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Related Experiment Video

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Modified Spared Nerve Injury Surgery Model of Neuropathic Pain in Mice
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Surgery for nerve injury: current and future perspectives.

Rajiv Midha1, Joey Grochmal2

  • 11Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada; and.

Journal of Neurosurgery
|March 6, 2019
PubMed
Summary

Nerve surgery has evolved from macroscopic exploration to microscopic techniques and nerve transfers. Distal-targeted nerve transfers offer improved outcomes for nerve injuries and show promise for central nervous system conditions.

Keywords:
AIN = anterior interosseous nerveCN = cranial nervePIN = posterior interosseous nerveSSN = suprascapular nervenerve graftingnerve transfersneurolysisperipheral nerve

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Area of Science:

  • Neurosurgery
  • Regenerative Medicine
  • Neuroscience

Background:

  • Nerve injury management has advanced significantly over the last century.
  • Early techniques involved macroscopic exploration and external neurolysis.
  • Modern approaches utilize microscopic dissection, internal neurolysis, and intraoperative electrophysiology.

Purpose of the Study:

  • To review the evolution of nerve surgery for nerve injuries.
  • To highlight current surgical management strategies, focusing on nerve transfers.
  • To discuss the potential of nerve transfers for central nervous system lesions.

Main Methods:

  • Review of historical and recent literature on nerve surgery techniques.
  • Analysis of the paradigm shift towards distal-targeted nerve transfers.
  • Emphasis on outcomes of nerve transfers for various nerve injuries.

Main Results:

  • Microscopic techniques and interfascicular nerve grafting improved nerve reconstruction outcomes.
  • Nerve transfers have become a preferred alternative, converting proximal injuries to distal ones for better regeneration.
  • Nerve transfers yield good to excellent results for brachial plexus and other proximal nerve injuries.
  • Emerging applications of nerve transfers for spinal cord injury and stroke show promise.

Conclusions:

  • Nerve transfers represent a paradigm shift in surgical nerve repair, offering superior functional recovery.
  • The rewiring approach with nerve transfers is expanding to CNS lesions, integrating with rehabilitation and neurotechnology.
  • The future of peripheral nerve repair and its application in CNS conditions is highly promising.