Peripheral nerve surgery: the road less traveled

Rasulić, Lukas

doi:10.1007/s00701-018-3569-x

Cited by 11 publications

(4 citation statements)

References 14 publications

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“…Nearly 3% to 10% of people involved in a traumatic accident present traumatic peripheral nerve injury (PNI), which equates to almost one million patients per year in Europe and the U.S.A. needing surgical reconstruction of their nerves [1,2]. Peripheral nerve surgery has been proven to be a life changing surgery, improving the sensory function, mobility, and ability of patients to cope with normal life, affecting directly their physical and psychological well-being, and in the U.S.A. this surgery accounts for approximately $150 billion spent in annual health care [3,4].…”

Section: Introductionmentioning

confidence: 99%

UV-Casting on Methacrylated PCL for the Production of a Peripheral Nerve Implant Containing an Array of Porous Aligned Microchannels

et al. 2020

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Peripheral nerves are basic communication structures guiding motor and sensory information from the central nervous system to receptor units. Severed peripheral nerve injuries represent a large clinical problem with relevant challenges to successful synthetic nerve repair scaffolds as substitutes to autologous nerve grafting. Numerous studies reported the use of hollow tubes made of synthetic polymers sutured between severed nerve stumps to promote nerve regeneration while providing protection for external factors, such as scar tissue formation and inflammation. Few approaches have described the potential use of a lumen structure comprised of microchannels or microfibers to provide axon growth avoiding misdirection and fostering proper healing. Here, we report the use of a 3D porous microchannel-based structure made of a photocurable methacrylated polycaprolactone, whose mechanical properties are comparable to native nerves. The neuro-regenerative properties of the polymer were assessed in vitro, prior to the implantation of the 3D porous structure, in a 6-mm rat sciatic nerve gap injury. The manufactured implants were biocompatible and able to be resorbed by the host’s body at a suitable rate, allowing the complete healing of the nerve. The innovative design of the highly porous structure with the axon guiding microchannels, along with the observation of myelinated axons and Schwann cells in the in vivo tests, led to a significant progress towards the standardized use of synthetic 3D multichannel-based structures in peripheral nerve surgery.

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Section: Introductionmentioning

confidence: 99%

UV-Casting on Methacrylated PCL for the Production of a Peripheral Nerve Implant Containing an Array of Porous Aligned Microchannels

et al. 2020

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“…Neurolysis relieves nerve compression and restores limb function [5]. However, the main causes of the failure of peripheral nerve surgery are adhesion, scarring, hemorrhage, and damage to the nerve as well as the surrounding tissues [6]. To prevent adhesion and scar formation, a variety of surgical methods have been developed, such as nerve transfer [7], fascial fat transplantation [8], venous encapsulation [9], and muscle flap transplantation [10].…”

Section: Introductionmentioning

confidence: 99%

Electrospun polycaprolactone (PCL)-amnion nanofibrous membrane prevents adhesions and promotes nerve repair in a rat model of sciatic nerve compression

et al. 2020

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Adhesion and scarring after neural surgery are detrimental to nerve regeneration and functional recovery. Amniotic membranes have been used in tissue repair due to their immunogenicity and richness in cytokines. In this study, an electrospun polycaprolactone (PCL)-amnion nanofibrous membrane was prepared for the treatment of sciatic nerve compression in a rat model. The effects of the PCL-amnion nanofibrous membrane on the prevention of adhesion formation and nerve regeneration were evaluated using electrophysiology and histological analyses. Compared with the medical chitosan hydrogel dressing, the PCL-amnion nanofibrous membrane significantly reduced peripheral nerve adhesion and promoted the rapid recovery of nerve conduction. Moreover, the immunohistochemical analysis identified more Schwann cells and less pro-inflammatory M1 macrophages in the PCL-amnion group. Western blot and RT-PCR results showed that the expression levels of type-Ⅰ and Ⅲ collagen in the PCL-treated rats were half of those in the control group after 12 weeks, while the expression level of nerve growth factor was approximately 3.5 times that found in the rats treated with medical chitosan hydrogel. In summary, electrospun PCL-amnion nanofibrous membranes can effectively reduce adhesion after neural surgery and promote nerve repair and regeneration. The long-term retention in vivo and sustained release of cytokines make PCL-amnion a promising biomaterial for clinical application.

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“…Neurosurgery is a field that has traditionally played a central role in the diagnosis and management of a wide range of disorders of the central and peripheral nervous system. However, in recent years, there has been a trend towards other specialties, such as neuroradiology and interventional radiology, otolaryngology, orthopedic and plastic surgery, and radiotherapy breaking into areas in which neurosurgeons have historically been leaders, such as such as pain and spasticity management, peripheral nerve surgery, stereotactic radiosurgery, high-intensity focused ultrasound (HIFU) ablation, spinal surgery, orbital surgery, and endovascular and carotid surgery ( Jeon and Kwon, 2008 ; Maniker and Passannante, 2003 ; Quadri et al, 2018 ; Rasulić, 2018 ; Yang et al, 2019 ). This phenomenon, which could be described as “scope creep” by other specialties, has implications not just for the profession but significantly for patient care, potentially leading to the underutilization of neurosurgical expertise in treating conditions in the aforementioned areas.…”

Section: Introductionmentioning

confidence: 99%

Revitalizing neurosurgical frontiers: The EANS frontiers in neurosurgery committee's strategic framework

Lawson McLean,

Vetrano,

Lawson McLean

et al. 2024

Brain and Spine

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Peripheral nerve surgery: the road less traveled

Cited by 11 publications

References 14 publications

UV-Casting on Methacrylated PCL for the Production of a Peripheral Nerve Implant Containing an Array of Porous Aligned Microchannels

UV-Casting on Methacrylated PCL for the Production of a Peripheral Nerve Implant Containing an Array of Porous Aligned Microchannels

Electrospun polycaprolactone (PCL)-amnion nanofibrous membrane prevents adhesions and promotes nerve repair in a rat model of sciatic nerve compression

Revitalizing neurosurgical frontiers: The EANS frontiers in neurosurgery committee's strategic framework

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