Researchers presented results today during the 81st American Association of Neurological Surgeons (AANS) Annual Scientific Meeting highlighting the effective use of nerve transfer in patients suffering from brachial plexus injuries for reconstruction of elbow flexion to help improve their quality of life.
With the rise in recent years of nerve transfers as an option for brachial plexus injuries, the researchers reviewed the clinical outcomes of their patients who have undergone different nerve transfers for restoration of elbow flexion between January 2001 and December 2011. Researchers retrospectively analyzed the medical records, electrophysiological examinations and radiological images of 107 patients who underwent nerve transfer operations in the aforementioned timeframe. Pre- and post-operative assessment of motor function was carried out using the Medical Research Council (MRC) grading scale. The results of this study, "10-year experience with nerve transfers for restoration of elbow function in patients with traumatic brachial plexus injuries," will be presented by Julia Oberhoffer, MD, on April 30. Co-authors are Gregor Antoniadis, PhD; Ralph König, PhD; Christian Heinen, MD; Thomas Kretschmer, PhD; Christian Wirtz, PhD; and Maria Pedro, MD.
During the time period reviewed, a total of 107 patients with a brachial plexus injury were treated by nerve transfer surgery in the researchers' institute, with seven patients lost to follow up. The average follow up was 23 months, and 49 percent of the patients recovered to MRC 3. The best results could be achieved by transferring the medial pectoral to musculocutaneous nerve (MCN), where 82 percent (n=11) recovered to MRC 3. Seventy-four percent of 31 patients who underwent an Oberlin transfer attained the same muscle strength and 80 percent of those patients (n=5) with median nerve to MCN regained MRC 3. The researchers did note that that the results of the following nerve transfers were not as encouraging: spinal accessory nerve to MCN (24 percent, N=45); phrenic nerve to MCN (17 percent, N=6); and intercostal to MCN (zero percent, N=2).
"The most important results we found in our evaluation was the significantly better outcome for the Oberlin procedure and the transfer of pectoral nerve to musculocutaneous nerve in contrast to transfer of spinal accessory nerve or phrenic nerve to musculocutaneous nerve," said Julia Oberhoffer, MD. "The reason for the huge advantage of these two transfers is the fact that you can coapt the nerve in an end-to-end way, so the nerves have to pass just one suture. Another important finding is the refutation of the well-established opinion that a nerve reconstruction has to be done as soon as possible. It only makes a difference when the reconstruction is done later than 10 months after the damage. So as plexus brachialis palsies are often devastating injuries, it is essential for the improvement of the quality of life for these patients that they will be transferred to a neurosurgical department within the first six months after a trauma, so that the operation can be conducted within the first 10 months. Furthermore a transfer where the nerves can be coapted through an end-to-end suture should always be the preferred procedure."
Dr. Oberhoffer added that "there is still no adequate explanation why some of the transfers of spinal accessory nerve to musculocutaneous nerve lead to good results and why the majority of them could not achieve a reinnervation of biceps muscle. From my point of view the main important goal for the future research is the detection of the differences between a successful outcome and a failed one to be able to appraise the operational outcome."
Materials provided by American Association of Neurological Surgeons (AANS). Note: Content may be edited for style and length.
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