Histopathologic Study of the Neuroma-in-Continuity in Obstetric Brachial Plexus Palsy

Chen, Liang; Gao, Shichang; Gu, Yajia; Hu, Song; Xu, Lei; Huang, Yigang

doi:10.1097/prs.0b013e3181706e7e

Cited by 28 publications

(15 citation statements)

References 13 publications

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“…Depending on the anatomical integrity of the different parts of the nerve elements involved, varying grades of recovery may take place. This may lead to axonal continuity in some way between the proximal and distal stump, which was demonstrated by electrical conduction studies [35, 36] and by histological investigation [37] of the neuroma. However, the extent to which this partial axonal continuity leads to clinical recovery at the end stage is not known.…”

Section: Discussionmentioning

confidence: 99%

The Evidence for Nerve Repair in Obstetric Brachial Plexus Palsy Revisited

Pondaag

Malessy

2014

BioMed Research International

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Strong scientific validation for nerve reconstructive surgery in infants with Obstetric Brachial Plexus Palsy is lacking, as no randomized trial comparing surgical reconstruction versus conservative treatment has been performed. A systematic review of the literature was performed to identify studies that compare nerve reconstruction to conservative treatment, including neurolysis. Nine papers were identified that directly compared the two treatment modalities. Eight of these were classified as level 4 evidence and one as level 5 evidence. All nine papers were evaluated in detail to describe strong and weak points in the methodology, and the outcomes from all studies were presented. Pooling of data was not possible due to differences in patient selection for surgery and outcome measures. The general consensus is that nerve reconstruction is indicated when the result of nerve surgery is assumedly better than the expected natural recovery, when spontaneous recovery is absent or severely delayed. The papers differed in methodology on how the cut-off point to select infants for nerve reconstructive surgical therapy should be determined. The justification for nerve reconstruction is further discussed.

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Section: Discussionmentioning

confidence: 99%

The Evidence for Nerve Repair in Obstetric Brachial Plexus Palsy Revisited

Pondaag

Malessy

2014

BioMed Research International

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“…Human traumatic NIC is characterized by aberrant intra-and extrafascicular axonal regeneration and scar formation within an unsevered injured nerve, resulting in impaired and erroneous end-organ reinnervation (Burger et al, 2002;Chen et al, 2008;Sunderland, 1951). Clinically prototypical NIC is encountered in brachial plexus injuries, the incidence of which approaches 5% among motorcycle and snowmobile accident victims (Midha, 1997).…”

Section: Introductionmentioning

confidence: 97%

Traumatic Neuroma in Continuity Injury Model in Rodents

Alant

Kemp

Khu

et al. 2012

Journal of Neurotrauma

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Traumatic neuroma in continuity (NIC) results in profound neurological deficits, and its management poses the most challenging problem to peripheral nerve surgeons today. The absence of a clinically relevant experimental model continues to handicap our ability to investigate ways of better diagnosis and treatment for these disabling injuries. Various injury techniques were tested on Lewis rat sciatic nerves. Optimal experimental injuries that consistently resulted in NIC combined both intense focal compression and traction forces. Nerves were harvested at 0, 5, 13, 21, and 65 days for histological examination. Skilled locomotion and ground reaction force (GRF) analysis were performed up to 9 weeks on the experimental (n=6) and crush-control injuries (n=5). Focal widening, disruption of endoneurium and perineurium with aberrant intra- and extrafascicular axonal regeneration and progressive fibrosis was consistently demonstrated in 14 of 14 nerves with refined experimental injuries. At 8 weeks, experimental animals displayed a significantly greater slip ratio in both skilled locomotor assessments, compared to nerve crush animals (p<0.01). GRFs of the crush- injured animals showed earlier improvement compared to the experimental animals, whose overall GRF patterns failed to recover as well as the crush group. We have demonstrated histological features and poor functional recovery consistent with NIC formation in a rat model. The injury mechanism employed combines traction and compression forces akin to the physical forces at play in clinical nerve injuries. This model may serve as a tool to help diagnose this injury earlier and to develop intervention strategies to improve patient outcomes.

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“…Following this type of injury, the proximal and distal stumps are physically separated and spontaneous recovery is unlikely, although fibrotic connective tissue (a neuroma) joins the injured stumps 11 . Neuroma formation may also occur following partial tears, in which case any regenerating axons are localized in disorganized mini-fascicles and surrounded by thin layers of perineurium encompassing small cohorts of axonal and Schwann cell units 12 . The worst brachial plexus injury occurs when traction causes root avulsion.…”

Section: Surgical Intervention In Brachial Plexus Nerve Palsymentioning

confidence: 99%