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Super-selective cervical nerve root stimulation in contralateral C7 transfer: An intraoperative study.
Nora Franziska Dengler1, Gregor Antoniadis2, Christian Heinen3
1Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Summary
Super-selective nerve root stimulation helps guide C7 nerve root transfer in patients with cervical injuries. This technique minimizes donor site complications by mapping individual nerve contributions, reducing surgical risks.
Area of Science:
- Neurosurgery
- Nerve Transfer Surgery
- Electrophysiology
Background:
- Multiple cervical root avulsion injuries present complex reconstructive challenges.
- Contralateral C7 (cC7) nerve root transfer is a common surgical strategy.
- Optimizing donor site selection is crucial to minimize morbidity.
Purpose of the Study:
- To evaluate super-selective intraoperative cervical nerve root stimulation for decision-making in cC7 nerve root transfer.
- To map individual nerve root contributions to specific muscles.
- To assess the impact of this technique on donor site morbidity.
Main Methods:
- Super-selective intraoperative stimulation of cervical nerve roots (C5-C8) was performed.
- Compound muscle action potentials (CMAPs) were recorded from multiple upper extremity muscles.
- Muscle strength was assessed pre- and post-operatively using the MRC scale.
Main Results:
- Specific nerve root stimulations elicited varying CMAP amplitudes in target muscles.
- The posterior aspect of C5 significantly influenced deltoid CMAPs.
- The lateral aspect of C7 maximally stimulated the triceps brachii.
- Individual innervation patterns showed significant variability.
Conclusions:
- Super-selective intraoperative stimulation aids in minimizing donor site morbidity during nerve transfer procedures.
- Understanding individual cervical nerve root innervation patterns is essential for future electrophysiological studies and surgical planning.
