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phrenic nerve transfer to the musculocutaneous nerve for the repair of brachial plexus injury: electrophysiological characteristics

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Neural Regeneration Research 2015年第2期10卷 328-333页

作者： Ying Liu Xun-cheng Xu Yi Zou Su-rong Li Bin Zhang Yue Wang Department of Neurology Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital Department of Orthopedics Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital

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 per-formed 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 conduc-tion 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 regener-ated potentials ifrst 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 ‘ex-cellent’ 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 func-tional recovery of a transplanted nerve can be dynamically observed after the surgery.

关键词： nerve regeneration phrenic nerve brachial plexus injury nerve transfer nerve repair musculocutaneous nerve nerve function test bibliometrics neural regeneration

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phrenic nerve displacement by intrapericardial balloon inflation during epicardial ablation of ventricular tachycardia: Four case reports

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World Journal of Cardiology 2020年第1期12卷 55-66页

作者： Sergio Conti Vito Bonomo Antonio Taormina Umberto Giordano Giuseppe Sgarito Department of Cardiology ElectrophysiologyPalermo 90127Italy Faculty of Medicine University of Tor VergataRome 00133Italy Department of Cardiology University of PalermoPalermo 90127Italy Department of Cardiology University of MessinaMessina 98122Italy

BACKGROUND phrenic nerve(PN)injury is one of the recognized possible complications following epicardial ablation of ventricular tachycardia(VT).High-output pacing is a widely used maneuver to establish a relationship between the PN and the ablation catheter tip.An absence of PN capture is usually considered an indication that it is safe to ablate,and that successful ablation may be performed at adjacent sites.However,PN capture may impact the procedural outcome.Only a few cases have been reported in the literature that avoid PN injury by using different techniques.CASE SUMMARY Three patients with a previous history of myocarditis and one patient with ischemic cardiomyopathy underwent epicardial ablation for drug-refractory VT.Before the procedure,transthoracic echocardiogram,coronary angiogram,and cardiac magnetic resonance imaging were performed on all patients.Under general anesthesia,endo/epicardial three-dimensional anatomical and substrate maps of the left ventricle were accomplished.Before radiofrequency delivery,the course of the PN was identified by provoking diaphragmatic stimulation with high-output pacing from the distal electrode of the ablation catheter.In every case,a scar region with late potentials was mapped along the PN course.After obtaining another epicardial access,a second introducer sheath was placed,and a vascular balloon catheter was inserted into the epicardial space and inflated with saline solution to separate the PN from the epicardium.Once the absence of PN capture had been proven,radiofrequency was applied to aim for complete late potential elimination and avoid VT induction.CONCLUSION PN injury can occur as one of the complications following epicardial VT ablation procedures,and may prevent successful ablation of these arrhythmias.PN displacement by using large balloon catheters into the epicardial space seems to be feasible and reproducible,avoid procedure-related morbidity,and improve ablation success when performed in selected centers and by experienced operators.

关键词： Catheter ablation Epicardial access Myocarditis Nonischemic cardiomyopathy Ventricular tachycardia phrenic nerve Case series

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Image features of two rare mediastinal tumors: schwannoma of intrathoracic phrenic nerve and clear cell chondrosarcoma of the rib

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Chinese Medical Journal 2005年第17期118卷 1493-1496页

作者： Ting-Kai Leung Chien-Jui Cheng Chi-Ming Lee Li-Kuo Shen Hung-Jung Wang Ya-Yen Chen Diagnostic Radiology Department of Taipei Medical University Hospital Taipei Medical University Taipei China Pathology Department of Taipei Medical University Hospital Taipei Medical University Taipei China

The current report focuses on two patients of the same age who presented similar appearances on initial anteroposterior chest images. Follow-up images showed superoanterior and superoposterior mediastinal lesions. The first patient with noninvasive cystic thymoma was suspected before surgery, while the pathologic diagnosis was intrathoracic phrenic nerve schwannoma. The second patient was with an asymmetric, dumbbell-shaped paravertebral tumor over T3 and T4 on the left side. The preoperative diagnostic images were interpreted as showing a neurogenic tumor. However, the pathologic report was cell chondrosarcoma.

关键词： mediastinal tumors schwannoma phrenic nerve clear cell chondrosarcoma

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Character of diaphragm compound muscle action potential and phrenic nerve conduction time in patients with obstructive sleep apnea-hypopnea syndrome

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Neural Regeneration Research 2008年第5期3卷 533-537页

作者： Yuhong HOU Rongchang Chen Jinbing Pan Yuanming Luo Nanshan Zhong Department of Emergency the First Affiliated Hospital Zhengzhou University Zhengzhou 450052 Henan Province China Guangzhou Institute of Respiratory Disease First Affiliated Hospital Guangzhou Medical College Guangzhou 510120 Guangdong Province China Department of Respiratory Medicine Henan Provincial Hospital Zhengzhou 450003 Henan Province China

BACKGROUND： Both hypoxia and.carbon dioxide retention can damage phrenic nerve and muscle conduction, as well as diaphragm function. Diaphragm compound muscle action potential and phrenic nerve conduction time are reliable indicators for measuring phrenic nerve and diaphragm function. OBJECTIVES： To verify the hypothesis that changes of phrenic nerve conduction time （PNCT） and diaphragm compound muscle action potential （CMAP） in obstructive sleep apnea-hypopnea syndrome （OSAHS） patients might contribute to the decline of phrenic nerve and diaphragm function. PNCT and CMAP were measured with multipair esophageal electrodes combined with unilateral magnetic stimulation. DESIGN, TIME AND SETTING： Case controlled study. The experiment was carried out in Guangzhou Institute of Respiratory Disease, Guangzhou MediCal College, from June 2005 to April 2006. PARTICIPANTS： Twenty seven OSAHS patients and eight primary snoring subjects from Guangzhou Institute of Respiratory Disease, Guangzhou Medical College were recruited and all subjects were diagnosed by polysomnography （PSG）. Sixteen healthy, non-snoring subjects in the hospital for medical examination during the same time period were selected as the control group. METHODS： Esophageal electrodes, made by Guangzhou Institute of Respiratory Disease, combined with unilateral magnetic stimulation, were used to measure PNCT and CMAP of all subjects. PNCT was defined as the time from stimulation artifact to the onset of CMAP and diaphragm CMAP amplitude was measured from peak to peak. Oxygen desaturation index and apnea-hypopnea index were measured using PSG, and their relevance to PNCT and CMAP were analyzed. PNCT and CMAP in five OSAHS patients were repeatedly measured after effective nasal continuous positive airway pressure treatment for more than 2 months. MAIN OUTCOME MEASURES：（1） PNCT and diaphragm CMAP of subjects in each group. （2） Relevance of oxygen desaturation index and apnea-hypopnea index to PNCT and CMAP. （3） Changes of PNCT and CMAP of OSAHS patients before

关键词： sleep apnea syndrome action potentials phrenic nerve

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Histological analysis and clinical observation of phrenic nerve cryotherapy following pulmonary resection

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Neural Regeneration Research 2010年第10期5卷 769-773页

作者： Yongfu Ma Yang Liu Xueliang Yang Department of Thoracic Surgery General Hospital of Chinese PLA Beijing 100853 China Department of Thoracic Surgery Shanxi Tumor Hospital Taiyuan 030013 Shanxi Province China

BACKGROUND： Residual postoperative pleural spaces （RPPS） are often encountered during pulmonary resection; this could adversely affect the outcome and prolong recovery. nerve cryotherapy reduces postoperative complications and does not affect neural regeneration. However, it remains unclear whether nerve cryotherapy reduces RPPS occurrence following pulmonary resection.OBJECTIVE： To explore pathological changes in the phrenic nerve following exposure to -50℃ for various freezing times, and to explore the feasibility and efficacy of phrenic nerve cryotherapy following pulmonary resection based on animal experiment results.DESIGN, TIME AND SETTING： A comparative animal study was conducted at the Animal Experimental Center of General Hospital of Chinese PLA from January to June 2008. Based on results from the animal study, a randomized, controlled, clinical study was initiated at the Department of Thoracic Surgery of General Hospital of Chinese PLA between July 2008 and July 2009.PARTICIPANTS： A total of 160 patients undergoing lobectomy were selected at the Department of Thoracic Surgery of General Hospital of Chinese PLA from July 2008 to July 2009.METHODS： Animal experiment： 27 adult goats were randomly assigned to three groups （n = 9）.The phrenic nerves were frozen at -50 ℃ for 30, 60, and 90 seconds, respectively. Clinical study： 160 patients undergoing lobectomy were randomly assigned to two groups （n = 80）. In the cryoanalgesia group, patients received phrenic nerve cryotherapy; phrenic nerves were frozen above the capsula cordis for 60 seconds at -50 ℃ prior to chest closure. Patients in the control group did not receive cryotherapy.MAIN OUTCOME MEASURES： Pathological changes were observed at days 1, 30, and 60 following phrenic nerve cryotherapy. In the clinical study, RPPS incidence rate was regularly recorded. Respiratory function tests, including measured forced vital capacity and forced expiratory volume in 1 second, were regularly conducted post-surgically. The incidence of post-surgical infection comp

关键词： lobectomy residual pleural spaces cryotherapy phrenic nerve postoperative complications neural regeneration

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Interest of thoracic ultrasound after cardiac surgery or interventional cardiology

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World Journal of Cardiology 2024年第3期16卷 118-125页

作者： Martin Boussuges Philippe Blanc Fabienne Bregeon Alain Boussuges Service de Pneumologie Centre Hospitalier Universitaire Sud ReunionSaint Pierre 97410Ile de la ReunionFrance Department of Cardiac and Pulmonary Rehabilitation Ste Clotilde&YlangYlang Rehabilitation CenterSainte Clotilde 97491Ile de la ReunionFrance Service d’Explorations Fonctionnelles Respiratoires Centre Hospitalier Universitaire NordAssistance Publique des Hôpitaux de MarseilleMarseille 13015France Institut Hospitalo-Universitaire-Méditerranée Infection Aix Marseille UniversitéMarseille 13005France Center for Cardiovascular and Nutrition Research Aix Marseille UniversitéInstitut National de la Santéet de la Recherche MédicaleInstitut National de Recherche pour l’Agriculturel’Alimentation et l’EnvironnementMarseille 13005France

Thoracic ultrasound has attracted much interest in detecting pleural effusion or pulmonary consolidation after cardiac surgery.In 2016,Trovato reported,in the World Journal of Cardiology,the interest of using,in addition to echocardiography,thoracic ultrasound.In this editorial,we highlight the value of assessing diaphragm function after cardiac surgery and interventional cardiology pro-cedures.Various factors are able to impair diaphragm function after such interventions.Diaphragm motion may be decreased by chest pain secondary to sternotomy,pleural effusion or impaired muscle function.Hemidiaphragmatic paralysis may be secondary to phrenic nerve damage complicating cardiac surgery or atrial fibrillation ablation.Diagnosis may be delayed.Indeed,respi-ratory troubles induced by diaphragm dysfunction are frequently attributed to pre-existing heart disease or pulmonary complications secondary to surgery.In addition,elevated hemidiaphragm secondary to diaphragm dysfunction is sometimes not observed on chest X-ray performed in supine position in the intensive care unit.Analysis of diaphragm function by ultrasound during the recovery period appears essential.Both hemidiaphragms can be studied by two complementary ultrasound methods.The mobility of each hemidiaphragms is measured by M-mode ultrasonography.In addition,recording the percentage of inspiratory thickening provides important information about the quality of muscle function.These two approaches make it possible to detect hemidiaphragm paralysis or dysfunction.Such a diagnosis is important because persistent diaphragm dysfunction after cardiac surgery has been shown to be associated with adverse respiratory outcome.Early respiratory physio-therapy is able to improve respiratory function through strengthening of the inspiratory muscles i.***.diaphragm and accessory inspiratory muscles.

关键词： Ultrasonography Diaphragm phrenic nerve Hemidiaphragm Thickening fraction Physiotherapy

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phrenic and intercostal nerves with rhythmic discharge can promote early nerve regeneration after brachial plexus repair in rats

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Neural Regeneration Research 2018年第5期13卷 862-868页

作者： Jing Rui Ya-Li Xu Xin Zhao Ji-Feng Li Yu-Dong Gu Jie Lao Department of Hand Surgery Huashan Hospital Fudan University Shanghai China Key Laboratory of Hand Reconstruction Ministry of Health Shanghai China Shanghai Key Laboratory of Peripheral nerve and Microsurgery Shanghai China

Exogenous discharge can positively promote nerve repair. We, therefore, hypothesized that endogenous discharges may have similar effects. The phrenic nerve and intercostal nerve, controlled by the respiratory center, can emit regular nerve impulses; therefore these endogenous automatically discharging nerves might promote nerve regeneration. Action potential discharge patterns were examined in the diaphragm, external intercostal and latissimus dorsi muscles of rats. The phrenic and intercostal nerves showed rhythmic clusters of discharge, which were consistent with breathing frequency. From the first to the third intercostal nerves, spontaneous discharge amplitude was gradually increased. There was no obvious rhythmic discharge in the thoracodorsal nerve. Four animal groups were performed in rats as the musculocutaneous nerve cut and repaired was bland control. The other three groups were followed by a side-to-side anastomosis with the phrenic nerve, intercostal nerve and thoracodorsal nerve. Compound muscle action potentials in the biceps muscle innervated by the musculocutaneous nerve were recorded with electrodes. The tetanic forces of ipsilateral and contralateral biceps muscles were detected by a force displacement transducer. Wet muscle weight recovery rate was measured and pathological changes were observed using hematoxylin-eosin staining. The number of nerve fibers was observed using toluidine blue staining and changes in nerve ultrastructure were observed using transmission electron microscopy. The compound muscle action potential amplitude was significantly higher at 1 month after surgery in phrenic and intercostal nerve groups compared with the thoracodorsal nerve and blank control groups. The recovery rate of tetanic tension and wet weight of the right biceps were significantly lower at 2 months after surgery in the phrenic nerve, intercostal nerve, and thoracodorsal nerve groups compared with the negative control group. The number of myelinated axons distal to the coaptation site of the musculocutan

关键词： nerve regeneration endogenous automatic discharge side-to-side nerve anastomosis peripheral nerve regeneration phrenic nerve intercostal nerve peripheral nerve injury neural regeneration

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Improved C_(3-4) transfer for treatment of root avulsion of the brachial plexus upper trunk Animal experiments and clinical application

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Neural Regeneration Research 2012年第20期7卷 1545-1555页

作者： Lin Zou Xuecheng Cao Jing Li Lifeng Liu Pingshan Wang Jinfang Cai Department of Orthopedics and Traumatic Surgery General Hospital of Jinan Military Command of Chinese PLA Jinan 250031 ShandongProvince China Department of Neurology General Hospital of Jinan Military Command of Chinese PLA Jinan 250031 Shandong Province China

Experimental rats with root avulsion of the brachial plexus upper trunk were treated with the improved C34 transfer for neurotization of 05-6. Results showed that Terzis grooming test scores were significantly increased at 6 months after treatment, the latency of C5-6 motor evoked potential was gradually shortened, and the amplitude was gradually increased. The rate of C3 instead of C5 and the C4 ＋ phrenic nerve instead of C6 myelinated nerve fibers crossing through the anastomotic stoma was approximately 80%. Myelinated nerve fibers were arranged loosely but the thickness of the myelin sheath was similar to that of the healthy side. In clinical applications, 39 patients with root avulsion of the brachial plexus upper trunk were followed for 6 months to 4.5 years after treatment using the improved C3 instead of C5 nerve root transfer and C4 nerve root and phrenic nerve instead of C6 nerve root transfer. Results showed that the strength of the brachial biceps and deltoid muscles recovered to level IIHV, scapular muscle to level Ill-W, latissimus dorsi and pectoralis major muscles to above level Ⅲ, and the brachial triceps muscle to level 0 Ill. Results showed that the improved 03-4 transfer for root avulsion of the brachial plexus upper trunk in animal models is similar to clinical findings and that C3-4 and the phrenic nerve transfer for neurotization of C5-6 can innervate the avulsed brachial plexus upper trunk and promote the recovery of nerve function in the upper extremity.

关键词： brachial plexus cervical plexus upper trunk root avulsion nerve transfer phrenic nerve translational medicine peripheral nerve injury neural regeneration

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

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Neural Regeneration Research 2018年第3期13卷 470-476页

作者： Kai-ming Gao Jing-jing Hu Jie Lao Xin Zhao Department of Hand Surgery Huashan Hospital Fudan University Shanghai China Nursing Department Huashan Hospital Fudan University Shanghai China Key Laboratory of Hand Reconstruction Ministry of Health Shanghai China Shanghai Key Laboratory of Peripheral nerve and Microsurgery Shanghai China

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 Clinical-Trials.gov （identifier： NCT03166033）.

关键词： nerve regeneration brachial plexus-avulsion injury nerve transfer phrenic nerve accessary nerve contralateral C7 nerve intercostal nerve shoulder function elbow function median nerve radial nerve neural regeneration

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A three-dimensional digital visualization model of cervical nerves in a healthy person

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Neural Regeneration Research 2013年第20期8卷 1829-1836页

作者： Jiaming Cao Dong Fu Sen Li Department of Anesthesiology the 98 Hospital of Chinese PLA Department of Surgery Hospital of 8691 People's Armed Police Force Department of Spinal Surgery Affiliated Hospital of Luzhou Medical College

Three-dimensional reconstruction nerve models are classically obtained from two-dimensional images of ＂visible human＂ frozen sections. However, because of the flexibility of nerve tissues and small color differences compared with surrounding tissues, the integrity and validity of nerve tissues can be impaired during milling. Thus, in the present study, we obtained two-dimensional data from a healthy volunteer based on continuous CT angiography and magnetic resonance myelography. Semi-automatic segmentation and reconstruction were then conducted at different thresholds in different tissues using Mimics software. Small anatomical structures such as muscles and cervical nerves were reconstructed using the medical computer aided design module. Three-dimensional digital models of the cervical nerves and their surrounding structures were successfully developed, which allowed visualization of the spatial relation of anatomical structures with a strong three-dimensional effect, distinct appearance, clear distribution, and good continuity, precision, and integrality. These results indicate the validity of a three-dimensional digital visualization model of healthy human cervical nerves, which overcomes the disadvantages of milling, avoids data loss, and exhibits a realistic appearance and three-dimensional image.

关键词： neural regeneration cervical three-dimension CT magnetic resonance myelography cervical plexus phrenic nerve vagus nerve recurrent laryngeal nerve ganglion stellate ganglion grants-supported paper neuroregeneration

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