Electron microscopy of human peripheral nerves of clinical relevance to the practice of nerve blocks. A structural and ultrastructural review based on original experimental and laboratory data

Reina, Miguel Ángel; Arriazu, Riánsares; Collier, Clive; Sala‐Blanch, Xavier; Izquierdo, Luís; Andrés, José De

doi:10.1016/j.redar.2013.06.006

Cited by 44 publications

(26 citation statements)

References 29 publications

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“…The endoneurium, perineurium, and epineurium are distinct structures on electron microscopy. 2 Each axon is bound by endoneurium, a thin layer of connective tissue composed mainly of thin collagen fibers. Nerve fibers are organized into groups called fascicles.…”

Section: Anatomical Considerationsmentioning

confidence: 99%

“…2 The layers of perineurial cells, their tight junctions, and the nonfenestrated capillaries within the endoneurium provide a barrier for diffusion of substances into and out of the fascicles. 2 This important diffusion barrier protects exposure of the axons to chemical injury. There are collagen fibers aligned predominantly along the longitudinal axis of the fascicle.…”

Section: Anatomical Considerationsmentioning

confidence: 99%

“…This inner layer of connective tissue that envelopes the fascicles contains adipose tissue, fibroblasts, mastocytes, blood vessels (and small nerve fibers innervating these vessels), and lymphatics. 2 This interfascicular tissue is loose connective tissue and is in contrast to the dense collagenous tissue that forms the epineurium.…”

Section: Anatomical Considerationsmentioning

confidence: 99%

“…As these capillaries reach the outer border of the perineurium, the capillaries become fenestrated. 2 Vessels that originate in the epineurium and traverse the perineurium form anastomosis between the 2 vascular systems.…”

Section: Anatomical Considerationsmentioning

confidence: 99%

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Pathophysiology and Etiology of Nerve Injury Following Peripheral Nerve Blockade

Brull

Hadžić

Reina

et al. 2015

Regional Anesthesia and Pain Medicine

184

106

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Section: Anatomical Considerationsmentioning

confidence: 99%

Section: Anatomical Considerationsmentioning

confidence: 99%

Section: Anatomical Considerationsmentioning

confidence: 99%

Section: Anatomical Considerationsmentioning

confidence: 99%

See 2 more Smart Citations

Pathophysiology and Etiology of Nerve Injury Following Peripheral Nerve Blockade

Brull

Hadžić

Reina

et al. 2015

Regional Anesthesia and Pain Medicine

184

106

View full text Add to dashboard Cite

show abstract

“…More than a century later Van Beek would refer to this as the “adventitia of the nerve” (Van Beek and Kleinert, ), highlighting its similarity to the connective tissue around blood vessels. The semantic conflict remains unresolved (Sala‐Blanch et al, ) with different authors referring to the layer as the outer epineurium (Sala‐Blanch et al, ; Vloka et al, ), epiepineurium (Reina et al, ) and mesoneurium (Sunderland, ). We believe that these terms are ambiguous and the latter has previously been used to describe a layer deep to the epineurium (Greenberg, ).…”

Section: Discussionmentioning

confidence: 99%

The subparaneurial compartment: A new concept in the clinicoanatomic classification of peripheral nerve lesions

et al. 2015

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Based on our experience in treating peripheral non-neural sheath derived pathology, we have identified a novel pattern of lesion progression along the anatomic course of nerves. This report highlights the existence of a subparaneurial compartment around peripheral nerves. We first applied an anatomic framework to review MR images and intraoperative photographs of patients treated by the senior author in the last 10 years. After identifying a pattern that was consistent with subparaneurial lesion progression, we searched for other examples of cases that might exhibit this pattern. Four examples of subparaneurial pathology were identified, a hemangioma of the ulnar nerve, a ganglion cyst of the common fibular nerve, a lymphoma of the sciatic nerve and a lipoma of the ulnar nerve. All four patients were operated on and had intraoperative photographs; three had high resolution MR imaging. This report highlights the existence of pathology contained within a subparaneurial compartment, outside of the epineurium, that follows the course of the nerve and surrounds it circumferentially. The subparaneurial localization of peripheral nerve lesions has hitherto received little attention. Identification of this new pattern on preoperative MRI may have implications for surgical management.

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3D reconstruction of peripheral nerves from optical projection tomography images: A method for studying fascicular interconnections and intraneural plexuses

et al. 2017

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The general microscopic characteristics of nerves are described in several textbooks of histology, but the specific microanatomies of most nerves that can be blocked by anesthesiologists are usually less well known. Our objective was to evaluate the 3D reconstruction of nerve fascicles from optical projection tomography images (OPT) and the ability to undertake an internal navigation exploring the morphology in detail, more specifically the fascicular interconnections. Median and lingual nerve samples were obtained from five euthanized piglets. OPT images of the samples were acquired and 3D reconstruction was performed. The OPT technique revealed the inner structure of the nerves at high resolution, including large and small fascicles, perineurium, interfascicular tissue, and epineurium. The fascicles were loosely packed inside the median nerve and more densely so in the lingual nerve. Analysis of the 3D models demonstrated that the nerve fascicles can show six general spatial patterns. Fascicular interconnections were clearly identified. The 3D reconstruction of nerve fascicles from OPT images opens a new path for research into the microstructure of the inner contents of fascicular nerve groups and their spatial disposition within the nerve including their interconnections. These techniques enable 3D images of partial areas of nerves to be produced and could became Clinical Anatomy 31: 424-431 (2018) an excellent tool for obtaining data concerning the 3D microanatomy of nerves, essential for better interpretation of ultrasound images in clinical practice and thus avoiding possible neurological complications. Clin. Anat. 31:424-431, 2018. V C 2017 Wiley Periodicals, Inc.

show abstract

Electron microscopy of human peripheral nerves of clinical relevance to the practice of nerve blocks. A structural and ultrastructural review based on original experimental and laboratory data

Cited by 44 publications

References 29 publications

Pathophysiology and Etiology of Nerve Injury Following Peripheral Nerve Blockade

Pathophysiology and Etiology of Nerve Injury Following Peripheral Nerve Blockade

The subparaneurial compartment: A new concept in the clinicoanatomic classification of peripheral nerve lesions

3D reconstruction of peripheral nerves from optical projection tomography images: A method for studying fascicular interconnections and intraneural plexuses

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