Functional Restoration of the Paralyzed Diaphragm Following the Cross-Union of the Vagus and Phrenic Nerves

Brown, James O.; Satinsky, Victor P.

doi:10.1097/00000441-195112000-00001

Cited by 17 publications

(7 citation statements)

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“…Proper restoration of diaphragmatic function was reported after vago-phrenic cross-union in the cat (Brown & Satinsky, 1951;Guth & Frank, 1959;Guth, Soutter, Frank, Campbell & Lloyd, 1960). Yet in these cases, re-innervation by a somatic motor component in the vagus was not excluded.…”

Section: Introductionmentioning

confidence: 98%

Contractile and electrical responses of vagus‐innervated frog sartorius muscles

Landmesser¹

1971

The Journal of Physiology

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SUMMARY1. Frog sartorius muscles were transplanted to the thoracic region and re-innervated by the gastric vagus nerve. Contractile responses of the re-innervated muscles were studied. Micro-electrodes were used to measure electrical properties of the muscle fibre membrane. Histological studies of the sartorius and vagus nerves and re-innervated muscles were also carried out.2. Autonomic nerve fibres of the gastric vagus form functional connexions with the skeletal muscle fibres. Such vagus-innervated muscle fibres do not atrophy.3. Neither the contractile nor the passive electrical properties of the muscle fibres are altered by vagal innervation.4. Synaptic transmission is quantal in nature and describable by a Poisson distribution as at normal sartorius junctions. The muscle fibres, however, do show extensive multiple-innervation, and unlike normal sartorius junctions, vagus-muscle junctions have a low quantal content and show a long-lasting facilitation.5. Properties of the vagus nerve fibres apparently are not altered by synapsing with skeletal muscle fibres. They remain small diameter and have high threshold for electrical stimulation.6. The ability of these nerve and muscle fibres to influence each other is rather limited in the adult amphibian.

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Section: Introductionmentioning

confidence: 98%

Contractile and electrical responses of vagus‐innervated frog sartorius muscles

Landmesser¹

1971

The Journal of Physiology

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“…Approximately 20% of patients with acute cervical spinal cord injuries will require some form of mechanical ventilatory support due to bilateral diaphragmatic paralysis. For these patients, an alternative technique could be diaphragm reinnervation [ 1 - 5 ]. Among the nerves tested to perform diaphragm reinnervation, the inferior laryngeal nerve, was certainly the optimal donor nerve because of its similarities with the phrenic nerve [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Restoration of diaphragmatic function after diaphragm reinnervation by inferior laryngeal nerve; experimental study in rabbits

et al. 2006

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Objectives: To assess the possibilities of reinnervation in a paralyzed hemidiaphragm via an anastomosis between phrenic nerve and inferior laryngeal nerve in rabbits. Reinnervation of a paralyzed diaphragm could be an alternative to treat patients with ventilatory insufficiency due to upper cervical spine injuries. Material and method:Rabbits were divided into five groups of seven rabbits each. Groups I and II were respectively the healthy and the denervated control groups. The 3 other groups were all reinnervated using three different surgical procedures. In groups III and IV, phrenic nerve was respectively anastomosed with the abductor branch of the inferior laryngeal nerve and with the trunk of the inferior laryngeal nerve. In group V, the fifth and fourth cervical roots were respectively anastomosed with the abductor branch of the inferior laryngeal nerve and with the nerve of the sternothyroid muscle (originating from the hypoglossal nerve). Animals were evaluated 4 months later using electromyography, transdiaphragmatic pressure measurements, sonomicrometry and histological examination.Results: A poor inspiratory activity was found in quiet breathing in the reinnervated groups, with an increasing pattern of activity during effort. In the reinnervated groups, transdiaphragmatic pressure measurements and sonomicrometry were higher in group III with no significant differencewith groups IV and V. Conclusion:Inspiratory contractility of an hemidiaphragm could be restored with immediate anastomosis after phrenic nerve section between phrenic nerve and inferior laryngeal nerve.

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“…13 Contraction of the previously paralyzed diaphragm was observed after VN-PN anastomosis in rats and dogs. 3,13 However, the VN is not an optimal candidate for anastomosis to the PN because of differing frequencies of their spontaneous discharges, 30 unsatisfied efficiency of motor fiber regeneration from the VN into the PN, 10,30 and interruption of homeostasis after vagotomy at the cervical level. 6,11 The recurrent laryngeal nerve (RLN) is a branch of the VN.…”

Section: Discussionmentioning

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 Following the Cross-Union of the Vagus and Phrenic Nerves

Cited by 17 publications

References 0 publications

Contractile and electrical responses of vagus‐innervated frog sartorius muscles

Contractile and electrical responses of vagus‐innervated frog sartorius muscles

Restoration of diaphragmatic function after diaphragm reinnervation by inferior laryngeal nerve; experimental study in rabbits

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

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