Correlation between histopathological findings in C-5 and C-6 nerve stumps and motor recovery following nerve grafting for repair of brachial plexus injury

Abstract

Both histopathological and morphometric examination showed a reduction of the quantity of myelin in C-5 or C-6 stumps used as donor sites for grafts. The amount of myelin is significantly correlated with biceps muscle function after nerve grafting. Because it is possible to assess the quantity of myelin by intraoperative examination of frozen sections, this correlation is potentially useful in the decision-making process of whether to use stumps for grafting or to use nerve transfer procedures to restore biceps muscle function.

Human Neuroma Contains Increased Levels of Semaphorin 3A, Which Surrounds Nerve Fibers and Reduces Neurite ExtensionIn Vitro

“…The proximal nerve stump consisted of a segment of the spinal nerve C5 (n ϭ 7) or C6 (n ϭ 2). All material was diagnosed intraoperatively as neuroma or as proximal nerve stump suitable for grafting according to previously described criteria (Malessy et al, 1999).…”

“…Tissue from the same nerve trunk proximal to the neuroma served as a control. A small segment of this proximal nerve stump is routinely harvested for intraoperative neuropathological assessment, as its quality influences surgical decision making (Malessy et al, 1999). The availability of this material provided us with the unique opportunity to compare, within a single nerve, two types of tissue with con-trasting properties: the outgrowth-inhibitory environment of the neuroma and the outgrowth-supporting environment in the stump proximal to the neuroma.…”

Evaluation of suprascapular nerve neurotization after nerve grafting or transfer in the treatment of brachial plexus traction lesions

“…20 4) The size of the cross-sectional area was equal to or larger than musculocutaneous nerve fascicles in the lateral cord or musculocutaneous nerve stump. If both C-5 and C-6 contained myelinated fibers, C-6 was selected to reinnervate the biceps when the quantity of myelin was equal to or greater than that of C-5 and when the cross-sectional area was equal to or larger than C-5.…”

“…The amount of stained myelin in a normal spinal nerve is 100%. 20 In all cases, the priority of repair was restoration of biceps function. The decision-making process is schematically depicted in Fig.…”

“…The surgical technique was similar to that previously described. 20 The entire trajectory of the brachial plexus was exposed. Root avulsions were confirmed 1 N C-5, AV C6-T1 C4-rad lat med, 18 30 7 25-50 0 0 4 3rd-5th ICNs-MC 2 partial C-5 AV, XII-MC, XII-distal XII, 17 67 6 50-75 3 † 1 3 C6-T1 AV, AXN N C4-rad lat med 3 TS N, TM, TI C6-ADTS, C7-C7 24 by the emptiness of the intervertebral foramen.…”