blocks were performed through the posterior access. Forty-eight hours after alcoholism. 14 patients (66%) had complete pain regression; 52% of the patients needed no analgesics for 6 to 54 days and only 9 patients (42%) needed another low opioid therapy. Complications included hypotension and diarrhea in all cases. One had a cardiac arrest and diet 8 days after the procedure. There were no other complications. The whole procedure usually lasted 60 min (range: 45 to 90 min). Splanchnic nerve neurolysis is a useful treatment in the patients with severe chronic abdominal pain. It is used as a second line treatment when large lesions change celia anatomy and complicate the percutaneous block of the celiac plexus. Endosulfan, Malathion and Methyl parathion, on the metabolic rate of the estuarine clam, Villorita cyprinoides var. cochinensis, have been investigated. The animals exposed to the lower sublethal concentrations of Endosulfan, Malthion and Methyl parathion consumed oxygen at the rate of 1.60, 1.98 and 2.09 ml. 0 2 g - 1 h -1 respectively, while at the higher concentrations of the pesticides, consumption of oxygen by the animal dropped to nearly half the control value. When compared to Malathion and Methyl parathion. Endosulfan induced animals recorded a greater reduction in her percentage deviation (from control) of oxygen consumption, possibly due to hypoxia induced by the pollutants

Assessment of nerve regeneration across nerve allografts treated with tacrolimus.

Science.gov (United States)

Haisheng, Han; Songjie, Zuo; Xin, Li

2008-01-01

Although regeneration of nerve allotransplant is a major concern in the clinic, there have been few papers quantitatively assessing functional recovery of animals' nerve allografts in the long term. In this study, functional recovery, histopathological study, and immunohistochemistry changes of rat nerve allograft with FK506 were investigated up to 12 weeks without slaughtering. C57 and SD rats were used for transplantation. The donor's nerve was sliced and transplanted into the recipient. The sciatic nerve was epineurally sutured with 10-0 nylon. In total, 30 models of transplantation were performed and divided into 3 groups that were either treated with FK506 or not. Functional recovery of the grafted nerve was serially assessed by the pin click test, walking track analysis and electrophysiological evaluations. A histopathological study and immunohistochemistry study were done in the all of the models. Nerve allografts treated with FK506 have no immune rejection through 12 weeks. Sensibility had similarly improved in both isografts and allografts. There has been no difference in each graft. Walk track analysis demonstrates significant recovery of motor function of the nerve graft. No histological results of difference were found up to 12 weeks in each graft. In the rodent nerve graft model, FK506 prevented nerve allograft rejection across a major histocompatibility barrier. Sensory recovery seems to be superior to motor function. Nerve isograft and allograft treated with FK506 have no significant difference in function recovery, histopathological result, and immunohistochemistry changes.

Peripheral nerve regeneration through P(DLLA-epsilon-CL) nerve guides

NARCIS (Netherlands)

Den Dunnen, WFA; Meek, MF; Robinson, PH; Schakernraad, JM

1998-01-01

P(DLLA-epsilon-CL) nerve guides can be used perfectly for short nerve gaps in rats, and are even better than short autologous nerve grafts. The tube dimensions, such as the internal diameter and wall thickness, are very important for the final outcome of peripheral nerve regeneration, as well as the

Catheter versus non-catheter angiography in isolated third nerve palsy

International Nuclear Information System (INIS)

Lee, A.G.

2007-01-01

To discuss the controversies surrounding the indications for catheter angiography versus non-catheter and less invasive angiography techniques (e.g. magnetic resonance angiography (MRA) and computerized tomography angiography (CTA)) in the evaluation of patients with a third nerve palsy. Clinical opinion-perspective and literature review. The patient with an isolated third nerve palsy might have a vasculopathic (and typically benign, self limited course) etiology or a life threatening intracranial posterior communicating artery aneurysm. Although it is clear that non-isolated third nerve palsies require imaging directed at the topographical localization of the clinical findings, the evaluation of the neurologically isolated third nerve palsy remains controversial. The completeness of the external (i.e. somatic) motor dysfunction and the presence or absence of internal (i.e. pupillary) dysfunction are generally used to guide the choice of initial neuroimaging. Advances in MRA and CTA technology have reduced but not eliminated our dependence upon catheter angiography in this setting. A properly performed and interpreted MRA or CTA probably will be able to detect greater than 95 % of aneurysms producing a third nerve palsy. The issues surrounding the use of catheter angiography in third nerve palsy are reviewed. If the clinician is highly confident in the capability, availability, and reliability of the neuroradiologist and of their institutional experience and quality of less invasive non-catheter MRA and CTA and if the risk of aneurysm is low or if the risk of angiography is high (e.g. elderly, renal failure, iodinated contrast allergy, risk of stroke) then MRI and MRA (or CTA) may be a reasonable alternative to catheter angiography. Patients with a moderate or uncertain risk of aneurysm and a lower risk for catheter angiography or if there is a low confidence in the quality or the interpretation of the institutional MRA (or CTA) may still require catheter

Primary olfactory projections and the nervus terminalis in the African lungfish: implications for the phylogeny of cranial nerves.

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von Bartheld, C S; Claas, B; Münz, H; Meyer, D L

1988-08-01

Primary olfactory and central projections of the nervus terminalis were investigated by injections of horseradish peroxidase into the olfactory epithelium in the African lungfish. In addition, gonadotropin-releasing hormone (GnRH) immunoreactivity of the nervus terminalis system was investigated. The primary olfactory projections are restricted to the olfactory bulb located at the rostral pole of the telencephalon; they do not extend into caudal parts of the telencephalon. A vomeronasal nerve and an accessory olfactory bulb could not be identified. The nervus terminalis courses through the dorsomedial telencephalon. Major targets include the nucleus of the anterior commissure and the nucleus praeopticus pars superior. some fibers cross to the contralateral side. A few fibers reach the diencephalon and mesencephalon. No label is present in the "posterior root of the nervus terminalis" (= "Pinkus's nerve" or "nervus praeopticus"). GnRH immunoreactivity is lacking in the "anterior root of the nervus terminalis," whereas it is abundant in nervus praeopticus (Pinkus's nerve). These findings may suggest that the nervus terminalis system originally consisted of two distinct cranial nerves, which have fused-in evolution-in most vertebrates. Theories of cranial nerve phylogeny are discussed in the light of the assumed "binerval origin" of the nervus terminalis system.

Application of Crestal Anesthesia for Treatment of Class I Caries in Posterior Mandibular Teeth

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Koroush Taheri Talesh

2011-03-01

Full Text Available Background and aims. Current infiltration techniques for achieving anesthesia in dental procedures are not applicable in posterior mandibular region because of its dense cortical bone. The aim of this study was to evaluate the efficacy of a specific infiltration anesthesia in posterior mandibular teeth instead of inferior alveolar nerve block for restorative procedures. Materials and methods. Crestal anesthesia (CA was assessed both clinically and by computed tomography scan for its efficacy and side effects. A combination of an opaque material (Ultravist and 2% lidocaine was used to trace the anesthetic solution. The combination was primarily injected in the gingival tissue of rabbit and was followed-up regularly for two weeks to assess any possible injury. After confirming its safety, a combination of these materials was injected to volunteers to assess efficacy and diffusion route. A total of 154 patients (77 female, 77 male with matched bilateral posterior teeth in mandible were selected randomly and an IANB and CA were performed randomly and separately in different sessions for the contra lateral teeth. The onset of anesthesia, anesthesia duration, pain, blood pressure, pulse rate, and consumed volume of anesthetic solution was recorded for each technique. Data were analyzed using paired t-test. Results. There were no significant differences in clinical attachment loss, pocket depth, bone level, plaque index, and free gingival margin between the two flaps (p>0.05. Conclusion. CA could be considered as a reliable and safe primary injection in posterior mandibular teeth for restorative treatments.

MR imaging of spondylolytic spondylolisthesis: changes of intervertebral foramen and nerve root compression

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Kim, Ji Hyung [Ajou Univ. College of Medicine, Seoul (Korea, Republic of); Chung, Tae Sub; Kim, Young Soo [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

1999-08-01

To evaluate the factors affecting intervertebral foramen stenosis and nerve root compression in spondylolytic spondylolisthesis. We investigated 120 intervertebral foramina of 60 patients with spondylolytic spondylolisthesis who had undergone lumbar MRI. A retrospective review of their MR images revealed the degree of intervertebral foramen stenosis and causes of nerve root compression. The relationship between disk height diminution following spondylolysis and degree of intervertebral foramen stenosis was also evaluated. Forty eight of 60 patients showed a similar degree of intervertebral foramen stenosis, and in 12 patients the degree of stenosis was different. In 110 intervertebral foramina, stenosis of both the superior and inferior compartments of intervertebral foramina was demonstrated. In 37 of 120 cases (30.8%), stenosis was mild ; in 44 of 120 (36.7%) it was modcrate, and in 29 of 120 (24.2%) it was severe. Stenosis of the inferior compartment was demonstrated in ten of 120 intervertebral foramina (8.3%). Nerve root compression was caused by posterior bulging of the intervertebral disk (65/120), descent of the pedicle (51/120), an isthmic bony segment above the site of spondylolytic (44/120), a bony spur formed at a spondylolytic site (11/120), and fibrocartilaginous callus at a spondylolytic site (5/48). In all cases there was degenerative change of the intervertebral disk at the affected level. There was no relationship between degree of disk height diminution and degree of intervertebral foramen stenosis (p > 0.05). The degree of intervertebral foramen stenosis and causes of nerve root compression in spondylolytic spondylolisthesis are variable, and MRI demonstrates them precisely. There was no positive relationship between degree of nerve root compression at an intervertebral foramen and degree of spondylolysis and degeneration of an intervertebral foramen. The degree of nerve root compression is believed to be another criterion for describing

MR imaging of spondylolytic spondylolisthesis: changes of intervertebral foramen and nerve root compression

International Nuclear Information System (INIS)

Kim, Ji Hyung; Chung, Tae Sub; Kim, Young Soo

1999-01-01

To evaluate the factors affecting intervertebral foramen stenosis and nerve root compression in spondylolytic spondylolisthesis. We investigated 120 intervertebral foramina of 60 patients with spondylolytic spondylolisthesis who had undergone lumbar MRI. A retrospective review of their MR images revealed the degree of intervertebral foramen stenosis and causes of nerve root compression. The relationship between disk height diminution following spondylolysis and degree of intervertebral foramen stenosis was also evaluated. Forty eight of 60 patients showed a similar degree of intervertebral foramen stenosis, and in 12 patients the degree of stenosis was different. In 110 intervertebral foramina, stenosis of both the superior and inferior compartments of intervertebral foramina was demonstrated. In 37 of 120 cases (30.8%), stenosis was mild ; in 44 of 120 (36.7%) it was modcrate, and in 29 of 120 (24.2%) it was severe. Stenosis of the inferior compartment was demonstrated in ten of 120 intervertebral foramina (8.3%). Nerve root compression was caused by posterior bulging of the intervertebral disk (65/120), descent of the pedicle (51/120), an isthmic bony segment above the site of spondylolytic (44/120), a bony spur formed at a spondylolytic site (11/120), and fibrocartilaginous callus at a spondylolytic site (5/48). In all cases there was degenerative change of the intervertebral disk at the affected level. There was no relationship between degree of disk height diminution and degree of intervertebral foramen stenosis (p > 0.05). The degree of intervertebral foramen stenosis and causes of nerve root compression in spondylolytic spondylolisthesis are variable, and MRI demonstrates them precisely. There was no positive relationship between degree of nerve root compression at an intervertebral foramen and degree of spondylolysis and degeneration of an intervertebral foramen. The degree of nerve root compression is believed to be another criterion for describing

Atypical clinical presentation and long-term survival in a patient with optic nerve medulloepithelioma: a case report

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Pastora-Salvador Natalia

2012-05-01

Full Text Available Abstract Introduction Medulloepithelioma is a rare congenital tumor of the primitive medullary neuroepithelium. A significant proportion of patients with medulloepithelioma arising from the optic nerve die from intracranial spread or cerebral metastasis. Because it has no known distinct clinical features and because of its low frequency, this tumor presents within the first two to six years of life and is usually misdiagnosed clinically as a different type of optic nerve tumor. Here, we describe a new and atypical case of medulloepithelioma of the optic nerve in a 12-year-old boy. To the best of our knowledge, he is the oldest reported patient to present with this disease and, now as an adult, has the longest documented period of disease-free survival. Case presentation A 12-year-old Caucasian boy with headache and unilateral amaurosis was referred for a presumed optic nerve glioma to our hospital. A computed tomography scan showed optic nerve enlargement, and fundoscopy showed a whitish mass at the optic disc. Our patient had been followed at his local hospital for four years for an 'optic disc cyst' with no change or progression. He experienced mild progressive visual impairment during that period. He was admitted for resection, and a histopathological analysis revealed a medulloepithelioma of the optic nerve. Supplemental orbital radiotherapy was performed. He remained disease-free for 25 years. Conclusions Medulloepithelioma of the optic nerve can clinically mimic more common pediatric tumors, such as optic glioma, meningioma, or retinoblastoma. Thus, medulloepithelioma should be included in the differential diagnoses of pediatric optic nerve lesions. Fundoscopy in these patients may provide relevant information for diagnosis. Anterior optic nerve medulloepitheliomas may behave differently from and have a better prognosis than medulloepitheliomas that have a more posterior location. Our case report illustrates that long-term survival can be

Non-invasive neurosensory testing used to diagnose and confirm successful surgical management of lower extremity deep distal posterior compartment syndrome

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Guyton Gregory P

2009-05-01

Full Text Available Abstract Background Chronic exertional compartment syndrome (CECS is characterized by elevated pressures within a closed space of an extremity muscular compartment, causing pain and/or disability by impairing the neuromuscular function of the involved compartment. The diagnosis of CECS is primarily made on careful history and physical exam. The gold standard test to confirm the diagnosis of CECS is invasive intra-compartmental pressure measurements. Sensory nerve function is often diminished during symptomatic periods of CECS. Sensory nerve function can be documented with the use of non-painful, non-invasive neurosensory testing. Methods Non-painful neurosensory testing of the myelinated large sensory nerve fibers of the lower extremity were obtained with the Pressure Specified Sensory Device™ in a 25 year old male with history and invasive compartment pressures consistent with CECS both before and after running on a tread mill. After the patient's first operation to release the deep distal posterior compartment, the patient failed to improve. Repeat sensory testing revealed continued change in his function with exercise. He was returned to the operating room where a repeat procedure revealed that the deep posterior compartment was not completely released due to an unusual anatomic variant, and therefore complete release was accomplished. Results The patient's symptoms numbness in the plantar foot and pain in the distal calf improved after this procedure and his repeat sensory testing performed before and after running on the treadmill documented this improvement. Conclusion This case report illustrates the principal that non-invasive neurosensory testing can detect reversible changes in sensory nerve function after a provocative test and may be a helpful non-invasive technique to managing difficult cases of persistent lower extremity symptoms after failed decompressive fasciotomies for CECS. It can easily be performed before and after

Posterior microphthalmos pigmentary retinopathy syndrome.

Science.gov (United States)

Pehere, Niranjan; Jalali, Subhadra; Deshmukh, Himanshu; Kannabiran, Chitra

2011-04-01

Posterior Microphthalmos Pigmentary Retinopathy Syndrome (PMPRS). Posterior microphthalmos (PM) is a relatively infrequent type of microphthalmos where posterior segment is predominantly affected with normal anterior segment measurements. Herein, we report two siblings with posterior microphthalmos retinopathy syndrome with postulated autosomal recessive mode of inheritance. A 13-year-old child had PM and retinitis pigmentosa (RP) and his 7-year-old sister had PM, RP, and foveoschisis. The genetics of this syndrome and variable phenotype is discussed. Importance of being aware of posterior microphthalmos and its posterior segment associations is highlighted.

[Positional damage of the sciatic nerve during neurosurgical intervention into the posterior cranial fossa in the sitting position].

Science.gov (United States)

Konovalov, A N; Lubnin, A Iu; Shimanskiĭ, V N; Kolycheva, M V; Ogurtsova, A A; Grigorian, A A

2009-01-01

The paper describes a rare case of severe, but reversible bilateral damage to the sciatic nerve (compression neuropathy) in a patient with Blumenbach's clivus meningioma developing during 12-hour operation removing the tumor in the patient's sitting position on the operating table. The etiology and prevention of this complication are discussed.

Echocardiographic Wall Motion Abnormality in Posterior Myocardial Infarction: The Diagnostic Value of Posterior Leads

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A Darehzereshki

2008-06-01

Full Text Available Background: For the purpose of ascertaining myocardial infarction (MI and ischemia, the sensitivity of the initial 12-lead ECG is inadequate. It is risky to diagnose posterior MI using only precordial reciprocal changes, since the other leads may be more optimally positioned for the identification of electrocardiographic changes. In this study, we evaluated the relationship between electrocardiography changes and wall motion abnormalities in patients with posterior MI for earlier and better diagnosis of posterior MI.Methods: In this prospective cross-sectional study, we enrolled patients with posterior MI who had come to the Emergency Department of Shariati Hospital with their first episode of chest pain. A 12-lead surface electrocardiogram using posterior leads (V7-V9 was performed for all participants. Patients with ST elevation >0.05 mV or pathologic Q wave in the posterior leads, as well as those with specific changes indicating posterior MI in V1-V2, were evaluated by echocardiography in terms of wall motion abnormalities. All data were analyzed using SPSS and p<0.05 were considered statistically significant.Results: Of a total 79 patients enrolled, 48 (60.8% were men, and the mean age was 57.35±8.22 years. Smoking (54.4% and diabetes (48% were the most prevalent risk factors. In the echocardiographic evaluation, all patients had wall motion abnormalities in the left ventricle and 19 patients (24.1% had wall motion abnormalities in the right ventricle. The most frequent segment with motion abnormality among the all patients was the mid-posterior. The posterior leads showed better positive predictive value than the anterior leads for posterior wall motion abnormality.Conclusion: Electrocardiography of the posterior leads in patients with acute chest pain can help in earlier diagnosis and in time treatment of posterior MI.

Genetics in Ophthalmology III – Posterior Segment Diseases

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Canan Aslı Utine

2012-10-01

Full Text Available Genetic diseases are congenital or acquired hereditary diseases that result from structural/functional disorders of the human genome. Today, the genetic factors that play a role in many diseases are being highlighted with the rapid progress in the field of genetics science. It becomes increasingly important that physicians from all disciplines have knowledge about the basic principles of genetics, patterns of inheritance, etc., so that they can follow the new developments. In genetic eye diseases, ophthalmologists should know the basic clinical and recently rapidly developing genetic characteristics of these diseases in order to properly approach the diagnosis and treatment and to provide genetic counseling. In this paper, posterior segment eye diseases of genetic origin are reviewed, and retinoblastoma, mitochondrial diseases, retinal dysplasia, retinitis pigmentosa, choroideremia, gyrate atrophy, Alström disease, ocular albinism, optic nerve hypoplasia, anophthalmia/microphthalmia and Leber’s congenital amaurosis are covered. (Turk J Ophthalmol 2012; 42: 386-92

Electrophysiology of Cranial Nerve Testing: Spinal Accessory and Hypoglossal Nerves.

Science.gov (United States)

Stino, Amro M; Smith, Benn E

2018-01-01

Multiple techniques have been developed for the electrodiagnostic evaluation of cranial nerves XI and XII. Each of these carries both benefits and limitations, with more techniques and data being available in the literature for spinal accessory than hypoglossal nerve evaluation. Spinal accessory and hypoglossal neuropathy are relatively uncommon cranial mononeuropathies that may be evaluated in the outpatient electrodiagnostic laboratory setting. A review of available literature using PubMed was conducted regarding electrodiagnostic technique in the evaluation of spinal accessory and hypoglossal nerves searching for both routine nerve conduction studies and repetitive nerve conduction studies. The review provided herein provides a resource by which clinical neurophysiologists may develop and implement clinical and research protocols for the evaluation of both of these lower cranial nerves in the outpatient setting.

Anterior interosseous nerve syndrome diagnosis and intraoperative findings: A case report

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Abdulla Aljawder

2016-01-01

Conclusion: Clinical suspicion should arise in the presence of isolated paralysis of the AIN-supplied muscles. MRI and electrodiagnostic studies will confirm the diagnosis and identify the etiology. The optimal treatment of AIN syndrome has not been established. We recommend surgical intervention in confirmed AIN syndrome from compression neuropathy, refractive to conservative therapy.

Evaluation of Morphological and Functional Nerve Recovery of Rat Sciatic Nerve with a Hyaff11-Based Nerve Guide

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K. Jansen

2006-01-01

Full Text Available Application of a Hyaff11-based nerve guide was studied in rats. Functional tests were performed to study motor nerve recovery. A withdrawal reflex test was performed to test sensory recovery. Morphology was studied by means of histology on explanted tissue samples. Motor nerve recovery was established within 7 weeks. Hereafter, some behavioral parameters like alternating steps showed an increase in occurence, while others remained stable. Sensory function was observed within the 7 weeks time frame. Nerve tissue had bridged the 10-mm gap within 7 weeks. The average nerve fiber surface area increased significantly in time. In situ degradation of the nerve conduit was fully going on at week 7 and tubes had collapsed by then. At weeks 15 and 21, the knitted tube wall structure was completely surrounded by macrophages and giant cells, and matrix was penetrating the tube wall. We conclude that a Hyaff11-based nerve guide can be used to bridge short peripheral nerve defects in rat. However, adaptations need to be made.

[Facial nerve neurinomas].

Science.gov (United States)

Sokołowski, Jacek; Bartoszewicz, Robert; Morawski, Krzysztof; Jamróz, Barbara; Niemczyk, Kazimierz

2013-01-01

Evaluation of diagnostic, surgical technique, treatment results facial nerve neurinomas and its comparison with literature was the main purpose of this study. Seven cases of patients (2005-2011) with facial nerve schwannomas were included to retrospective analysis in the Department of Otolaryngology, Medical University of Warsaw. All patients were assessed with history of the disease, physical examination, hearing tests, computed tomography and/or magnetic resonance imaging, electronystagmography. Cases were observed in the direction of potential complications and recurrences. Neurinoma of the facial nerve occurred in the vertical segment (n=2), facial nerve geniculum (n=1) and the internal auditory canal (n=4). The symptoms observed in patients were analyzed: facial nerve paresis (n=3), hearing loss (n=2), dizziness (n=1). Magnetic resonance imaging and computed tomography allowed to confirm the presence of the tumor and to assess its staging. Schwannoma of the facial nerve has been surgically removed using the middle fossa approach (n=5) and by antromastoidectomy (n=2). Anatomical continuity of the facial nerve was achieved in 3 cases. In the twelve months after surgery, facial nerve paresis was rated at level II-III° HB. There was no recurrence of the tumor in radiological observation. Facial nerve neurinoma is a rare tumor. Currently surgical techniques allow in most cases, the radical removing of the lesion and reconstruction of the VII nerve function. The rate of recurrence is low. A tumor of the facial nerve should be considered in the differential diagnosis of nerve VII paresis. Copyright © 2013 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.

Flight behavior of the rhinoceros beetle Trypoxylus dichotomus during electrical nerve stimulation

International Nuclear Information System (INIS)

Truong, Tien Van; Byun, Doyoung; Lavine, Laura Corley; Emlen, Douglas J; Park, Hoon Cheol; Kim, Min Jun

2012-01-01

Neuronal stimulation is an intricate part of understanding insect flight behavior and control insect itself. In this study, we investigated the effects of electrical pulses applied to the brain and basalar muscle of the rhinoceros beetle (Trypoxylus dichotomus). To understand specific neuronal stimulation mechanisms, responses and flight behavior of the beetle, four electrodes were implanted into the two optic lobes, the brain's central complex and the ventral nerve cord in the posterior pronotum. We demonstrated flight initiation, turning and cessation by stimulating the brain. The change undergone by the wing flapping in response to the electrical signal was analyzed from a sequence of images captured by a high-speed camera. Here, we provide evidence to distinguish the important differences between neuronal and muscular flight stimulations in beetles. We found that in the neural potential stimulation, both the hind wing and the elytron were suppressed. Interestingly, the beetle stopped flying whenever a stimulus potential was applied between the pronotum and one side of the optic lobe, or between the ventral nerve cord in the posterior pronotum and the central complex. In-depth experimentation demonstrated the effective of neural stimulation over muscle stimulation for flight control. During electrical stimulation of the optic lobes, the beetle performed unstable flight, resulting in alternating left and right turns. By applying the electrical signal into both the optic lobes and the central complex of the brain, we could precisely control the direction of the beetle flight. This work provides an insight into insect flight behavior for future development of insect-micro air vehicle. (paper)

Flight behavior of the rhinoceros beetle Trypoxylus dichotomus during electrical nerve stimulation.

Science.gov (United States)

Van Truong, Tien; Byun, Doyoung; Lavine, Laura Corley; Emlen, Douglas J; Park, Hoon Cheol; Kim, Min Jun

2012-09-01

Neuronal stimulation is an intricate part of understanding insect flight behavior and control insect itself. In this study, we investigated the effects of electrical pulses applied to the brain and basalar muscle of the rhinoceros beetle (Trypoxylus dichotomus). To understand specific neuronal stimulation mechanisms, responses and flight behavior of the beetle, four electrodes were implanted into the two optic lobes, the brain's central complex and the ventral nerve cord in the posterior pronotum. We demonstrated flight initiation, turning and cessation by stimulating the brain. The change undergone by the wing flapping in response to the electrical signal was analyzed from a sequence of images captured by a high-speed camera. Here, we provide evidence to distinguish the important differences between neuronal and muscular flight stimulations in beetles. We found that in the neural potential stimulation, both the hind wing and the elytron were suppressed. Interestingly, the beetle stopped flying whenever a stimulus potential was applied between the pronotum and one side of the optic lobe, or between the ventral nerve cord in the posterior pronotum and the central complex. In-depth experimentation demonstrated the effective of neural stimulation over muscle stimulation for flight control. During electrical stimulation of the optic lobes, the beetle performed unstable flight, resulting in alternating left and right turns. By applying the electrical signal into both the optic lobes and the central complex of the brain, we could precisely control the direction of the beetle flight. This work provides an insight into insect flight behavior for future development of insect-micro air vehicle.

Use of superficial peroneal nerve graft for treating peripheral nerve injuries

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Samuel Ribak

2016-02-01

Full Text Available ABSTRACT OBJECTIVE: To evaluate the clinical results from treating chronic peripheral nerve injuries using the superficial peroneal nerve as a graft donor source. METHODS: This was a study on eleven patients with peripheral nerve injuries in the upper limbs that were treated with grafts from the sensitive branch of the superficial peroneal nerve. The mean time interval between the dates of the injury and surgery was 93 days. The ulnar nerve was injured in eight cases and the median nerve in six. There were three cases of injury to both nerves. In the surgery, a longitudinal incision was made on the anterolateral face of the ankle, thus viewing the superficial peroneal nerve, which was located anteriorly to the extensor digitorum longus muscle. Proximally, the deep fascia between the extensor digitorum longus and the peroneal longus muscles was dissected. Next, the motor branch of the short peroneal muscle (one of the branches of the superficial peroneal nerve was identified. The proximal limit of the sensitive branch was found at this point. RESULTS: The average space between the nerve stumps was 3.8 cm. The average length of the grafts was 16.44 cm. The number of segments used was two to four cables. In evaluating the recovery of sensitivity, 27.2% evolved to S2+, 54.5% to S3 and 18.1% to S3+. Regarding motor recovery, 72.7% presented grade 4 and 27.2% grade 3. There was no motor deficit in the donor area. A sensitive deficit in the lateral dorsal region of the ankle and the dorsal region of the foot was observed. None of the patients presented complaints in relation to walking. CONCLUSIONS: Use of the superficial peroneal nerve as a graft source for treating peripheral nerve injuries is safe and provides good clinical results similar to those from other nerve graft sources.

Rat optic nerve head anatomy within 3D histomorphometric reconstructions of normal control eyes.

Science.gov (United States)

Pazos, Marta; Yang, Hongli; Gardiner, Stuart K; Cepurna, William O; Johnson, Elaine C; Morrison, John C; Burgoyne, Claude F

2015-10-01

The purpose of this study is to three-dimensionally (3D) characterize the principal macroscopic and microscopic relationships within the rat optic nerve head (ONH) and quantify them in normal control eyes. Perfusion-fixed, trephinated ONH from 8 normal control eyes of 8 Brown Norway Rats were 3D histomorphometrically reconstructed, visualized, delineated and parameterized. The rat ONH consists of 2 scleral openings, (a superior neurovascular and inferior arterial) separated by a thin connective tissue strip we have termed the "scleral sling". Within the superior opening, the nerve abuts a prominent extension of Bruch's Membrane (BM) superiorly and is surrounded by a vascular plexus, as it passes through the sclera, that is a continuous from the choroid into and through the dural sheath and contains the central retinal vein (CRV), (inferiorly). The inferior scleral opening contains the central retinal artery and three long posterior ciliary arteries which obliquely pass through the sclera to obtain the choroid. Bruch's Membrane Opening (BMO) is irregular and vertically elongated, enclosing the nerve (superiorly) and CRV and CRA (inferiorly). Overall mean BMO Depth, BMO Area, Choroidal Thickness and peripapillary Scleral Thickness were 29 μm, 56.5 × 10(3) μm(2), 57 μm and 104 μm respectively. Mean anterior scleral canal opening (ASCO) and posterior scleral canal opening (PSCO) radii were 201 ± 15 μm and 204 ± 16 μm, respectively. Mean optic nerve area at the ASCO and PSCO were 46.3 × 10(3)±4.4 × 10(3) μm(2) and 44.1 × 10(3)±4.5 × 10(3) μm(2) respectively. In conclusion, the 3D complexity of the rat ONH and the extent to which it differs from the primate have been under-appreciated within previous 2D studies. Properly understood, these anatomic differences may provide new insights into the relative susceptibilities of the rat and primate ONH to elevated intraocular pressure. Copyright © 2015 Elsevier Ltd. All rights reserved.

Posterior fossa epidural hematoma

International Nuclear Information System (INIS)

Kushner, M.J.; Luken, M.G. III

1983-01-01

CT demonstrated posterior fossa epidural hematoma in three patients with head trauma in whom this diagnosis was not clinically apparent. No patient was in stupor or coma and no patient experienced a lucid interval. Only one patient had signs referable to the posterior fossa. Two patients had occipital skull fracture disclosed by plain radiographs. CT revealed a unilateral biconvex hematoma in two cases, and a bilateral hematoma with supratentorial extension in the third. All patients underwent suboccipital craniectomy and recovered. Therapeutic success in these cases was facilitated by early CT and the rapid disclosure of the unsuspected posterior fossa lesions. CT showing contiguous hematoma below and above the tentorium cerebelli after posterior head trauma is highly suggestive of epidural hematoma arising from the posterior fossa. (orig.)

Diagnostic gait pattern of a patient with longstanding left femoral nerve palsy: a case report.

LENUS (Irish Health Repository)

Burke, Neil G

2010-12-01

The gait pattern of a 35-year-old man with longstanding, left femoral nerve palsy was assessed using 3-dimensional kinematic and kinetic analysis. Stability of his left knee in stance was achieved by manipulating the external moments of the limb so that the ground reaction force passes in front of the knee joint. This compensatory mechanism of locking the knee in extension is reliant on the posterior capsular structures. The patient was managed conservatively and continued to walk without aids.

Delayed peripheral nerve repair: methods, including surgical 'cross-bridging' to promote nerve regeneration.

Science.gov (United States)

Gordon, Tessa; Eva, Placheta; Borschel, Gregory H

2015-10-01

Despite the capacity of Schwann cells to support peripheral nerve regeneration, functional recovery after nerve injuries is frequently poor, especially for proximal injuries that require regenerating axons to grow over long distances to reinnervate distal targets. Nerve transfers, where small fascicles from an adjacent intact nerve are coapted to the nerve stump of a nearby denervated muscle, allow for functional return but at the expense of reduced numbers of innervating nerves. A 1-hour period of 20 Hz electrical nerve stimulation via electrodes proximal to an injury site accelerates axon outgrowth to hasten target reinnervation in rats and humans, even after delayed surgery. A novel strategy of enticing donor axons from an otherwise intact nerve to grow through small nerve grafts (cross-bridges) into a denervated nerve stump, promotes improved axon regeneration after delayed nerve repair. The efficacy of this technique has been demonstrated in a rat model and is now in clinical use in patients undergoing cross-face nerve grafting for facial paralysis. In conclusion, brief electrical stimulation, combined with the surgical technique of promoting the regeneration of some donor axons to 'protect' chronically denervated Schwann cells, improves nerve regeneration and, in turn, functional outcomes in the management of peripheral nerve injuries.

Endovascular treatment of the posterior inferior cerebellar artery aneurysms

Energy Technology Data Exchange (ETDEWEB)

Bradac, G.B.; Bergui, M. [Neuroradiology, Univ. di Torino, Turin (Italy)

2004-12-01

Aneurysms may arise at various locations along the course of the posterior inferior cerebellar artery. Brainstem and cranial nerves manipulation make the surgical approach to proximal aneurysms difficult, while the occlusion of the parent vessel is sometimes unavoidable in peripheral aneurysms. Endovascular treatment can be a good alternative, but also with this approach the location of the aneurysm is critical. If occlusion of the parent vessel is planned, anatomical variations and vascular territories of the brainstem should be considered. We report our experience with 18 consecutive aneurysms (12 proximal, 6 peripheral) treated by coils. Complete occlusion was achieved in 14 patients and subtotal in 4. In three patients the parent vessel had to be sacrificed. During treatment two perforations occurred; aneurysms were completely occluded without clinical consequences. Two small asymptomatic cerebellar infarctions were seen on postoperative computed tomography. Clinical outcome was good in 16 patients. (orig.)

Sensory nerve function and auto-mutilation after reconstruction of various gap lengths with nerve guides and autologous nerve grafts

NARCIS (Netherlands)

den Dunnen, WFA; Meek, MF

The aim of this study was to evaluate sensory nerve recovery and auto-mutilation after reconstruction of various lengths of nerve gaps in the sciatic nerve of the rat, using different techniques. Group 4, in which the longest nerve gap (15 mm) was reconstructed with a thin-walled

Irreducible Traumatic Posterior Shoulder Dislocation

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Blake Collier

2017-01-01

Full Text Available History of present illness: A 22-year-old male presented to the Emergency Department complaining of right shoulder pain after a motocross accident. He was traveling at approximately 10 mph around a turn when he lost control and was thrown over the handlebars, landing directly on his right shoulder. On arrival, he was holding his arm in adduction and internal rotation. An area of swelling was noted over his anterior shoulder. He was unable to abduct his shoulder. No humeral gapping was noted. He had normal neuro-vascular status distal to the injury. Significant findings: Radiographs demonstrated posterior displacement of the humeral head on the “Y” view (see white arrow and widening of the glenohumeral joint space on anterior-posterior view (see red arrow. The findings were consistent with posterior dislocation and a Hill-Sachs type deformity. Sedation was performed and reduction was attempted using external rotation, traction counter-traction. An immediate “pop” was felt during the procedure. Post-procedure radiographs revealed a persistent posterior subluxation with interlocking at posterior glenoid. CT revealed posterior dislocation with acute depressed impaction deformity medial to the biceps groove with the humeral head perched on the posterior glenoid, interlocked at reverse Hill-Sachs deformity (see blue arrow. Discussion: Posterior shoulder dislocations are rare and represent only 2% of all shoulder dislocations. Posterior shoulder dislocations are missed on initial diagnosis in more than 60% of cases.1 Posterior shoulder dislocations result from axial loading of the adducted and internally rotated shoulder, violent muscle contractions (resulting from seizures or electrocution, a direct posterior force applied to the anterior shoulder.1 Physical findings include decreased anterior prominence of the humeral head, increased palpable posterior prominence of the humeral head below the acromion, increased palpable prominence of the

Tissue-engineered rhesus monkey nerve grafts for the repair of long ulnar nerve defects: similar outcomes to autologous nerve grafts

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Chang-qing Jiang

2016-01-01

Full Text Available Acellular nerve allografts can help preserve normal nerve structure and extracellular matrix composition. These allografts have low immunogenicity and are more readily available than autologous nerves for the repair of long-segment peripheral nerve defects. In this study, we repaired a 40-mm ulnar nerve defect in rhesus monkeys with tissue-engineered peripheral nerve, and compared the outcome with that of autograft. The graft was prepared using a chemical extract from adult rhesus monkeys and seeded with allogeneic Schwann cells. Pathomorphology, electromyogram and immunohistochemistry findings revealed the absence of palmar erosion or ulcers, and that the morphology and elasticity of the hypothenar eminence were normal 5 months postoperatively. There were no significant differences in the mean peak compound muscle action potential, the mean nerve conduction velocity, or the number of neurofilaments between the experimental and control groups. However, outcome was significantly better in the experimental group than in the blank group. These findings suggest that chemically extracted allogeneic nerve seeded with autologous Schwann cells can repair 40-mm ulnar nerve defects in the rhesus monkey. The outcomes are similar to those obtained with autologous nerve graft.

Tissue-engineered rhesus monkey nerve gratfs for the repair of long ulnar nerve defects：similar outcomes to autologous nerve gratfs

Institute of Scientific and Technical Information of China (English)

Chang-qing Jiang; Jun Hu; Jian-ping Xiang; Jia-kai Zhu; Xiao-lin Liu; Peng Luo

2016-01-01

Acellular nerve allogratfs can help preserve normal nerve structure and extracellular matrix composition. These allogratfs have low immu-nogenicity and are more readily available than autologous nerves for the repair of long-segment peripheral nerve defects. In this study, we repaired a 40-mm ulnar nerve defect in rhesus monkeys with tissue-engineered peripheral nerve, and compared the outcome with that of autogratf. The gratf was prepared using a chemical extract from adult rhesus monkeys and seeded with allogeneic Schwann cells. Pathomo-rphology, electromyogram and immunohistochemistry ifndings revealed the absence of palmar erosion or ulcers, and that the morphology and elasticity of the hypothenar eminence were normal 5 months postoperatively. There were no signiifcant differences in the mean peak compound muscle action potential, the mean nerve conduction velocity, or the number of neuroiflaments between the experimental and control groups. However, outcome was signiifcantly better in the experimental group than in the blank group. These ifndings suggest that chemically extracted allogeneic nerve seeded with autologous Schwann cells can repair 40-mm ulnar nerve defects in the rhesus monkey. The outcomes are similar to those obtained with autologous nerve gratf.

Optic nerve oxygenation

DEFF Research Database (Denmark)

Stefánsson, Einar; Pedersen, Daniella Bach; Jensen, Peter Koch

2005-01-01

The oxygen tension of the optic nerve is regulated by the intraocular pressure and systemic blood pressure, the resistance in the blood vessels and oxygen consumption of the tissue. The oxygen tension is autoregulated and moderate changes in intraocular pressure or blood pressure do not affect...... the optic nerve oxygen tension. If the intraocular pressure is increased above 40 mmHg or the ocular perfusion pressure decreased below 50 mmHg the autoregulation is overwhelmed and the optic nerve becomes hypoxic. A disturbance in oxidative metabolism in the cytochromes of the optic nerve can be seen...... at similar levels of perfusion pressure. The levels of perfusion pressure that lead to optic nerve hypoxia in the laboratory correspond remarkably well to the levels that increase the risk of glaucomatous optic nerve atrophy in human glaucoma patients. The risk for progressive optic nerve atrophy in human...

Serum levels of TGF-β1 in patients of diabetic peripheral neuropathy and its correlation with nerve conduction velocity in type 2 diabetes mellitus.

Science.gov (United States)

Hussain, Gauhar; Rizvi, S Aijaz Abbas; Singhal, Sangeeta; Zubair, Mohammad; Ahmad, Jamal

2016-01-01

To correlate serum levels of TGF-β1 with motor and sensory nerve conduction velocities in patients of type 2 diabetes mellitus The study was conducted in diagnosed type 2 diabetes mellitus patients which were divided in patients with clinically detectable peripheral neuropathy of shorter duration (n=37) and longer duration (n=27). They were compared with patients without clinical neuropathy (n=22). Clinical diagnosis was based on neuropathy symptom score (NSS) and Neuropathy disability score (NDS) for signs. Blood samples were collected for baseline investigations and estimation of serum TGF-β1. Nerve conduction velocity was measured in both upper and lower limbs. Median, Ulnar, Common Peroneal and Posterior Tibial nerves were selected for motor nerve conduction study and Median and Sural nerves were selected for sensory nerve conduction study In patients of type 2 diabetes mellitus with clinically detectable and serum TGF-β1 showed positive correlation with nerve conduction velocities High level of TGF-β1 in serum of T2DM patients with neuropathy show possible contribution in development of neuropathy. Due to its independent association this cytokine might be used as biomarker for diabetic peripheral neuropathy. Copyright © 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.

The Role of Nerve Exploration in Supracondylar Humerus Fracture in Children with Nerve Injury

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Anuar RIM

2015-11-01

Full Text Available The supracondylar humerus fracture (SCHF in children is common and can be complicated with nerve injury either primarily immediate post-trauma or secondarily posttreatment. The concept of neurapraxic nerve injury makes most surgeons choose to ‘watch and see’ the nerve recovery before deciding second surgery if the nerve does not recover. We report three cases of nerve injury in SCHF, all of which underwent nerve exploration for different reasons. Early reduction in the Casualty is important to release the nerve tension before transferring the patient to the operation room. If close reduction fails, we proceed to explore the nerve together with open reduction of the fracture. In iatrogenic nerve injury, we recommend nerve exploration to determine the surgical procedure that is causing the injury. Primary nerve exploration will allow early assessment of the injured nerve and minimize subsequent surgery.

Fungiform taste bud degeneration in C57BL/6J mice following chorda-lingual nerve transection.

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Guagliardo, Nick A; Hill, David L

2007-09-10

Taste buds are dependent on innervation for normal morphology and function. Fungiform taste bud degeneration after chorda tympani nerve injury has been well documented in rats, hamsters, and gerbils. The current study examines fungiform taste bud distribution and structure in adult C57BL/6J mice from both intact taste systems and after unilateral chorda-lingual nerve transection. Fungiform taste buds were visualized and measured with the aid of cytokeratin 8. In control mice, taste buds were smaller and more abundant on the anterior tip (taste buds were smaller and fewer on the side of the tongue ipsilateral to the transection and continued to decrease in both size and number until 15 days posttransection. Degenerating fungiform taste buds were smaller due to a loss of taste bud cells rather than changes in taste bud morphology. While almost all taste buds disappeared in more posterior fungiform papillae by 15 days posttransection, the anterior tip of the tongue retained nearly half of its taste buds compared to intact mice. Surviving taste buds could not be explained by an apparent innervation from the remaining intact nerves. Contralateral effects of nerve transection were also observed; taste buds were larger due to an increase in the number of taste bud cells. These data are the first to characterize adult mouse fungiform taste buds and subsequent degeneration after unilateral nerve transection. They provide the basis for more mechanistic studies in which genetically engineered mice can be used. (c) 2007 Wiley-Liss, Inc.

Poly(DL-lactide-epsilon-caprolactone) nerve guides perform better than autologous nerve grafts

NARCIS (Netherlands)

DenDunnen, WFA; VanderLei, B; Schakenraad, JM; Stokroos, [No Value; Blaauw, E; Pennings, AJ; Robinson, PH; Bartels, H.

1996-01-01

The aim of this study was to compare the speed and quality of nerve regeneration after reconstruction using a biodegradable nerve guide or an autologous nerve graft. We evaluated nerve regeneration using light microscopy, transmission electron microscopy and morphometric analysis. Nerve regeneration

Neural stem cells enhance nerve regeneration after sciatic nerve injury in rats.

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Xu, Lin; Zhou, Shuai; Feng, Guo-Ying; Zhang, Lu-Ping; Zhao, Dong-Mei; Sun, Yi; Liu, Qian; Huang, Fei

2012-10-01

With the development of tissue engineering and the shortage of autologous nerve grafts in nerve reconstruction, cell transplantation in a conduit is an alternative strategy to improve nerve regeneration. The present study evaluated the effects and mechanism of brain-derived neural stem cells (NSCs) on sciatic nerve injury in rats. At the transection of the sciatic nerve, a 10-mm gap between the nerve stumps was bridged with a silicon conduit filled with 5 × 10(5) NSCs. In control experiments, the conduit was filled with nerve growth factor (NGF) or normal saline (NS). The functional and morphological properties of regenerated nerves were investigated, and expression of hepatocyte growth factor (HGF) and NGF was measured. One week later, there was no connection through the conduit. Four or eight weeks later, fibrous connections were evident between the proximal and distal segments. Motor function was revealed by measurement of the sciatic functional index (SFI) and sciatic nerve conduction velocity (NCV). Functional recovery in the NSC and NGF groups was significantly more advanced than that in the NS group. NSCs showed significant improvement in axon myelination of the regenerated nerves. Expression of NGF and HGF in the injured sciatic nerve was significantly lower in the NS group than in the NSCs and NGF groups. These results and other advantages of NSCs, such as ease of harvest and relative abundance, suggest that NSCs could be used clinically to enhance peripheral nerve repair.

Using Eggshell Membrane as Nerve Guide Channels in Peripheral Nerve Regeneration

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Gholam Hossein Farjah

2013-08-01

Full Text Available Objective(s:  The aim of this study was to evaluate the final outcome of nerve regeneration across the eggsell membrane (ESM tube conduit in comparison with autograft. Materials and Methods: Thirty adult male rats (250-300 g were randomized into (1 ESM conduit, (2 autograft, and (3 sham surgery groups. The eggs submerged in 5% acetic acid. The decalcifying membranes were cut into four pieces, rotated over the teflon mandrel and dried at   37°C. The left sciatic nerve was surgically cut. A 10-mm nerve segment was cut and removed. In the ESM group, the proximal and distal cut ends of the sciatic nerve were telescoped into the nerve guides. In the autograft group, the 10 mm nerve segment was reversed and used as an autologous nerve graft. All animals were evaluated by sciatic functional index (SFI and electrophysiology testing.  Results:The improvement in SFI from the first to the last evalution in ESM and autograft groups were evaluated. On days 49 and 60 post-operation, the mean SFI of ESM group was significantly greater than the autograft group (P 0.05. Conclusion:These findings demonstrate that ESM effectively enhances nerve regeneration and promotes functional recovery in injured sciatic nerve of rat.

Treatment of Spinal Tuberculosis by Debridement, Interbody Fusion and Internal Fixation via Posterior Approach Only.

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Tang, Ming-xing; Zhang, Hong-qi; Wang, Yu-xiang; Guo, Chao-feng; Liu, Jin-yang

2016-02-01

Surgical treatment for spinal tuberculosis includes focal tuberculosis debridement, segmental stability reconstruction, neural decompression and kyphotic deformity correction. For the lesions mainly involved anterior and middle column of the spine, anterior operation of debridement and fusion with internal fixation has been becoming the most frequently used surgical technique for the spinal tuberculosis. However, high risk of structural damage might relate with anterior surgery, such as damage in lungs, heart, kidney, ureter and bowel, and the deformity correction is also limited. Due to the organs are in the front of spine, there are less complications in posterior approach. Spinal pedicle screw passes through the spinal three-column structure, which provides more powerful orthopedic forces compared with the vertebral body screw, and the kyphotic deformity correction effect is better in posterior approach. In this paper, we report a 68-year-old male patient with thoracic tuberculosis who underwent surgical treatment by debridement, interbody fusion and internal fixation via posterior approach only. The patient was placed in prone position under general anesthesia. Posterior midline incision was performed, and the posterior spinal construction was exposed. Then place pedicle screw, and fix one side rod temporarily. Make the side of more bone destruction and larger abscess as lesion debridement side. Resect the unilateral facet joint, and retain contralateral structure integrity. Protect the spinal cord, nerve root. Clear sequestrum, necrotic tissue, abscess of paravertebral and intervertebral space. Specially designed titanium mesh cages or bone blocks were implanted into interbody. Fix both side rods and compress both sides to make the mesh cages and bone blocks tight. Reconstruct posterior column structure with allogeneic bone and autologous bone. Using this technique, the procedures of debridement, spinal cord decompression, deformity correction, bone grafting

An analysis of facial nerve function in irradiated and unirradiated facial nerve grafts

International Nuclear Information System (INIS)

Brown, Paul D.; Eshleman, Jeffrey S.; Foote, Robert L.; Strome, Scott E.

2000-01-01

Purpose: The effect of high-dose radiation therapy on facial nerve grafts is controversial. Some authors believe radiotherapy is so detrimental to the outcome of facial nerve graft function that dynamic or static slings should be performed instead of facial nerve grafts in all patients who are to receive postoperative radiation therapy. Unfortunately, the facial function achieved with dynamic and static slings is almost always inferior to that after facial nerve grafts. In this retrospective study, we compared facial nerve function in irradiated and unirradiated nerve grafts. Methods and Materials: The medical records of 818 patients with neoplasms involving the parotid gland who received treatment between 1974 and 1997 were reviewed, of whom 66 underwent facial nerve grafting. Fourteen patients who died or had a recurrence less than a year after their facial nerve graft were excluded. The median follow-up for the remaining 52 patients was 10.6 years. Cable nerve grafts were performed in 50 patients and direct anastomoses of the facial nerve in two. Facial nerve function was scored by means of the House-Brackmann (H-B) facial grading system. Twenty-eight of the 52 patients received postoperative radiotherapy. The median time from nerve grafting to start of radiotherapy was 5.1 weeks. The median and mean doses of radiation were 6000 and 6033 cGy, respectively, for the irradiated grafts. One patient received preoperative radiotherapy to a total dose of 5000 cGy in 25 fractions and underwent surgery 1 month after the completion of radiotherapy. This patient was placed, by convention, in the irradiated facial nerve graft cohort. Results: Potential prognostic factors for facial nerve function such as age, gender, extent of surgery at the time of nerve grafting, preoperative facial nerve palsy, duration of preoperative palsy if present, or number of previous operations in the parotid bed were relatively well balanced between irradiated and unirradiated patients. However

Displacement of the posterior part of the eyeball in myopia

International Nuclear Information System (INIS)

Akizawa, Yasuko; Ida, Masahiro

2006-01-01

The principal aim of this study was to investigate displacement of the posterior part of the eyeball within the muscle cone in myopic eyes, particularly in moderately myopic subjects as well as in high myopes. Secondly, the correlation of the amount of displacement and the outer axial length of the globe was studied. The direction of displacement was also examined to clarify whether the eyeball tends to shift toward a certain direction. Seven patients with moderate myopia (moderate myopia group), fifteen patients with high myopia without esotropia (high myopia group), five patients with high myopia and esotropia (myopic esotropia group), and twenty-two controls (control group) were examined. Using magnetic resonance imaging, the outer axial length and the displacement of the posterior portion of the eyeball in the muscle cone were measured. In order to eliminate interindividual differences in the facial configuration, the coronal scanning was done perpendicularly to the orbital axis. The displacement was measured in a plane 4 mm anterior to the globe-optic nerve junction. The displacement was represented by the distance and direction of the globe center from the center of the muscle cone. In the moderate myopia group, there was no displacement of the posterior part of the eyeball in the muscle cone. It was the same as in the control group. But among the three groups, the displacement (mean±standard deviation) was significantly greater in the myopic esotropia group (1.53±0.49 mm) and the high myopia group (0.94±0.52 mm) than in the control group (0.11±0.18 mm) (one way ANOVA and multiple comparison). The outer axial length and the distance of the displacement in all cases was significantly correlated (r=0.87, p=0.01). Moreover, the posterior part of the eyeball of the myopic esotropia group and the high myopia group was displaced superiorly and temporally. The posterior part of the eyeball of myopic eyes was displaced superotemporally in the muscle cone

Optic Nerve Imaging

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... News About Us Donate In This Section Optic Nerve Imaging email Send this article to a friend ... measurements of nerve fiber damage (or loss). The Nerve Fiber Analyzer (GDx) uses laser light to measure ...

POROSITY OF THE WALL OF A NEUROLAC (R) NERVE CONDUIT HAMPERS NERVE REGENERATION

NARCIS (Netherlands)

Meek, Marcel F.; Den Dunnen, Wilfred F. A.

2009-01-01

One way to improve nerve regeneration and bridge longer nerve gaps may be the use of semipermeable/porous conduits. With porosity less biomaterial is used for the nerve conduit. We evaluated the short-term effects of porous Neurolac (R) nerve conduits for in vivo peripheral nerve regeneration. In 10

Magnetic resonance imaging study of lumbosacral spinal cord nerves before artificial somatic-central nervous system-autonomic reflex pathway establish ment

International Nuclear Information System (INIS)

Deng Xianbo; Kong Xiangquan; Feng Gansheng; Han Ping; Liu Dingxi; Ma Hui

2005-01-01

Objective: To investigate the value of MRI as imaging technique for lumbosacral spinal nerves before artificial somatic-central nervous system-autonomic reflex pathway establish ment. Methods: Conventional MRI and T 2 W CISS 3D were performed in 10 patients with neurogenic bladder planned for the operation of artificial somatic-central nervous system-autonomic reflex pathway. The Three-dimensional data were then constructed into composite images using a standard multiple planar reformation (MPR). Results: Five patients showed tethered spinal cord syndrome, whose spinal cord nerves were circuitous distributed and had abnormity number when penetrated the dura. Of these 5 patients, one patient was accompanied by spinal cord vas malformation. Four patients had vertebral fracture and spinal injury, and the other one patients demonstrated tumor in vertebral canal on MRI examinations. The spinal cord nerves in these 5 patients floated down river and had normal number of spinal cord nerves. Conclusion: Conventional MRI and T 2 W CISS 3D MRI were essential for the pre-operative planning of artificial somatic-central nervous system-autonomic reflex pathway, especially in patients with tethered spinal cord syndrome. Spinal cord nerves distribute and anterior and posterior roots array can be clearly showed by MPR. (authors)

Complement components of nerve regeneration conditioned fluid influence the microenvironment of nerve regeneration

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Guang-shuai Li

2016-01-01

Full Text Available Nerve regeneration conditioned fluid is secreted by nerve stumps inside a nerve regeneration chamber. A better understanding of the proteinogram of nerve regeneration conditioned fluid can provide evidence for studying the role of the microenvironment in peripheral nerve regeneration. In this study, we used cylindrical silicone tubes as the nerve regeneration chamber model for the repair of injured rat sciatic nerve. Isobaric tags for relative and absolute quantitation proteomics technology and western blot analysis confirmed that there were more than 10 complement components (complement factor I, C1q-A, C1q-B, C2, C3, C4, C5, C7, C8ß and complement factor D in the nerve regeneration conditioned fluid and each varied at different time points. These findings suggest that all these complement components have a functional role in nerve regeneration.

Delayed peripheral nerve repair: methods, including surgical ?cross-bridging? to promote nerve regeneration

OpenAIRE

Gordon, Tessa; Eva, Placheta; Borschel, Gregory H.

2015-01-01

Despite the capacity of Schwann cells to support peripheral nerve regeneration, functional recovery after nerve injuries is frequently poor, especially for proximal injuries that require regenerating axons to grow over long distances to reinnervate distal targets. Nerve transfers, where small fascicles from an adjacent intact nerve are coapted to the nerve stump of a nearby denervated muscle, allow for functional return but at the expense of reduced numbers of innervating nerves. A 1-hour per...

Electrophysiology of Cranial Nerve Testing: Trigeminal and Facial Nerves.

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Muzyka, Iryna M; Estephan, Bachir

2018-01-01

The clinical examination of the trigeminal and facial nerves provides significant diagnostic value, especially in the localization of lesions in disorders affecting the central and/or peripheral nervous system. The electrodiagnostic evaluation of these nerves and their pathways adds further accuracy and reliability to the diagnostic investigation and the localization process, especially when different testing methods are combined based on the clinical presentation and the electrophysiological findings. The diagnostic uniqueness of the trigeminal and facial nerves is their connectivity and their coparticipation in reflexes commonly used in clinical practice, namely the blink and corneal reflexes. The other reflexes used in the diagnostic process and lesion localization are very nerve specific and add more diagnostic yield to the workup of certain disorders of the nervous system. This article provides a review of commonly used electrodiagnostic studies and techniques in the evaluation and lesion localization of cranial nerves V and VII.

Changes in motor unit behavior following isometric fatigue of the first dorsal interosseous muscle

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Rymer, William Z.; Lowery, Madeleine M.; Suresh, Nina L.

2015-01-01

The neuromuscular strategies employed to compensate for fatigue-induced muscle force deficits are not clearly understood. This study utilizes surface electromyography (sEMG) together with recordings of a population of individual motor unit action potentials (MUAPs) to investigate potential compensatory alterations in motor unit (MU) behavior immediately following a sustained fatiguing contraction and after a recovery period. EMG activity was recorded during abduction of the first dorsal interosseous in 12 subjects at 20% maximum voluntary contraction (MVC), before and directly after a 30% MVC fatiguing contraction to task failure, with additional 20% MVC contractions following a 10-min rest. The amplitude, duration and mean firing rate (MFR) of MUAPs extracted with a sEMG decomposition system were analyzed, together with sEMG root-mean-square (RMS) amplitude and median frequency (MPF). MUAP duration and amplitude increased immediately postfatigue and were correlated with changes to sEMG MPF and RMS, respectively. After 10 min, MUAP duration and sEMG MPF recovered to prefatigue values but MUAP amplitude and sEMG RMS remained elevated. MU MFR and recruitment thresholds decreased postfatigue and recovered following rest. The increase in MUAP and sEMG amplitude likely reflects recruitment of larger MUs, while recruitment compression is an additional compensatory strategy directly postfatigue. Recovery of MU MFR in parallel with MUAP duration suggests a possible role for metabolically sensitive afferents in MFR depression postfatigue. This study provides insight into fatigue-induced neuromuscular changes by examining the properties of a large population of concurrently recorded single MUs and outlines possible compensatory strategies involving alterations in MU recruitment and MFR. PMID:25761952

Miconazole enhances nerve regeneration and functional recovery after sciatic nerve crush injury.

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Lin, Tao; Qiu, Shuai; Yan, Liwei; Zhu, Shuang; Zheng, Canbin; Zhu, Qingtang; Liu, Xiaolin

2018-05-01

Improving axonal outgrowth and remyelination is crucial for peripheral nerve regeneration. Miconazole appears to enhance remyelination in the central nervous system. In this study we assess the effect of miconazole on axonal regeneration using a sciatic nerve crush injury model in rats. Fifty Sprague-Dawley rats were divided into control and miconazole groups. Nerve regeneration and myelination were determined using histological and electrophysiological assessment. Evaluation of sensory and motor recovery was performed using the pinprick assay and sciatic functional index. The Cell Counting Kit-8 assay and Western blotting were used to assess the proliferation and neurotrophic expression of RSC 96 Schwann cells. Miconazole promoted axonal regrowth, increased myelinated nerve fibers, improved sensory recovery and walking behavior, enhanced stimulated amplitude and nerve conduction velocity, and elevated proliferation and neurotrophic expression of RSC 96 Schwann cells. Miconazole was beneficial for nerve regeneration and functional recovery after peripheral nerve injury. Muscle Nerve 57: 821-828, 2018. © 2017 Wiley Periodicals, Inc.

Delayed peripheral nerve repair: methods, including surgical ′cross-bridging′ to promote nerve regeneration

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Tessa Gordon

2015-01-01

Full Text Available Despite the capacity of Schwann cells to support peripheral nerve regeneration, functional recovery after nerve injuries is frequently poor, especially for proximal injuries that require regenerating axons to grow over long distances to reinnervate distal targets. Nerve transfers, where small fascicles from an adjacent intact nerve are coapted to the nerve stump of a nearby denervated muscle, allow for functional return but at the expense of reduced numbers of innervating nerves. A 1-hour period of 20 Hz electrical nerve stimulation via electrodes proximal to an injury site accelerates axon outgrowth to hasten target reinnervation in rats and humans, even after delayed surgery. A novel strategy of enticing donor axons from an otherwise intact nerve to grow through small nerve grafts (cross-bridges into a denervated nerve stump, promotes improved axon regeneration after delayed nerve repair. The efficacy of this technique has been demonstrated in a rat model and is now in clinical use in patients undergoing cross-face nerve grafting for facial paralysis. In conclusion, brief electrical stimulation, combined with the surgical technique of promoting the regeneration of some donor axons to ′protect′ chronically denervated Schwann cells, improves nerve regeneration and, in turn, functional outcomes in the management of peripheral nerve injuries.

Optic Nerve Disorders

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The optic nerve is a bundle of more than 1 million nerve fibers that carry visual messages. You have one connecting ... retina) to your brain. Damage to an optic nerve can cause vision loss. The type of vision ...

Pathological confirmation of nerve-sparing types performed during robot-assisted radical prostatectomy (RARP).

Science.gov (United States)

Ko, Woo Jin; Hruby, Gregory W; Turk, Andrew T; Landman, Jaime; Badani, Ketan K

2013-03-01

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Incremental nerve-sparing techniques (NSTs) improve postoperative erectile function after robot-assisted radical prostatectomy (RARP). However, there are no studies to date that histologically confirm the surgeon intended NST. Thus, in the present study, we histologically confirmed that the surgeon performed the nerve preservation as his intended NSTs during RARP. Also, we found that there was more variability in fascia width outcome on the left side compared with the right. Therefore, when performing nerve preservation on the surgeon's non-dominant side, we need to pay more close attention. To confirm that the surgeon achieved true intended histological nerve sparing during robot-assisted radical prostatectomy (RARP) by studying RP specimens. To aid the novice robotic surgeon to develop the skills of RARP. Between June 2008 and May 2009, 122 consecutive patients underwent RARP by a single surgeon (K.K.B.). The degree of nerve sparing (wide resection [WR], interfascial nerve sparing [ITE-NS], intrafascial nerve sparing [ITR-NS]) on both sides was recorded. The posterior sectors of RP specimens from distal, mid, and proximal parts were evaluated. Fascia width (FW) of each position in RP specimens were compared across nerve-sparing types (NSTs). FW was recorded at 15 ° intervals (3-9 o'clock position), measured as the distance between the outermost prostate gland and surgical margin. The slides were reviewed by an experienced uropathologist who was 'blinded' to the NST. In all, 93 men were included. The overall mean (sd) FW was the greatest in the order of WR, ITE-NS, and ITR-NS, at 2.42 (1.62), 1.71 (1.40) and 1.16 (1.08) mm, respectively (P ITE-NS, bilateral ITE-NS, ITE-NS/WR, and bilateral WR, respectively. To further validate and confirm these preliminary findings, additional studies involving multicentre cohorts would be required. The surgeon intended dissection and FW correlate, with ITR

Posterior pole asymmetry analysis and retinal thickness measurements in young relatives of glaucoma patients

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Gökhan Pekel

2015-08-01

Full Text Available The presence of a family history of glaucoma is a known risk factor for primary open-angle glaucoma (POAG in middle-aged and older individuals. In this study, our aim was to demonstrate possible early glaucomatous alterations in young first- and second-degree relatives of POAG patients by spectral-domain optical coherence tomography. A total of 104 participants (52 relatives of POAG patients and 52 healthy individuals were recruited in this cross-sectional study. All the participants were between 17 years and 45 years of age. All eyes underwent testing with spectral-domain optical coherence tomography. Peripapillary retinal nerve fiber layer thickness, hemifield macular thickness, macular ganglion cell complex thickness, posterior pole asymmetry analysis, and retinal arteriolar caliber measurements were taken for comparison between the study and control groups. The mean peripapillary retinal nerve fiber layer thickness was 104.9 ± 8.8 μm in the study group and 105.6 ± 7.4 μm in the control group (p = 0.68. Although whole macular thickness measurements were higher in the control group when compared with the study group (p = 0.008, the macular ganglion cell complex thickness was similar in both groups (p = 0.87. The posterior pole asymmetry analysis revealed no statistically significant difference between the groups in the aspect of consecutive black squares (p = 0.79. The mean retinal arteriolar caliber was 85.9 ± 4.8 μm in the study group and 86.0 ± 5.0 μm in the control group (p = 0.90. In conclusion, young relatives of POAG patients do not show characteristic glaucomatous damage when compared with the controls.

Progress of nerve bridges in the treatment of peripheral nerve disruptions

OpenAIRE

Ao,Qiang

2016-01-01

Qiang Ao Department of Tissue Engineering, School of Fundamental Science, China Medical University, Shenyang, Liaoning, Peoples’ Republic of China Abstract: Clinical repair of a nerve defect is one of the most challenging surgical problems. Autologous nerve grafting remains the gold standard treatment in addressing peripheral nerve injuries that cannot be bridged by direct epineural suturing. However, the autologous nerve graft is not readily available, and the process of harvesting...

Optic Nerve Pit

Science.gov (United States)

... Conditions Frequently Asked Questions Español Condiciones Chinese Conditions Optic Nerve Pit What is optic nerve pit? An optic nerve pit is a ... may be seen in both eyes. How is optic pit diagnosed? If the pit is not affecting ...

Posterior Decompression, Lumber Interbody Fusion and Internal Fixation in the Treatment of Upper Lumbar Intervertebral Disc Herniation

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DONG Zhan

2014-12-01

Full Text Available Objective: To assess the clinical outcomes of posterior decompression, interbody fusion and internal fixationfor the treatment of the upper lumbar intervertebral disc herniation. Methods: Twelve patients with the upper lumbar intervertebral disc herniation were treated by posterior decompression, interbosy fusion and internal fixation. The time of the operation, the amount of bleeding and the clinical efficacy were evaluated. Results: The time of operation was (143±36 min and the amount of bleeding during operation was (331.5±47.9 mL. There was no spinal cord and injuries, nerve injury, epidural damage and leakage of cerebrospinal fluid. All patients were followed up for 10～19 months with the average being 12.6 months. The functional scoring of Japanese Orthopedic Association (JOA before the operation was (11.4±3.3 scores and final score after follow-up was (22.9±3.1 scores and there were statistical difference (P＜0.01. Lumber interbody fusion of all patients completed successfully and the good rate after the operation was 91.7%. Conclusion: Posterior decompression, interbody fusion and internal fixation for the treatment of the upper lumbar intervertebral disc herniation was characterized by full exposure, safety and significant efficacy.

The vestibulocochlear nerve (VIII).

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Benoudiba, F; Toulgoat, F; Sarrazin, J-L

2013-10-01

The vestibulocochlear nerve (8th cranial nerve) is a sensory nerve. It is made up of two nerves, the cochlear, which transmits sound and the vestibular which controls balance. It is an intracranial nerve which runs from the sensory receptors in the internal ear to the brain stem nuclei and finally to the auditory areas: the post-central gyrus and superior temporal auditory cortex. The most common lesions responsible for damage to VIII are vestibular Schwannomas. This report reviews the anatomy and various investigations of the nerve. Copyright © 2013. Published by Elsevier Masson SAS.

Classification of posterior vitreous detachment

Science.gov (United States)

Kakehashi, Akihiro; Takezawa, Mikiko; Akiba, Jun

2014-01-01

Diagnosing a posterior vitreous detachment (PVD) is important for predicting the prognosis and determining the indication for vitreoretinal surgery in many vitreoretinal diseases. This article presents both classifications of a PVD by slit-lamp biomicroscopy and of a shallow PVD by optical coherence tomography (OCT). By biomicroscopy, the vitreous condition is determined based on the presence or absence of a PVD. The PVD then is classified as either a complete posterior vitreous detachment (C-PVD) or a partial posterior vitreous detachment (P-PVD). A C-PVD is further divided into a C-PVD with collapse and a C-PVD without collapse, while a P-PVD is divided into a P-PVD with shrinkage of the posterior hyaloid membrane (P-PVD with shrinkage) and a P-PVD without shrinkage of the posterior hyaloid membrane (P-PVD without shrinkage). A P-PVD without shrinkage has a subtype characterized by vitreous gel attachment through the premacular hole in a posterior hyaloid membrane to the macula (P-PVD without shrinkage [M]). By OCT, a shallow PVD is classified as the absence of a shallow PVD or as a shallow PVD. A shallow PVD is then subclassified as a shallow PVD without shrinkage of the posterior vitreous cortex, a shallow PVD with shrinkage of the posterior vitreous cortex, and a peripheral shallow PVD. A shallow PVD without shrinkage of the posterior vitreous cortex has two subtypes: an age-related shallow PVD and a perifoveal PVD associated with a macular hole. PMID:24376338

Implanting straight into cochlea risks the facial nerve: a Cartesian coordinate study.

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Deshpande, Anita S; Wendell Todd, N

2016-12-01

To describe the straight-into-cochlea line that affords the best access for an electrode array to enter via the round window, and how this line relates to the facial nerve, the incus, and mastoid size. The straight-into-cochlea line is important to minimize the cochlear trauma and maximize the likelihood of placement into the scala tympani. High-resolution CT scans were obtained for ten craniums with the extremes of large (N = 5) and small (N = 5) mastoid pneumatization; the specimens were from a series of 41 ear normal craniums. Using FIJI, a publicly available software program, the straight-into-cochlea insertion line was determined by defining the x-y-z coordinates of the middle of the round window and a point 6.0 mm into the cochlea on its centrifugal wall. Then, from the extended straight-into-cochlea insertion line, we determined the shortest perpendicular distance to the middle of the fallopian canal, and from that "fallopian point" to the apex of the posterior process of the incus. We found good repeatability of measurements. We found the extended straight-into-cochlea insertion lines routinely close to or in the midst of the fallopian canal (50 % ≤ 1.0 mm). We found the lines 4.7-7.8 mm from the apex of the posterior process of the incus. Line positions relative to "fallopian point" and incus showed no relation to mastoid pneumatization. For the distance "fallopian point" to incus, bilateral symmetry was suggested. Using landmarks registered in an x-y-z coordinate system, straight-into-cochlea insertion via the round window puts the facial nerve at risk.

Functional nerve recovery after bridging a 15 mm gap in rat sciatic nerve with a biodegradable nerve guide

NARCIS (Netherlands)

Meek, MF; Klok, F; Robinson, PH; Nicolai, JPA; Gramsbergen, A; van der Werf, J.F.A.

2003-01-01

Recovery of nerve function was evaluated after bridging a 15 mm sciatic nerve gap in 51 rats with a biodegradable poly(DL-lactide-epsilon-caprolactone) nerve guide. Recovery of function was investigated by analysing the footprints, by analysing video recordings of gait, by electrically eliciting the

Multiple Identified Neurons and Peripheral Nerves Innervating the Prothoracic Defense Glands in Stick Insects Reveal Evolutionary Conserved and Novel Elements of a Chemical Defense System

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Johannes Strauß

2017-11-01

Full Text Available The defense glands in the dorsal prothorax are an important autapomorphic trait of stick insects (Phasmatodea. Here, we study the functional anatomy and neuronal innervation of the defense glands in Anisomorpha paromalus (Westwood, 1859 (Pseudophasmatinae, a species which sprays its defense secretions when disturbed or attacked. We use a neuroanatomical approach to identify the nerves innervating the gland muscles and the motoneurons with axons in the different nerves. The defense gland is innervated by nerves originating from two segments, the subesophageal ganglion (SOG, and the prothoracic ganglion. Axonal tracing confirms the gland innervation via the anterior subesophageal nerve, and two intersegmental nerves, the posterior subesophageal nerve, and the anterior prothoracic nerve. Axonal tracing of individual nerves reveals eight identified neuron types in the subesophageal or prothoracic ganglion. The strongest innervating nerve of the gland is the anterior subesophageal nerve, which also supplies dorsal longitudinal thorax muscles (neck muscles by separate nerve branches. Tracing of individual nerve branches reveals different sets of motoneurons innervating the defense gland (one ipsilateral and one contralateral subesophageal neuron or the neck muscle (ventral median neurons. The ipsilateral and contralateral subesophageal neurons have no homologs in related taxa like locusts and crickets, and thus evolved within stick insects with the differentiation of the defense glands. The overall innervation pattern suggests that the longitudinal gland muscles derived from dorsal longitudinal neck muscles. In sum, the innervating nerves for dorsal longitudinal muscles are conserved in stick insects, while the neuronal control system was specialized with conserved motoneurons for the persisting neck muscles, and evolutionarily novel subesophageal and prothoracic motoneurons innervating the defense gland.

Overlapping sphincteroplasty and posterior repair.

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Crane, Andrea K; Myers, Erinn M; Lippmann, Quinn K; Matthews, Catherine A

2014-12-01

Knowledge of how to anatomically reconstruct extensive posterior-compartment defects is variable among gynecologists. The objective of this video is to demonstrate an effective technique of overlapping sphincteroplasty and posterior repair. In this video, a scripted storyboard was constructed that outlines the key surgical steps of a comprehensive posterior compartment repair: (1) surgical incision that permits access to posterior compartment and perineal body, (2) dissection of the rectovaginal space up to the level of the cervix, (3) plication of the rectovaginal muscularis, (4) repair of internal and external anal sphincters, and (5) reconstruction of the perineal body. Using a combination of graphic illustrations and live video footage, tips on repair are highlighted. The goals at the end of repair are to: (1) have improved vaginal caliber, (2) increase rectal tone along the entire posterior vaginal wall, (3) have the posterior vaginal wall at a perpendicular plane to the perineal body, (4) reform the hymenal ring, and (5) not have an overly elongated perineal body. This video provides a step-by-step guide on how to perform an overlapping sphincteroplasty and posterior repair.

The Use of Degradable Nerve Conduits for Human Nerve Repair: A Review of the Literature

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M. F. Meek

2005-01-01

Full Text Available The management of peripheral nerve injury continues to be a major clinical challenge. The most widely used technique for bridging defects in peripheral nerves is the use of autologous nerve grafts. This technique, however, has some disadvantages. Many alternative experimental techniques have thus been developed, such as degradable nerve conduits. Degradable nerve guides have been extensively studied in animal experimental studies. However, the repair of human nerves by degradable nerve conduits has been limited to only a few clinical studies. In this paper, an overview of the available international published literature on degradable nerve conduits for bridging human peripheral nerve defects is presented for literature available until 2004. Also, the philosophy on the use of nerve guides and nerve grafts is given.

[Glaucoma and optic nerve drusen: Limitations of optic nerve head OCT].

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Poli, M; Colange, J; Goutagny, B; Sellem, E

2017-09-01

Optic nerve head drusen are congenital calcium deposits located in the prelaminar section of the optic nerve head. Their association with visual field defects has been classically described, but the diagnosis of glaucoma is not easy in these cases of altered optic nerve head anatomy. We describe the case of a 67-year-old man with optic nerve head drusen complicated by glaucoma, which was confirmed by visual field and OCT examination of the peripapillary retinal nerve fiber layer (RNFL), but the measurement of the minimum distance between the Bruch membrane opening and the internal limiting membrane (minimum rim width, BMO-MRW) by OCT was normal. OCT of the BMO-MRW is a new diagnostic tool for glaucoma. Superficial optic nerve head drusen, which are found between the internal limiting membrane and the Bruch's membrane opening, overestimate the value of this parameter. BMO-MRW measurement is not adapted to cases of optic nerve head drusen and can cause false-negative results for this parameter, and the diagnosis of glaucoma in this case should be based on other parameters such as the presence of a fascicular defect in the retinal nerve fibers, RNFL or macular ganglion cell complex thinning, as well as visual field data. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Transient facial nerve palsy after occipital nerve block: a case report.

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Strauss, Lauren; Loder, Elizabeth; Rizzoli, Paul

2014-01-01

Occipital nerve blocks are commonly performed to treat a variety of headache syndromes and are generally believed to be safe and well tolerated. We report the case of an otherwise healthy 24-year-old woman with left side-locked occipital, parietal, and temporal pain who was diagnosed with probable occipital neuralgia. She developed complete left facial nerve palsy within minutes of blockade of the left greater and lesser occipital nerves with a solution of bupivicaine and triamcinolone. Magnetic resonance imaging of the brain with gadolinium contrast showed no abnormalities, and symptoms had completely resolved 4-5 hours later. Unintended spread of the anesthetic solution along tissue planes seems the most likely explanation for this adverse event. An aberrant course of the facial nerve or connections between the facial and occipital nerves also might have played a role, along with the patient's prone position and the use of a relatively large injection volume of a potent anesthetic. Clinicians should be aware that temporary facial nerve palsy is a possible complication of occipital nerve block. © 2014 American Headache Society.

142 Key words: Brachialis, radial nerve, musculocutaneous nerve.

African Journals Online (AJOL)

AWORI KIRSTEEN

The innervation of brachialis muscle by the musculocutaneous nerve has been described as either type I or type II and the main trunk to this muscle is rarely absent. The contribution .... brachialis muscle by fiber analysis of supply nerves].

Facial reanimation by muscle-nerve neurotization after facial nerve sacrifice. Case report.

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Taupin, A; Labbé, D; Babin, E; Fromager, G

2016-12-01

Recovering a certain degree of mimicry after sacrifice of the facial nerve is a clinically recognized finding. The authors report a case of hemifacial reanimation suggesting a phenomenon of neurotization from muscle-to-nerve. A woman benefited from a parotidectomy with sacrifice of the left facial nerve indicated for recurrent tumor in the gland. The distal branches of the facial nerve, isolated at the time of resection, were buried in the masseter muscle underneath. The patient recovered a voluntary hémifacial motricity. The electromyographic analysis of the motor activity of the zygomaticus major before and after block of the masseter nerve showed a dependence between mimic muscles and the masseter muscle. Several hypotheses have been advanced to explain the spontaneous reanimation of facial paralysis. The clinical case makes it possible to argue in favor of muscle-to-nerve neurotization from masseter muscle to distal branches of the facial nerve. It illustrates the quality of motricity that can be obtained thanks to this procedure. The authors describe a simple implantation technique of distal branches of the facial nerve in the masseter muscle during a radical parotidectomy with facial nerve sacrifice and recovery of resting tone but also a quality voluntary mimicry. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

The longitudinal epineural incision and complete nerve transection method for modeling sciatic nerve injury

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Xing-long Cheng

2015-01-01

Full Text Available Injury severity, operative technique and nerve regeneration are important factors to consider when constructing a model of peripheral nerve injury. Here, we present a novel peripheral nerve injury model and compare it with the complete sciatic nerve transection method. In the experimental group, under a microscope, a 3-mm longitudinal incision was made in the epineurium of the sciatic nerve to reveal the nerve fibers, which were then transected. The small, longitudinal incision in the epineurium was then sutured closed, requiring no stump anastomosis. In the control group, the sciatic nerve was completely transected, and the epineurium was repaired by anastomosis. At 2 and 4 weeks after surgery, Wallerian degeneration was observed in both groups. In the experimental group, at 8 and 12 weeks after surgery, distinct medullary nerve fibers and axons were observed in the injured sciatic nerve. Regular, dense myelin sheaths were visible, as well as some scarring. By 12 weeks, the myelin sheaths were normal and intact, and a tight lamellar structure was observed. Functionally, limb movement and nerve conduction recovered in the injured region between 4 and 12 weeks. The present results demonstrate that longitudinal epineural incision with nerve transection can stably replicate a model of Sunderland grade IV peripheral nerve injury. Compared with the complete sciatic nerve transection model, our method reduced the difficulties of micromanipulation and surgery time, and resulted in good stump restoration, nerve regeneration, and functional recovery.

An anatomical study of porcine peripheral nerve and its potential use in nerve tissue engineering

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Zilic, Leyla; Garner, Philippa E; Yu, Tong; Roman, Sabiniano; Haycock, John W; Wilshaw, Stacy-Paul

2015-01-01

Current nerve tissue engineering applications are adopting xenogeneic nerve tissue as potential nerve grafts to help aid nerve regeneration. However, there is little literature that describes the exact location, anatomy and physiology of these nerves to highlight their potential as a donor graft. The aim of this study was to identify and characterise the structural and extracellular matrix (ECM) components of porcine peripheral nerves in the hind leg. Methods included the dissection of porcine nerves, localisation, characterisation and quantification of the ECM components and identification of nerve cells. Results showed a noticeable variance between porcine and rat nerve (a commonly studied species) in terms of fascicle number. The study also revealed that when porcine peripheral nerves branch, a decrease in fascicle number and size was evident. Porcine ECM and nerve fascicles were found to be predominately comprised of collagen together with glycosaminoglycans, laminin and fibronectin. Immunolabelling for nerve growth factor receptor p75 also revealed the localisation of Schwann cells around and inside the fascicles. In conclusion, it is shown that porcine peripheral nerves possess a microstructure similar to that found in rat, and is not dissimilar to human. This finding could extend to the suggestion that due to the similarities in anatomy to human nerve, porcine nerves may have utility as a nerve graft providing guidance and support to regenerating axons. PMID:26200940

Microvascular Cranial Nerve Palsy

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... Español Eye Health / Eye Health A-Z Microvascular Cranial Nerve Palsy Sections What Is Microvascular Cranial Nerve Palsy? ... Microvascular Cranial Nerve Palsy Treatment What Is Microvascular Cranial Nerve Palsy? Leer en Español: ¿Qué es una parálisis ...

Engineering a multimodal nerve conduit for repair of injured peripheral nerve

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Quigley, A. F.; Bulluss, K. J.; Kyratzis, I. L. B.; Gilmore, K.; Mysore, T.; Schirmer, K. S. U.; Kennedy, E. L.; O'Shea, M.; Truong, Y. B.; Edwards, S. L.; Peeters, G.; Herwig, P.; Razal, J. M.; Campbell, T. E.; Lowes, K. N.; Higgins, M. J.; Moulton, S. E.; Murphy, M. A.; Cook, M. J.; Clark, G. M.; Wallace, G. G.; Kapsa, R. M. I.

2013-02-01

Injury to nerve tissue in the peripheral nervous system (PNS) results in long-term impairment of limb function, dysaesthesia and pain, often with associated psychological effects. Whilst minor injuries can be left to regenerate without intervention and short gaps up to 2 cm can be sutured, larger or more severe injuries commonly require autogenous nerve grafts harvested from elsewhere in the body (usually sensory nerves). Functional recovery is often suboptimal and associated with loss of sensation from the tissue innervated by the harvested nerve. The challenges that persist with nerve repair have resulted in development of nerve guides or conduits from non-neural biological tissues and various polymers to improve the prognosis for the repair of damaged nerves in the PNS. This study describes the design and fabrication of a multimodal controlled pore size nerve regeneration conduit using polylactic acid (PLA) and (PLA):poly(lactic-co-glycolic) acid (PLGA) fibers within a neurotrophin-enriched alginate hydrogel. The nerve repair conduit design consists of two types of PLGA fibers selected specifically for promotion of axonal outgrowth and Schwann cell growth (75:25 for axons; 85:15 for Schwann cells). These aligned fibers are contained within the lumen of a knitted PLA sheath coated with electrospun PLA nanofibers to control pore size. The PLGA guidance fibers within the nerve repair conduit lumen are supported within an alginate hydrogel impregnated with neurotrophic factors (NT-3 or BDNF with LIF, SMDF and MGF-1) to provide neuroprotection, stimulation of axonal growth and Schwann cell migration. The conduit was used to promote repair of transected sciatic nerve in rats over a period of 4 weeks. Over this period, it was observed that over-grooming and self-mutilation (autotomy) of the limb implanted with the conduit was significantly reduced in rats implanted with the full-configuration conduit compared to rats implanted with conduits containing only an alginate

Late-onset Alzheimer disease genetic variants in posterior cortical atrophy and posterior AD.

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Carrasquillo, Minerva M; Khan, Qurat ul Ain; Murray, Melissa E; Krishnan, Siddharth; Aakre, Jeremiah; Pankratz, V Shane; Nguyen, Thuy; Ma, Li; Bisceglio, Gina; Petersen, Ronald C; Younkin, Steven G; Dickson, Dennis W; Boeve, Bradley F; Graff-Radford, Neill R; Ertekin-Taner, Nilüfer

2014-04-22

To investigate association of genetic risk factors for late-onset Alzheimer disease (LOAD) with risk of posterior cortical atrophy (PCA), a syndrome of visual impairment with predominant Alzheimer disease (AD) pathology in posterior cortical regions, and with risk of "posterior AD" neuropathology. We assessed 81 participants with PCA diagnosed clinically and 54 with neuropathologic diagnosis of posterior AD vs 2,523 controls for association with 11 significant single nucleotide polymorphisms (SNPs) from published LOAD risk genome-wide association studies. There was highly significant association with APOE ε4 and increased risk of PCA (p = 0.0003, odds ratio [OR] = 3.17) and posterior AD (p = 1.11 × 10(-17), OR = 6.43). No other locus was significant after corrections for multiple testing, although rs11136000 near CLU (p = 0.019, OR = 0.60) and rs744373 near BIN1 (p = 0.025, OR = 1. 63) associated nominally significantly with posterior AD, and rs3851179 at the PICALM locus had significant association with PCA (p = 0.0003, OR = 2.84). ABCA7 locus SNP rs3764650, which was also tested under the recessive model because of Hardy-Weinberg disequilibrium, also had nominally significant association with PCA risk. The direction of association at APOE, CLU, and BIN1 loci was the same for participants with PCA and posterior AD. The effects for all SNPs, except rs3851179, were consistent with those for LOAD risk. We identified a significant effect for APOE and nominate CLU, BIN1, and ABCA7 as additional risk loci for PCA and posterior AD. Our findings suggest that at least some of the genetic risk factors for LOAD are shared with these atypical conditions and provide effect-size estimates for their future genetic studies.

International comparative evaluation of fixed-bearing non-posterior-stabilized and posterior-stabilized total knee replacements.

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Comfort, Thomas; Baste, Valborg; Froufe, Miquel Angel; Namba, Robert; Bordini, Barbara; Robertsson, Otto; Cafri, Guy; Paxton, Elizabeth; Sedrakyan, Art; Graves, Stephen

2014-12-17

Differences in survivorship of non-posterior-stabilized compared with posterior-stabilized knee designs carry substantial economic consequences, especially with limited health-care resources. However, these comparisons have often been made between relatively small groups of patients, often with short-term follow-up, with only small differences demonstrated between the groups. The goal of this study is to compare the outcomes of non-posterior-stabilized and posterior-stabilized total knee arthroplasties with use of a unique collaboration of multiple established knee arthroplasty registries. A distributed health data network was developed by the International Consortium of Orthopaedic Registries and was used in this study to reduce barriers to participation (such as security, propriety, legal, and privacy issues) compared with a centralized data warehouse approach. The study included only replacements in osteoarthritis patients who underwent total knee procedures involving fixed-bearing devices from 2001 to 2010. The outcome of interest was time to first revision. On average, not resurfacing showed a more harmful effect than resurfacing did when posterior-stabilized and non-posterior-stabilized knee replacements were compared, while the risk of revision for posterior-stabilized compared with non-posterior-stabilized knees was highest in year zero to one, followed by year one to two, years eight through ten, and years two through eight. Posterior-stabilized knees did significantly worse than non-posterior-stabilized knees did when the patella was not resurfaced. This difference was most pronounced in the first two years (year zero to one: hazard ratio [HR] = 2.15, 95% confidence interval [CI] = 1.56 to 2.95, p < 0.001; year one to two: HR = 1.61, 95% CI = 1.48 to 1.75, p < 0.001). When the patella was resurfaced, posterior-stabilized knees did significantly worse than non-posterior-stabilized knees did. This was again most pronounced in the first two years (year zero

Isolated optic nerve gliomas: a multicenter historical cohort study.

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Shofty, Ben; Ben-Sira, Liat; Kesler, Anat; Jallo, George; Groves, Mari L; Iyer, Rajiv R; Lassaletta, Alvaro; Tabori, Uri; Bouffet, Eric; Thomale, Ulrich-Wilhelm; Hernáiz Driever, Pablo; Constantini, Shlomi

2017-12-01

OBJECTIVE Isolated optic nerve gliomas (IONGs) constitute a rare subgroup of optic pathway gliomas (OPGs). Due to the rarity of this condition and the difficulty in differentiating IONGs from other types of OPGs in most clinical series, little is known about these tumors. Currently, due to lack of evidence, they are managed the same as any other OPG. METHODS The authors conducted a multicenter retrospective cohort study aimed at determining the natural history of IONGs. Included were patients with clear-cut glioma of the optic nerve without posterior (chiasmatic/hypothalamic) involvement. At least 1 year of follow-up, 2 MRI studies, and 2 neuro-ophthalmological examinations were required for inclusion. RESULTS Thirty-six patients with 39 tumors were included in this study. Age at diagnosis ranged between 6 months and 16 years (average 6 years). The mean follow-up time was 5.6 years. Twenty-five patients had neurofibromatosis Type 1. During the follow-up period, 59% of the tumors progressed, 23% remained stable, and 18% (all with neurofibromatosis Type 1) displayed some degree of spontaneous regression. Fifty-one percent of the patients presented with visual decline, of whom 90% experienced further deterioration. Nine patients were treated with chemotherapy, 5 of whom improved visually. Ten patients underwent operation, and no local or distal recurrence was noted. CONCLUSIONS Isolated optic nerve gliomas are highly dynamic tumors. Radiological progression and visual deterioration occur in greater percentages than in the general population of patients with OPGs. Response to chemotherapy may be better in this group, and its use should be considered early in the course of the disease.

Transfer of obturator nerve for femoral nerve injury: an experiment study in rats.

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Meng, Depeng; Zhou, Jun; Lin, Yaofa; Xie, Zheng; Chen, Huihao; Yu, Ronghua; Lin, Haodong; Hou, Chunlin

2018-07-01

Quadriceps palsy is mainly caused by proximal lesions in the femoral nerve. The obturator nerve has been previously used to repair the femoral nerve, although only a few reports have described the procedure, and the outcomes have varied. In the present study, we aimed to confirm the feasibility and effectiveness of this treatment in a rodent model using the randomized control method. Sixty Sprague-Dawley rats were randomized into two groups: the experimental group, wherein rats underwent femoral neurectomy and obturator nerve transfer to the femoral nerve motor branch; and the control group, wherein rats underwent femoral neurectomy without nerve transfer. Functional outcomes were measured using the BBB score, muscle mass, and histological assessment. At 12 and 16 weeks postoperatively, the rats in the experimental group exhibited recovery to a stronger stretch force of the knee and higher BBB score, as compared to the control group (p nerve with myelinated and unmyelinated fibers was observed in the experimental group. No significant differences were observed between groups at 8 weeks postoperatively (p > 0.05). Obturator nerve transfer for repairing femoral nerve injury was feasible and effective in a rat model, and can hence be considered as an option for the treatment of femoral nerve injury.

Wound and Sural Nerve Complications of the Sinus Tarsi Approach for Calcaneus Fractures.

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Li, Shaoliang

2018-05-01

Background The purpose of this study was to evaluate the optimal timing and measures of the sinus tarsi approach for calcaneus fractures to avoid iatrogenic injury of the sural nerve and to assess for wound complications. A case series of 53 patients with calcaneus fractures treated by a single surgeon with the sinus tarsi approach was retrospectively analyzed. On the basis of the delay time from injury to surgery, patients were classified into 4 groups: immediate (0-3 days), early (4-6 days), intermediate (7-14 days), and late (14-18 days). All patients were followed for at least 1 year to observe wound conditions. The rate of wound complications and iatrogenic sural nerve injury was described. Incisions were classified into 2 groups: group A included patients with incisions extending posterior to the lateral malleolus, and group B included patients with incisions confined anterior to the lateral malleolus. The rates of nerve injury were compared between both groups. Forty-three patients with 52 Sanders type II fractures were included. The average time to surgery from injury was 8.8 days (range, 0-18 days). The overall postoperative rate of wound complications was 5.8% (3 of 52). In the immediate group, deep infections and wound necrosis were found in 2 of 8 fractures (25%). In the early group, 1 of 15 fractures developed superficial infection (6.7%). In the intermediate and late groups, no wound complication was identified. Iatrogenic sural nerve injury was recorded in 5 of 52 patients (9.6%). Group A had 33% (4 of 12) nerve injuries and group B had 2.5% (1 of 40) ( P = .009). In 70% of cases, a main branch of the sural nerve was directly under the incision. The sinus tarsi approach was generally effective and safe for calcaneus fractures. However, it was relatively risky to perform open reduction and internal fixation by the sinus tarsi approach within 6 days of injury. Because the sural nerve is in the vicinity of the approach, iatrogenic injury should be

Enhanced peripheral nerve regeneration through asymmetrically porous nerve guide conduit with nerve growth factor gradient.

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Oh, Se Heang; Kang, Jun Goo; Kim, Tae Ho; Namgung, Uk; Song, Kyu Sang; Jeon, Byeong Hwa; Lee, Jin Ho

2018-01-01

In this study, we fabricated a nerve guide conduit (NGC) with nerve growth factor (NGF) gradient along the longitudinal direction by rolling a porous polycaprolactone membrane with NGF concentration gradient. The NGF immobilized on the membrane was continuously released for up to 35 days, and the released amount of the NGF from the membrane gradually increased from the proximal to distal NGF ends, which may allow a neurotrophic factor gradient in the tubular NGC for a sufficient period. From the in vitro cell culture experiment, it was observed that the PC12 cells sense the NGF concentration gradient on the membrane for the cell proliferation and differentiation. From the in vivo animal experiment using a long gap (20 mm) sciatic nerve defect model of rats, the NGC with NGF concentration gradient allowed more rapid nerve regeneration through the NGC than the NGC itself and NGC immobilized with uniformly distributed NGF. The NGC with NGF concentration gradient seems to be a promising strategy for the peripheral nerve regeneration. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 52-64, 2018. © 2017 Wiley Periodicals, Inc.

Primary nerve-sheath tumours of the trigeminal nerve: clinical and MRI findings

International Nuclear Information System (INIS)

Majoie, C.B.L.M.; Hulsmans, F.J.H.; Sie, L.H.; Castelijns, J.A.; Valk, J.; Walter, A.; Albrecht, K.W.

1999-01-01

We reviewed the clinical and MRI findings in primary nerve-sheath tumours of the trigeminal nerve. We retrospectively reviewed the medical records, imaging and histological specimens of 10 patients with 11 primary tumours of the trigeminal nerve. We assessed whether tumour site, size, morphology or signal characteristics were related to symptoms and signs or histological findings. Histological proof was available for 8 of 11 tumours: six schwannomas and two plexiform neurofibromas. The other three tumours were thought to be schwannomas, because they were present in patients with neurofibromatosis type 2 and followed the course of the trigeminal nerve. Uncommon MRI appearances were observed in three schwannomas and included a large intratumoral haemorrhage, a mainly low-signal appearance on T2-weighted images and a rim-enhancing, multicystic appearance. Only four of nine schwannomas caused trigeminal nerve symptoms, including two with large cystic components, one haemorrhagic and one solid tumor. Of the five schwannomas which did not cause any trigeminal nerve symptoms, two were large. Only one of the plexiform neurofibromas caused trigeminal nerve symptoms. Additional neurological symptoms and signs, not related to the trigeminal nerve, could be attributed to the location of the tumour in three patients. (orig.)

A case of reversible posterior leukoencephalopathy syndrome which developed during chemoradiotherapy for head and neck cancer. The involvement of bacterial translocation was considered

International Nuclear Information System (INIS)

Tachibana, Shinya; Terao, Hajime; Sanbe, Takeyuki; Katsuno, Masahiro; Takemura, Hideki

2007-01-01

Combination therapy such as chemotherapy and radiotherapy is often chosen, depending on the case, for head and neck cancer in view of the preservation of potency. However, on the other hand, it is necessary to note the onset of therapeutic side effects. The patient was a 35-year-old woman. During chemoradiotherapy for mesopharyngeal carcinoma, she suddenly developed shock and multiple organ failure, requiring intensive treatment. She also developed reversible central nerve symptoms during the course. The involvement of bacterial translocation was thought to be the cause of shock, and the reversible central nerve symptoms were considered to be a pathological condition, known as reversible posterior leukoencephalopathy syndrome. We discuss these conditions on the basis of the clinical features, and the process that led to diagnosis in this case. (author)

HIV Distal Neuropathic Pain Is Associated with Smaller Ventral Posterior Cingulate Cortex.

Science.gov (United States)

Keltner, John R; Connolly, Colm G; Vaida, Florin; Jenkinson, Mark; Fennema-Notestine, Christine; Archibald, Sarah; Akkari, Cherine; Schlein, Alexandra; Lee, Jisu; Wang, Dongzhe; Kim, Sung; Li, Han; Rennels, Austin; Miller, David J; Kesidis, George; Franklin, Donald R; Sanders, Chelsea; Corkran, Stephanie; Grant, Igor; Brown, Gregory G; Atkinson, J Hampton; Ellis, Ronald J

2017-03-01

. Despite modern antiretroviral therapy, HIV-associated neuropathy is one of the most prevalent, disabling and treatment-resistant complications of HIV disease. The presence and intensity of distal neuropathic pain is not fully explained by the degree of peripheral nerve damage. A better understanding of brain structure in HIV distal neuropathic pain may help explain why some patients with HIV neuropathy report pain while the majority does not. Previously, we reported that more intense distal neuropathic pain was associated with smaller total cerebral cortical gray matter volumes. The objective of this study was to determine which parts of the cortex are smaller. . HIV positive individuals with and without distal neuropathic pain enrolled in the multisite (N = 233) CNS HIV Antiretroviral Treatment Effects (CHARTER) study underwent structural brain magnetic resonance imaging. Voxel-based morphometry was used to investigate regional brain volumes in these structural brain images. . Left ventral posterior cingulate cortex was smaller for HIV positive individuals with versus without distal neuropathic pain (peak P  = 0.017; peak t = 5.15; MNI coordinates x = -6, y = -54, z = 20). Regional brain volumes within cortical gray matter structures typically associated with pain processing were also smaller for HIV positive individuals having higher intensity ratings of distal neuropathic pain. . The posterior cingulate is thought to be involved in inhibiting the perception of painful stimuli. Mechanistically a smaller posterior cingulate cortex structure may be related to reduced anti-nociception contributing to increased distal neuropathic pain. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Treatment of peroneal nerve injuries with simultaneous tendon transfer and nerve exploration.

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Ho, Bryant; Khan, Zubair; Switaj, Paul J; Ochenjele, George; Fuchs, Daniel; Dahl, William; Cederna, Paul; Kung, Theodore A; Kadakia, Anish R

2014-08-06

Common peroneal nerve palsy leading to foot drop is difficult to manage and has historically been treated with extended bracing with expectant waiting for return of nerve function. Peroneal nerve exploration has traditionally been avoided except in cases of known traumatic or iatrogenic injury, with tendon transfers being performed in a delayed fashion after exhausting conservative treatment. We present a new strategy for management of foot drop with nerve exploration and concomitant tendon transfer. We retrospectively reviewed a series of 12 patients with peroneal nerve palsies that were treated with tendon transfer from 2005 to 2011. Of these patients, seven were treated with simultaneous peroneal nerve exploration and repair at the time of tendon transfer. Patients with both nerve repair and tendon transfer had superior functional results with active dorsiflexion in all patients, compared to dorsiflexion in 40% of patients treated with tendon transfers alone. Additionally, 57% of patients treated with nerve repair and tendon transfer were able to achieve enough function to return to running, compared to 20% in patients with tendon transfer alone. No patient had full return of native motor function resulting in excessive dorsiflexion strength. The results of our limited case series for this rare condition indicate that simultaneous nerve repair and tendon transfer showed no detrimental results and may provide improved function over tendon transfer alone.

A STUDY OF TUMOURS OF THE CRANIAL NERVE AND PARASPINAL NERVE

Directory of Open Access Journals (Sweden)

Sudesh Shetty

2016-03-01

Full Text Available INTRODUCTION One of the frequent sites of tumour formation is the cranial nerves and paraspinal nerves. The cranial nerves perform a plethora of functions and so the signs and symptoms caused may be different. They are mainly classified into four different types. The aim of the study is: 1. To study the tumours arising from the cranial nerves in an epidemiological point of view. 2. To study the tumours histopathologically. 3. To classify the tumours according to WHO classification. Thirty-eight brain tumor cases were studied in the Department of Medicine, A. J. Shetty Institute of Medical Sciences, Mangalore. Cranial nerve tumours accounts for 4(10% among the intracranial tumours. Schwannomas makes up 3(7.39% among the Intracranial tumours. and constituted 3(75% among cranial nerve tumours. All the 3 schwannomas were located in CP angle. The geographic distribution of cases was found to be 28 cases from Mangalore and 10 cases from Kerala.

Posterior capsule opacification.

Science.gov (United States)

Wormstone, I Michael; Wang, Lixin; Liu, Christopher S C

2009-02-01

Posterior Capsule Opacification (PCO) is the most common complication of cataract surgery. At present the only means of treating cataract is by surgical intervention, and this initially restores high visual quality. Unfortunately, PCO develops in a significant proportion of patients to such an extent that a secondary loss of vision occurs. A modern cataract operation generates a capsular bag, which comprises a proportion of the anterior and the entire posterior capsule. The bag remains in situ, partitions the aqueous and vitreous humours, and in the majority of cases, houses an intraocular lens. The production of a capsular bag following surgery permits a free passage of light along the visual axis through the transparent intraocular lens and thin acellular posterior capsule. However, on the remaining anterior capsule, lens epithelial cells stubbornly reside despite enduring the rigours of surgical trauma. This resilient group of cells then begin to re-colonise the denuded regions of the anterior capsule, encroach onto the intraocular lens surface, occupy regions of the outer anterior capsule and most importantly of all begin to colonise the previously cell-free posterior capsule. Cells continue to divide, begin to cover the posterior capsule and can ultimately encroach on the visual axis resulting in changes to the matrix and cell organization that can give rise to light scatter. This review will describe the biological mechanisms driving PCO progression and discuss the influence of IOL design, surgical techniques and putative drug therapies in regulating the rate and severity of PCO.

Intramuscular myxoid lipoma in the proximal forearm presenting as an olecranon mass with superficial radial nerve palsy: a case report

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Hildebrand Kevin A

2011-07-01

Full Text Available Abstract Background Extremity lipomas may occur in any location, including the proximal forearm. We describe a case of a patient with an intramuscular lipoma presenting as an unusual posterior elbow mass. Case presentation We discuss the case of a 57-year-old Caucasian man who presented with a tender, posterior elbow mass initially diagnosed as chronic olecranon bursitis. A minor sensory disturbance in the distribution of the superficial radial nerve was initially thought to be unrelated, but was likely caused by mass effect from the lipoma. No pre-operative advanced imaging was obtained because the diagnosis was felt to have already been made. At the time of surgery, a fatty mass originating in the volar forearm muscles was found to have breached the dorsal forearm fascia and displaced the olecranon bursa. Tissue diagnosis was made by histopathology as a myxoid lipoma with no aggressive features. Post-operative recovery was uneventful. Conclusion We present a case of an unusual elbow mass presenting with symptoms consistent with chronic olecranon bursitis, a relatively common condition. The only unexplained pre-operative finding was the non-specific finding of a transient superficial radial nerve deficit. We remind clinicians to be cautious when diagnosing soft tissue masses in the extremities when unexplained physical findings are present.

Electrophysiology of Cranial Nerve Testing: Cranial Nerves IX and X.

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Martinez, Alberto R M; Martins, Melina P; Moreira, Ana Lucila; Martins, Carlos R; Kimaid, Paulo A T; França, Marcondes C

2018-01-01

The cranial nerves IX and X emerge from medulla oblongata and have motor, sensory, and parasympathetic functions. Some of these are amenable to neurophysiological assessment. It is often hard to separate the individual contribution of each nerve; in fact, some of the techniques are indeed a composite functional measure of both nerves. The main methods are the evaluation of the swallowing function (combined IX and X), laryngeal electromyogram (predominant motor vagal function), and heart rate variability (predominant parasympathetic vagal function). This review describes, therefore, the techniques that best evaluate the major symptoms presented in IX and X cranial nerve disturbance: dysphagia, dysphonia, and autonomic parasympathetic dysfunction.

Facial nerve paralysis and partial brachial plexopathy after epidural blood patch: a case report and review of the literature

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Radi Shahien

2011-02-01

Full Text Available Radi Shahien, Abdalla BowirratDepartment of Neurology, Ziv Medical Center, Zfat, IsraelAbstract: We report a complication related to epidural analgesia for delivery in a 24-year-old woman who was admitted with mild pre-eclampsia and for induction of labor. At the first postpartum day she developed a postdural puncture headache, which was unresponsive to conservative measures. On the fifth day an epidural blood patch was done, and her headache subsided. Sixteen hours later she developed paralysis of the right facial nerve, which was treated with prednisone. Seven days later she complained of pain in the left arm and the posterior region of the shoulder. She was later admitted and diagnosed with partial brachial plexopathy.Keywords: facial nerve paralysis, partial brachial plexopathy, epidural blood patch

Phrenic nerve transfer to the musculocutaneous nerve for the repair of brachial plexus injury: electrophysiological characteristics

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Ying Liu

2015-01-01

Full Text Available Phrenic nerve transfer is a major dynamic treatment used to repair brachial plexus root avulsion. We analyzed 72 relevant articles on phrenic nerve transfer to repair injured brachial plexus that were indexed by Science Citation Index. The keywords searched were brachial plexus injury, phrenic nerve, repair, surgery, protection, nerve transfer, and nerve graft. In addition, we performed neurophysiological analysis of the preoperative condition and prognosis of 10 patients undergoing ipsilateral phrenic nerve transfer to the musculocutaneous nerve in our hospital from 2008 to 201 3 and observed the electromyograms of the biceps brachii and motor conduction function of the musculocutaneous nerve. Clinically, approximately 28% of patients had brachial plexus injury combined with phrenic nerve injury, and injured phrenic nerve cannot be used as a nerve graft. After phrenic nerve transfer to the musculocutaneous nerve, the regenerated potentials first appeared at 3 months. Recovery of motor unit action potential occurred 6 months later and became more apparent at 12 months. The percent of patients recovering ′excellent′ and ′good′ muscle strength in the biceps brachii was 80% after 18 months. At 12 months after surgery, motor nerve conduction potential appeared in the musculocutaneous nerve in seven cases. These data suggest that preoperative evaluation of phrenic nerve function may help identify the most appropriate nerve graft in patients with an injured brachial plexus. The functional recovery of a transplanted nerve can be dynamically observed after the surgery.

Phrenic nerve transfer to the musculocutaneous nerve for the repair of brachial plexus injury: electrophysiological characteristics.

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Liu, Ying; Xu, Xun-Cheng; Zou, Yi; Li, Su-Rong; Zhang, Bin; Wang, Yue

2015-02-01

Phrenic nerve transfer is a major dynamic treatment used to repair brachial plexus root avulsion. We analyzed 72 relevant articles on phrenic nerve transfer to repair injured brachial plexus that were indexed by Science Citation Index. The keywords searched were brachial plexus injury, phrenic nerve, repair, surgery, protection, nerve transfer, and nerve graft. In addition, we performed neurophysiological analysis of the preoperative condition and prognosis of 10 patients undergoing ipsilateral phrenic nerve transfer to the musculocutaneous nerve in our hospital from 2008 to 201 3 and observed the electromyograms of the biceps brachii and motor conduction function of the musculocutaneous nerve. Clinically, approximately 28% of patients had brachial plexus injury combined with phrenic nerve injury, and injured phrenic nerve cannot be used as a nerve graft. After phrenic nerve transfer to the musculocutaneous nerve, the regenerated potentials first appeared at 3 months. Recovery of motor unit action potential occurred 6 months later and became more apparent at 12 months. The percent of patients recovering 'excellent' and 'good' muscle strength in the biceps brachii was 80% after 18 months. At 12 months after surgery, motor nerve conduction potential appeared in the musculocutaneous nerve in seven cases. These data suggest that preoperative evaluation of phrenic nerve function may help identify the most appropriate nerve graft in patients with an injured brachial plexus. The functional recovery of a transplanted nerve can be dynamically observed after the surgery.

Motor branches of the ulnar nerve to the forearm: an anatomical study and guidelines for selective neurectomy.

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Paulos, Renata; Leclercq, Caroline

2015-11-01

Precise knowledge of motor nerve branches is critical to plan selective neurectomies for the treatment of spastic limbs. Our objective is to describe the muscular branching pattern of the ulnar nerve in the forearm and suggest an ideal surgical approach for selective neurectomy of the flexor carpi ulnaris. The ulnar nerve was dissected under loop magnification in 20 upper limbs of fresh frozen cadavers and its branches to the flexor carpi ulnaris muscle (FCU) and to the flexor digitorum profundus muscle (FDP) were quantified. We measured their diameter, length and distance between their origin and the medial epicondyle. The point where the ulnar artery joined the nerve was observed. The position in which the ulnar nerve gave off each branch was noted (ulnar, posterior or radial) and the Martin-Gruber connection, when present, had its origin observed and its diameter measured. The ulnar nerve gave off two to five muscular branches, among which, one to four to the FCU and one or two to the FDP. In all cases, the first branch was to the FCU. It arose on average 1.4 cm distal to the epicondyle, but in four specimens it arose above or at the level of the medial epicondyle (2.0 cm above in one case, 1.5 cm above in two cases, and at the level of the medial epicondyle in one). The first branch to the FDP arose on average 5.0 cm distal to the medial epicondyle. All the branches to FDP but one arose from the radial aspect of the ulnar nerve. A Martin-Gruber connection was present in nine cases. All motor branches arose in the proximal half of the forearm and the ulnar nerve did not give off branches distal to the point where it was joined by the ulnar artery. The number of motor branches of the ulnar nerve to the FCU varies from 2 to 4. An ideal approach for selective neurectomy of the FCU should start 4 cm above the medial epicondyle, and extend distally to 50% of the length of the forearm or just to the point where the ulnar artery joins the nerve.

An update-tissue engineered nerve grafts for the repair of peripheral nerve injuries.

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Patel, Nitesh P; Lyon, Kristopher A; Huang, Jason H

2018-05-01

Peripheral nerve injuries (PNI) are caused by a range of etiologies and result in a broad spectrum of disability. While nerve autografts are the current gold standard for the reconstruction of extensive nerve damage, the limited supply of autologous nerve and complications associated with harvesting nerve from a second surgical site has driven groups from multiple disciplines, including biomedical engineering, neurosurgery, plastic surgery, and orthopedic surgery, to develop a suitable or superior alternative to autografting. Over the last couple of decades, various types of scaffolds, such as acellular nerve grafts (ANGs), nerve guidance conduits, and non-nervous tissues, have been filled with Schwann cells, stem cells, and/or neurotrophic factors to develop tissue engineered nerve grafts (TENGs). Although these have shown promising effects on peripheral nerve regeneration in experimental models, the autograft has remained the gold standard for large nerve gaps. This review provides a discussion of recent advances in the development of TENGs and their efficacy in experimental models. Specifically, TENGs have been enhanced via incorporation of genetically engineered cells, methods to improve stem cell survival and differentiation, optimized delivery of neurotrophic factors via drug delivery systems (DDS), co-administration of platelet-rich plasma (PRP), and pretreatment with chondroitinase ABC (Ch-ABC). Other notable advancements include conduits that have been bioengineered to mimic native nerve structure via cell-derived extracellular matrix (ECM) deposition, and the development of transplantable living nervous tissue constructs from rat and human dorsal root ganglia (DRG) neurons. Grafts composed of non-nervous tissues, such as vein, artery, and muscle, will be briefly discussed.

Silk fibroin enhances peripheral nerve regeneration by improving vascularization within nerve conduits.

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Wang, Chunyang; Jia, Yachao; Yang, Weichao; Zhang, Cheng; Zhang, Kuihua; Chai, Yimin

2018-07-01

Silk fibroin (SF)-based nerve conduits have been widely used to bridge peripheral nerve defects. Our previous study showed that nerve regeneration in a SF-blended poly (l-lactide-co-ɛ-caprolactone) [P(LLA-CL)] nerve conduit is better than that in a P(LLA-CL) conduit. However, the involved mechanisms remain unclarified. Because angiogenesis within a nerve conduit plays an important role in nerve regeneration, vascularization of SF/P(LLA-CL) and P(LLA-CL) conduits was compared both in vitro and in vivo. In the present study, we observed that SF/P(LLA-CL) nanofibers significantly promoted fibroblast proliferation, and vascular endothelial growth factor secreted by fibroblasts seeded in SF/P(LLA-CL) nanofibers was more than seven-fold higher than that in P(LLA-CL) nanofibers. Conditioned medium of fibroblasts in the SF/P(LLA-CL) group stimulated more human umbilical vein endothelial cells (HUVEC) to form capillary-like networks and promoted faster HUVEC migration. The two kinds of nerve conduits were used to bridge 10-mm-length nerve defects in rats. At 3 weeks of reparation, the blood vessel area in the SF/P(LLA-CL) group was significantly larger than that in the P(LLA-CL) group. More regenerated axons and Schwann cells were also observed in the SF/P(LLA-CL) group, which was consistent with the results of blood vessels. Collectively, our data revealed that the SF/P(LLA-CL) nerve conduit enhances peripheral nerve regeneration by improving angiogenesis within the conduit. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 2070-2077, 2018. © 2018 Wiley Periodicals, Inc.

Pre-differentiation of mesenchymal stromal cells in combination with a microstructured nerve guide supports peripheral nerve regeneration in the rat sciatic nerve model.

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Boecker, Arne Hendrik; van Neerven, Sabien Geraldine Antonia; Scheffel, Juliane; Tank, Julian; Altinova, Haktan; Seidensticker, Katrin; Deumens, Ronald; Tolba, Rene; Weis, Joachim; Brook, Gary Anthony; Pallua, Norbert; Bozkurt, Ahmet

2016-02-01

Many bioartificial nerve guides have been investigated pre-clinically for their nerve regeneration-supporting function, often in comparison to autologous nerve transplantation, which is still regarded as the current clinical gold standard. Enrichment of these scaffolds with cells intended to support axonal regeneration has been explored as a strategy to boost axonal regeneration across these nerve guides Ansselin et al. (1998). In the present study, 20 mm rat sciatic nerve defects were implanted with a cell-seeded microstructured collagen nerve guide (Perimaix) or an autologous nerve graft. Under the influence of seeded, pre-differentiated mesenchymal stromal cells, axons regenerated well into the Perimaix nerve guide. Myelination-related parameters, like myelin sheath thickness, benefitted from an additional seeding with pre-differentiated mesenchymal stromal cells. Furthermore, both the number of retrogradely labelled sensory neurons and the axon density within the implant were elevated in the cell-seeded scaffold group with pre-differentiated mesenchymal stromal cells. However, a pre-differentiation had no influence on functional recovery. An additional cell seeding of the Perimaix nerve guide with mesenchymal stromal cells led to an extent of functional recovery, independent of the differentiation status, similar to autologous nerve transplantation. These findings encourage further investigations on pre-differentiated mesenchymal stromal cells as a cellular support for peripheral nerve regeneration. © 2015 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

Should we routinely expose recurrent laryngeal nerve(s) during thyroid surgery

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Ahmed, M.; Aurangzeb, A.; Rashid, A.Z.; Qureshi, M.A.; Iqbal, N.; Boota, M.; Ashfaq, M.

2013-01-01

Objective: To compare the frequency of recurrent laryngeal nerve(s) (RLNs) palsy after various thyroid procedures with and without identification of recurrent laryngeal nerve during the operation. Study Design: Randomized controlled trial. Place and Duration of Study: Department of Surgery, Military Hospital, Rawalpindi, from August 2008 to April 2010. Methodology: Patients undergoing indirect laryngoscopy with normal vocal cords and those with carcinoma and re-do surgery having normal vocal cord were included in the study. Patients with hoarseness of voice, abnormal vocal cord movements and with solitary nodule in the isthmus were excluded. These patients were randomly divided into 2 groups of 50 each using random number tables. RLN was identified by exposing the inferior thyroid artery and traced along its entire course in group-A. Whereas, in group-B, nerves were not identified during the operations. Immediate postoperative direct laryngoscopy was performed by a surgeon with the help of an anaesthesiologist for the assessment of vocal cords. Patients with persistent hoarseness of voice were followed-up with indirect laryngoscopy at 3 and 6 months. Results: Temporary unilateral recurrent laryngeal nerve palsies occurred in 2 (4%) patients in group-A where the voice and cord movements returned to normal in 6 months. In group-B, it occurred in 8 (16%) patients, 2 bilateral (4%) injuries requiring tracheostomy and 6 unilateral injuries (12%). Among the 2 bilateral recurrent laryngeal nerve injuries, the tracheostomy was removed in one case after 6 months with persistent hoarseness of voice but no respiratory difficulty during routine activities. Tracheostomy was permanent in the other case. Among the 6 cases of unilateral nerve injuries, the voice improved considerably in 4 cases within 6 months but in 2 cases hoarseness persisted even after 6 months. Frequency of recurrent laryngeal nerve palsies was significantly lower in group-A as compared to group-B (p = 0

Intraoperative cranial nerve monitoring.

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Harper, C Michel

2004-03-01

The purpose of intraoperative monitoring is to preserve function and prevent injury to the nervous system at a time when clinical examination is not possible. Cranial nerves are delicate structures and are susceptible to damage by mechanical trauma or ischemia during intracranial and extracranial surgery. A number of reliable electrodiagnostic techniques, including nerve conduction studies, electromyography, and the recording of evoked potentials have been adapted to the study of cranial nerve function during surgery. A growing body of evidence supports the utility of intraoperative monitoring of cranial nerve nerves during selected surgical procedures.

Short-term observations of the regenerative potential of injured proximal sensory nerves crossed with distal motor nerves

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Xiu-xiu Zhang

2017-01-01

Full Text Available Motor nerves and sensory nerves conduct signals in different directions and function in different ways. In the surgical treatment of peripheral nerve injuries, the best prognosis is obtained by keeping the motor and sensory nerves separated and repairing the nerves using the suture method. However, the clinical consequences of connections between sensory and motor nerves currently remain unknown. In this study, we analyzed the anatomical structure of the rat femoral nerve, and observed the motor and sensory branches of the femoral nerve in the quadriceps femoris. After ligation of the nerves, the proximal end of the sensory nerve was connected with the distal end of the motor nerve, followed by observation of the changes in the newly-formed regenerated nerve fibers. Acetylcholinesterase staining was used to distinguish between the myelinated and unmyelinated motor and sensory nerves. Denervated muscle and newly formed nerves were compared in terms of morphology, electrophysiology and histochemistry. At 8 weeks after connection, no motor nerve fibers were observed on either side of the nerve conduit and the number of nerve fibers increased at the proximal end. The proportion of newly-formed motor and sensory fibers was different on both sides of the conduit. The area occupied by autonomic nerves in the proximal regenerative nerve was limited, but no distinct myelin sheath was visible in the distal nerve. These results confirm that sensory and motor nerves cannot be effectively connected. Moreover, the change of target organ at the distal end affects the type of nerves at the proximal end.

Adult Stem Cell Based Enhancement of Nerve Conduit for Peripheral Nerve Repair

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2016-10-01

accompanied by injuries to peripheral nerves; if not repaired, the trauma can lead to significant dysfunction and disability . While nerves have the ability to...recovery, minimized disability , and increased quality of life for our wounded warriors. 2. KEYWORDS: Stem Cell, Nerve Conduit, Peripheral Nerve...would be a paradigm shift away from ordering X-rays at 10-12 weeks and only ordering a CT scan. It has the potential to change the standard of care

Selective recurrent laryngeal nerve stimulation using a penetrating electrode array in the feline model.

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Haidar, Yarah M; Sahyouni, Ronald; Moshtaghi, Omid; Wang, Beverly Y; Djalilian, Hamid R; Middlebrooks, John C; Verma, Sunil P; Lin, Harrison W

2017-10-31

Laryngeal muscles (LMs) are controlled by the recurrent laryngeal nerve (RLN), injury of which can result in vocal fold (VF) paralysis (VFP). We aimed to introduce a bioelectric approach to selective stimulation of LMs and graded muscle contraction responses. Acute experiments in cats. The study included six anesthetized cats. In four cats, a multichannel penetrating microelectrode array (MEA) was placed into an uninjured RLN. For RLN injury experiments, one cat received a standardized hemostat-crush injury, and one cat received a transection-reapproximation injury 4 months prior to testing. In each experiment, three LMs (thyroarytenoid, posterior cricoarytenoid, and cricothyroid muscles) were monitored with an electromyographic (EMG) nerve integrity monitoring system. Electrical current pulses were delivered to each stimulating channel individually. Elicited EMG voltage outputs were recorded for each muscle. Direct videolaryngoscopy was performed for visualization of VF movement. Stimulation through individual channels led to selective activation of restricted nerve populations, resulting in selective contraction of individual LMs. Increasing current levels resulted in rising EMG voltage responses. Typically, activation of individual muscles was successfully achieved via single placement of the MEA by selection of appropriate stimulation channels. VF abduction was predominantly observed on videolaryngoscopy. Nerve histology confirmed injury in cases of RLN crush and transection experiments. We demonstrated the ability of a penetrating MEA to selectively stimulate restricted fiber populations within the feline RLN and selectively elicit contractions of discrete LMs in both acute and injury-model experiments, suggesting a potential role for intraneural MEA implantation in VFP management. NA Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Sectional anatomy aid for improvement of decompression surgery approach to vertical segment of facial nerve.

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Feng, Yan; Zhang, Yi Qun; Liu, Min; Jin, Limin; Huangfu, Mingmei; Liu, Zhenyu; Hua, Peiyan; Liu, Yulong; Hou, Ruida; Sun, Yu; Li, You Qiong; Wang, Yu Fa; Feng, Jia Chun

2012-05-01

The aim of this study was to find a surgical approach to a vertical segment of the facial nerve (VFN) with a relatively wide visual field and small lesion by studying the location and structure of VFN with cross-sectional anatomy. High-resolution spiral computed tomographic multiplane reformation was used to reform images that were parallel to the Frankfort horizontal plane. To locate the VFN, we measured the distances as follows: from the VFN to the paries posterior bony external acoustic meatus on 5 typical multiplane reformation images, to the promontorium tympani and the root of the tympanic ring on 2 typical images. The mean distances from the VFN to the paries posterior bony external acoustic meatus are as follows: 4.47 mm on images showing the top of the external acoustic meatus, 4.20 mm on images with the best view of the window niche, 3.35 mm on images that show the widest external acoustic meatus, 4.22 mm on images with the inferior margin of the sulcus tympanicus, and 5.49 mm on images that show the bottom of the external acoustic meatus. The VFN is approximately 4.20 mm lateral to the promontorium tympani on images with the best view of the window niche and 4.12 mm lateral to the root of the tympanic ring on images with the inferior margin of the sulcus tympanicus. The other results indicate that the area and depth of the surgical wound from the improved approach would be much smaller than that from the typical approach. The surgical approach to the horizontal segment of the facial nerve through the external acoustic meatus and the tympanic cavity could be improved by grinding off the external acoustic meatus to show the VFN. The VFN can be found by taking the promontorium tympani and tympanic ring as references. This improvement is of high potential to expand the visual field to the facial nerve, remarkably without significant injury to the patients compared with the typical approach through the mastoid process.

Posterior Urethral Valves

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Steve J. Hodges

2009-01-01

Full Text Available The most common cause of lower urinary tract obstruction in male infants is posterior urethral valves. Although the incidence has remained stable, the neonatal mortality for this disorder has improved due to early diagnosis and intensive neonatal care, thanks in part to the widespread use of prenatal ultrasound evaluations. In fact, the most common reason for the diagnosis of posterior urethral valves presently is the evaluation of infants for prenatal hydronephrosis. Since these children are often diagnosed early, the urethral obstruction can be alleviated rapidly through catheter insertion and eventual surgery, and their metabolic derangements can be normalized without delay, avoiding preventable infant mortality. Of the children that survive, however, early diagnosis has not had much effect on their long-term prognosis, as 30% still develop renal insufficiency before adolescence. A better understanding of the exact cause of the congenital obstruction of the male posterior urethra, prevention of postnatal bladder and renal injury, and the development of safe methods to treat urethral obstruction prenatally (and thereby avoiding the bladder and renal damage due to obstructive uropathy are the goals for the care of children with posterior urethral valves[1].

Microsurgical reconstruction of large nerve defects using autologous nerve grafts.

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Daoutis, N K; Gerostathopoulos, N E; Efstathopoulos, D G; Misitizis, D P; Bouchlis, G N; Anagnostou, S K

1994-01-01

Between 1986 and 1993, 643 patients with peripheral nerve trauma were treated in our clinic. Primary neurorraphy was performed in 431 of these patients and nerve grafting in 212 patients. We present the functional results after nerve grafting in 93 patients with large nerve defects who were followed for more than 2 years. Evaluation of function was based on the Medical Research Council (MRC) classification for motor and sensory recovery. Factors affecting functional outcome, such as age of the patient, denervation time, length of the defect, and level of the injury were noted. Good results according to the MRC classification were obtained in the majority of cases, although function remained less than that of the uninjured side.

Gradual nerve elongation affects nerve cell bodies and neuro-muscular junctions.

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Kazuo Ikeda, K I; Masaki Matsuda, M M; Daisuke Yamauchi, D Y; Katsuro Tomita, K T; Shigenori Tanaka, S T

2005-07-01

The purpose of this study is to clarify the reactions of the neuro-muscular junction and nerve cell body to gradual nerve elongation. The sciatic nerves of Japanese white rabbits were lengthened by 30 mm in increments of 0.8 mm/day, 2.0 mm/day and 4.0 mm/day. A scanning electron microscopic examination showed no degenerative change at the neuro-muscular junction, even eight weeks after elongation in the 4-mm group. Hence, neuro-muscular junction is not critical for predicting damage from gradual nerve elongation. There were no axon reaction cells in the 0.8-mm group, a small amount in the 2-mm group, and a large amount in the 4-mm group. The rate of growth associated protein-43 positive nerve cells was significant in the 4-mm group. Hence, the safe speed for nerve cells appeared to be 0.8-mm/day, critical speed to be 2.0-mm/day, and dangerous speed to be 4.0-mm/day in this elongation model.

Anatomical etiology of “pseudo-sciatica” from superior cluneal nerve entrapment: a laboratory investigation

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Konno T

2017-11-01

Full Text Available Tomoyuki Konno,1 Yoichi Aota,2 Hiroshi Kuniya,1 Tomoyuki Saito,1 Ning Qu,3 Shogo Hayashi,3 Shinichi Kawata,3 Masahiro Itoh3 1Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, 2Department of Spine & Spinal Cord Surgery, Yokohama Brain and Spine Center, Yokohama, 3Department of Anatomy, Tokyo Medical University, Tokyo, Japan Objective: The superior cluneal nerve (SCN may become entrapped where it pierces the thoracolumbar fascia over the iliac crest; this can cause low back pain (LBP and referred pain radiating into the posterior thigh, calf, and occasionally the foot, producing the condition known as “pseudo-sciatica.” Because the SCN was thought to be a cutaneous branch of the lumbar dorsal rami, originating from the dorsal roots of L1–L3, previous anatomical studies failed to explain why SCN causes “pseudo-sciatica”. The purpose of the present anatomical study was to better elucidate the anatomy and improve the understanding of “pseudo-sciatica” from SCN entrapment. Materials and methods: SCN branches were dissected from their origin to termination in subcutaneous tissue in 16 cadavers (5 male and 11 female with a mean death age of 88 years (range 81–101 years. Special attention was paid to identify SCNs from their emergence from nerve roots and passage through the fascial attachment to the iliac crest. Results: Eighty-one SCN branches were identified originating from T12 to L5 nerve roots with 13 branches passing through the osteofibrous tunnel. These 13 branches originated from L3 (two sides, L4 (six sides, and L5 (five sides. Ten of the 13 branches showed macroscopic entrapment in the tunnel. Conclusion: The majority of SCNs at risk of nerve entrapment originated from the lower lumbar nerve. These anatomical results may explain why patients with SCN entrapment often evince leg pain or tingling that mimics sciatica. Keywords: superior cluneal nerve, entrapment neuropathy, dorsal rami

Ossification of the Interosseous Membrane of the Leg in a Football Player: Case Report and Review of the Literature

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Roberto Postacchini

2016-01-01

Full Text Available Introduction. We report a case of ossification of the interosseous membrane (OIM of the leg in a football player who had no history of severe local traumas. A review of the literature of the OIM of the leg in athletes was also carried out. Case Report. A 38-year-old Caucasian male patient complained of pain on lateral aspect of the leg when playing football. Pain progressively worsened until he had to stop the sporting activity. Radiographs, and then CT and MRI, showed OIM in the middle third of the left leg. MRI showed inflammation of tibia periosteum and bone adjacent to the ossification, which was then excised. Two months after surgery the patient returned to play football. Conclusion. A thorough analysis of the literature revealed three types of OIM of the leg in athletes. Type I usually occurs after a syndesmosis ankle sprain, Type II appears to result from a tibia fracture, and Type III, of which only one fully recorded case has been published, is probably caused, as in our patient, by repetitive minor traumas to the leg. Awareness of the existence of Type III OIM can avoid erroneous diagnoses leading to useless investigations and treatments.

Comparison of percutaneous electrical nerve stimulation and ultrasound imaging for nerve localization

NARCIS (Netherlands)

Wegener, J. T.; Boender, Z. J.; Preckel, B.; Hollmann, M. W.; Stevens, M. F.

2011-01-01

Background. Percutaneous nerve stimulation (PNS) is a non-invasive technique to localize superficial nerves before performing peripheral nerve blocks, but its precision has never been evaluated by high-resolution ultrasound. This study compared stimulating points at the skin with the position of