End-to-Side Neurorrhaphy with Removal of the Epineurial Sheath

Viterbo, Fausto; Trindade, José Carlos Souza; Hoshino, Katsumasa; Neto, Augusto Mazzoni

doi:10.1097/00006534-199412000-00019

Cited by 233 publications

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“…One of the landmark advanced occurred in 1992 when Viterbo et al 4 proposed end-to-side neurorrhaphy (ESN) that would not contribute to donor nerve damage and also without the removal of the epineurium 5 . In an experimental study in rats, Viterbo et al 4 performed a section of the peroneal nerve, which innervates the cranial tibial muscle (CTM), and its distal stump was sutured to the lateral surface of the intact tibial nerve.…”

Section: Introductionmentioning

confidence: 99%

“…This technique has brought great contribution, because from then on, any nerve can be used as a donor nerve without harming itself or any of the structures innervated by it. Several experimental and clinical studies has validated the study of Viterbo [5][6][7] . Use of ESN has been indicated in clinical situations in which the proximal stump of injured nerve is not available 8 .…”

Section: Introductionmentioning

confidence: 99%

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Effect of electrical stimulation of the cranial tibial muscle after end-to-side neurorrhaphy of the peroneal nerve in rats

Maciel

Viterbo

Chinaque³

et al. 2013

Acta Cir. Bras.

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PURPOSE:To investigate the efficiency of electrical stimulation in the muscle maintenance and nerve regeneration after end-to-side neurorrhaphy (ESN). METHODS:Sixty male Wistar rats (Rattus norvegicus) were divided into four experimental groups. Control group (Control), Denervated Group (Denervated); Group with End-to-side neurorrhaphy (ESN); Group with End-to-side neurorrhaphy and electrical stimulation (ESN + ES). We perform electrical stimulation in rats after they had undergone muscle reinnervation by ESN. We collected morphometric and functional data. RESULTS:When comparing the mass of the treated side of cranial tibial muscle (CTM) and that of normal side of CTM, the group ESN + ES (26.12%) exhibited lower mass loss than that of group ESN (37.23%). The peroneal functional index showed that group ESN + ES equaled that of the Control group and showed an evolution of 60.5% while group ESN showed an evolution of 9.5%. In measuring maximum strength of CTM, the group ES + ESN outperformed group ESN. The muscle and nerve morphometry showed superiority of group ES+ESN over ESN group in all parameters. CONCLUSION:Electrical stimulation is an effective means of maintaining functional muscle and nerve regeneration after end-to-side neurorrhaphy.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of electrical stimulation of the cranial tibial muscle after end-to-side neurorrhaphy of the peroneal nerve in rats

Maciel

Viterbo

Chinaque³

et al. 2013

Acta Cir. Bras.

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“…The use of the fibular nerve in studies of nerve regeneration was boosted after the reintroduction of the end-to-side neurorrhaphy 1,2,3,4,5,6,7,8,9,10,11,23,13 . We were not able to find many references to the unmyelinated axons of the fibular nerve in these and other recent studies.…”

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confidence: 99%

A histomorphometric study of unmyelinated fibers of the fibular nerve in Wistar rats

Tognon-Miguel

Nascimento-Elias

Schiavoni

et al. 2016

Arq. Neuro-Psiquiatr.

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There are few histomorphometric studies on the unmyelinated fibers of the fibular nerve in rats, and the number of experimental studies using this nerve has been increasing in the last years. Sixty-two percent of the endoneurial area from 10 fibular nerves of adult Wistar rats was scanned by electron microscopy, and digitized. The total number of unmyelinated axons (1.882 ± 271) was significantly lesser, and their axon diameters (0.2 µm to 2.8 µm) significantly higher than that determined in previous studies. The histogram peaked at 1 µm. The differences could be due to the nerve sampled area, the number and the age of the animals evaluated, and the laboratory techniques used. This study brings new and referential data to be used in experimental investigations involving histomorphometric evaluation of the rat fibular nerve.

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“…12,13,29,[48][49][50]54 but not later from 4 up to 8 months after surgery. 16,51,53,64 Interestingly, if epineurial or perineurial windows were enlarged from 1 to 4 or 5 mm, respectively, then, also, the magnitude of axonal ingrowth into the recipient nerve was increased. 65,66 Subepineurial focal degeneration and demyelination of the donor nerve distal to the site of coaptation in experimental groups Notably, bimodality coefficient > 0.555 indicates that a distribution is bimodal 56 (but see Jackson, P.R., Tucker, G.T., and Woods, H.F. (1989).…”

Section: Kovač Ič Et Almentioning

confidence: 99%

Influence of Breaching the Connective Sheaths of the Donor Nerve on Its Myelinated Sensory Axons and on Their Sprouting into the End-to-Side Coapted Nerve in the Rat

Kovačič

Žele²,

Tomšič³

et al. 2012

Journal of Neurotrauma

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The influence of breaching the connective sheaths of the donor sural nerve on axonal sprouting into the end-to-side coapted peroneal nerve was examined in the rat. In parallel, the effect of these procedures on the donor nerve was assessed. The sheaths of the donor nerve at the coaptation site were either left completely intact (group A) or they were breached by epineurial sutures (group B), an epineurial window (group C), or a perineurial window (group D). In group A, the compound action potential (CAP) of sensory axons was detected in *10% and 40% of the recipient nerves at 4 and 8 weeks, respectively, which was significantly less frequently than in group D at both recovery periods. In addition, the number of myelinated axons in the recipient nerve was significantly larger in group D than in other groups at 4 weeks. At 8 weeks, the number of axons in group A was only *15% of the axon numbers in other groups ( p < 0.05). Focal subepineurial degenerative changes in the donor nerves were only seen after 4 weeks, but not later. The average CAP area and the total number of myelinated axons in the donor nerves were not different among the experimental groups. In conclusion, myelinated sensory axons are able to penetrate the epiperineurium of donor nerves after end-to-side nerve coaption; however, their ingrowth into recipient nerves is significantly enhanced by breaching the epiperineurial sheets at the coaptation site. Breaching does not cause permanent injury to the donor nerve.

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End-to-Side Neurorrhaphy with Removal of the Epineurial Sheath

Cited by 233 publications

References 0 publications

Effect of electrical stimulation of the cranial tibial muscle after end-to-side neurorrhaphy of the peroneal nerve in rats

Effect of electrical stimulation of the cranial tibial muscle after end-to-side neurorrhaphy of the peroneal nerve in rats

A histomorphometric study of unmyelinated fibers of the fibular nerve in Wistar rats

Influence of Breaching the Connective Sheaths of the Donor Nerve on Its Myelinated Sensory Axons and on Their Sprouting into the End-to-Side Coapted Nerve in the Rat

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