Functional restoration of the paralyzed diaphragm in high cervical quadriplegia via phrenic nerve neurotization utilizing the functional spinal accessory nerve

Yang, Mingliang; Li, Jianjun; Zhang, Shaocheng; Du, Liyong; Gao, Feng; Li, Jun; Wang, Yuming; Gong, Huiming; Cheng, Liang

doi:10.3171/2011.3.spine10911

Cited by 21 publications

(13 citation statements)

References 11 publications

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“…Application of peripheral nerve transfers for SCI is not new. 3 4 11 26 27 28 29 30 31 32 33 34 Most clinical applications have utilized intercostal nerve roots proximal to the SCI to reinnervate lumbar plexus nerve. The nerve transfer strategies for the treatment of cervical SCI are relatively sparse, especially for restoration of hand function.…”

Section: Discussionmentioning

confidence: 99%

Transfer of the Brachialis to the Anterior Interosseous Nerve as a Treatment Strategy for Cervical Spinal Cord Injury: Technical Note

Hawasli

Chang

Reynolds

et al. 2014

Global Spine Journal

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Study Design Technical report. Objective To provide a technical description of the transfer of the brachialis to the anterior interosseous nerve (AIN) for the treatment of tetraplegia after a cervical spinal cord injury (SCI). Methods In this technical report, the authors present a case illustration of an ideal surgical candidate for a brachialis-to-AIN transfer: a 21-year-old patient with a complete C7 spinal cord injury and failure of any hand motor recovery. The authors provide detailed description including images and video showing how to perform the brachialis-to-AIN transfer. Results The brachialis nerve and AIN fascicles can be successfully isolated using visual inspection and motor mapping. Then, careful dissection and microsurgical coaptation can be used for a successful anterior interosseous reinnervation. Conclusion The nerve transfer techniques for reinnervation have been described predominantly for the treatment of brachial plexus injuries. The majority of the nerve transfer techniques have focused on the upper brachial plexus or distal nerves of the lower brachial plexus. More recently, nerve transfers have reemerged as a potential reinnervation strategy for select patients with cervical SCI. The brachialis-to-AIN transfer technique offers a potential means for restoration of intrinsic hand function in patients with SCI.

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Section: Discussionmentioning

confidence: 99%

Transfer of the Brachialis to the Anterior Interosseous Nerve as a Treatment Strategy for Cervical Spinal Cord Injury: Technical Note

Hawasli

Chang

Reynolds

et al. 2014

Global Spine Journal

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“…Follow‐up of patients on which this type of procedure has been carried out have demonstrated optimal results . To the best of our knowledge, there have been no reports in the literature which have focused on the technique we performed here, even though some teams have proposed other approaches such as neurotization of the phrenic nerve with the trapezius branch of the ipsilateral spinal accessory nerve, or reconstruction of the phrenic nerve employing fibers of sural nerve . In the light of chemotherapeutic failure in this patient, a surgical option was derived from a MDT decision, and this approach enabled removal of the tumor which offered a better life expectancy, as well as achieving spontaneous breathing effort.…”

Section: Discussionmentioning

confidence: 98%

Importance of muldisciplinary management of giant mediastinal sarcoma: A case report with phrenic nerve reconstruction

et al. 2020

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Primary synovial sarcoma is a soft tissue tumor which originates from synoviallike undeveloped mesenchymal structures. Here, we report the case of a giant mediastinal sarcoma in a 41-year-old female patient. After diagnosis, she underwent neoadjuvant chemotherapy. Due to its low efficacy, we collegially decided to undergo cytoreductive debulking surgery. The mass invaded the phrenic nerve bilaterally and its excision caused a severe lesion of the left nerve and a partial impairment of the right one. Thus, plastic surgeons decided to reconstruct the right phrenic nerve employing the contralateral remaining fibers. The invasiveness of this tumor, its difficult removal, histological profile and the peculiar technique to preserve diaphragmatic function classify this case as very rare. The therapeutic strategy was based on interdisciplinary teamwork which comprised several specialists' opinions. Our strategy allowed us to pursue the challenging objective to give a young woman with a severe diagnosis the best possible chance of achieving a good quality of life. To the best of our knowledge, this phrenic nerve reconstructive technique is very rare and has not previously been reported in the literature. The report emphasizes that it is possible to deal with an apparently impossible case through a collaborative approach involving several different medical specialist professionals.

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“…The spinal accessory nerve (SAN) has been shown to be a possible donor nerve for anastomosis with the PN to restore physiological respiration. 9,28,29,31 However, the SAN does not have spontaneous discharge, and an external electronic pacing has to be provided. Spontaneous discharge from a donor nerve is important for restoration of spontaneous respiratory function.…”

Section: Discussionmentioning

confidence: 99%

“…Spinal accessory nerve (SAN) and PN anastomosis has been shown to be a possible way to restore the respiratory movement of the diaphragm. 9,28,29,31 Our previous study showed that vagus nerve (VN) to PN anastomosis could partially improve respiratory function in rabbits that had been subjected to unilateral PN transection. 30 Nevertheless, there are drawbacks to using the VN for anastomosis to the PN, even though the VN contains some fibers that produce efferent discharges synchronous with the PN.…”

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confidence: 99%

Recovery of respiratory function and autonomic diaphragm movement following unilateral recurrent laryngeal nerve to phrenic nerve anastomosis in rabbits

Wen

Han²,

Guo³

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVERespiratory dysfunction is the leading cause of mortality following upper cervical spinal cord injury (SCI). The authors’ previous study suggested that vagus nerve (VN) and phrenic nerve (PN) anastomosis could partially improve respiratory function in rabbits that had been subjected to PN transection. As a branch of the VN and a motor fiber–dominated nerve, the recurrent laryngeal nerve (RLN) seems a better choice to anastomose with the PN for respiratory function restoration after upper cervical SCI. This study was designed to determine whether RLN-PN anastomosis could restore the respiratory function after upper cervical SCI in rabbits.METHODSTwelve male New Zealand rabbits were randomly divided into 3 groups: 1) sham group (no injury), 2) transection group (right RLN and PN were transected), and 3) bridge group (transected right RLN and PN were immediately anastomosed). Spontaneous discharges of the RLN and PN were compared using a bio-signal collection system. RLN and PN cross sections were stained for acetylcholinesterase (AChE), and the numbers of motor fibers were compared. Three months after the initial surgical procedures, the movement of the diaphragm was assessed using a digital subtraction angiography (DSA) system, and discharges from the right diaphragm muscle were recorded. Toluidine blue staining, electron microscopy, and staining for AChE were used to assess whether motor fibers from the RLN regenerated into the PN, and sections of diaphragm were examined after AChE staining to assess the motor endplates.RESULTSBoth the RLN and PN exhibited highly rhythmic discharges, synchronized with respiration, and most fibers in the RLN and PN were found to be motor fibers. Numerous myelinated fibers were observed in anastomosed PN using toluidine blue staining and electron microscopy. Staining for AChE showed that those regenerated fibers had typical characteristics of motor fibers, and motor endplates with typical morphological characteristics were observed in the diaphragm. Reestablished rhythmic contraction of the hemidiaphragm was directly observed using the DSA system, and rhythmic spontaneous discharge was recorded from the reinnervated hemidiaphragm using the bio-signal collection system.CONCLUSIONSMotor fibers from the RLN could regenerate into the PN after end-to-end anastomosis and reinnervate the denervated hemidiaphragm in rabbits. Those regenerated motor fibers restored rhythmic and autonomic movement of the paralyzed diaphragm. These results suggest that the RLN is an optimal donor nerve to anastomose with the PN in order to reestablish the autonomic movement of paralyzed diaphragms after high-level SCI.

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Functional restoration of the paralyzed diaphragm in high cervical quadriplegia via phrenic nerve neurotization utilizing the functional spinal accessory nerve

Cited by 21 publications

References 11 publications

Transfer of the Brachialis to the Anterior Interosseous Nerve as a Treatment Strategy for Cervical Spinal Cord Injury: Technical Note

Transfer of the Brachialis to the Anterior Interosseous Nerve as a Treatment Strategy for Cervical Spinal Cord Injury: Technical Note

Importance of muldisciplinary management of giant mediastinal sarcoma: A case report with phrenic nerve reconstruction

Recovery of respiratory function and autonomic diaphragm movement following unilateral recurrent laryngeal nerve to phrenic nerve anastomosis in rabbits

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