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Perineurial Window is Critical for Experimental Reverse End-to-Side Nerve Transfer
Tak-Ho Chu1,2, Saud Alzahrani1,2, Amanda McConnachie1,2
1Department of Clinical Neurosciences, University of Calgary, Calgary , Alberta , Canada.
Neurosurgery
|April 5, 2023
Summary
Creating a perineurial window during nerve repair surgery significantly improves donor axonal regeneration. This deep window technique in reverse end-to-side transfers (RETS) enhances nerve recovery for better surgical outcomes.
Area of Science:
- Neurosurgery
- Regenerative Medicine
- Nerve Repair
Background:
- The optimal depth for creating a connective tissue window in recipient nerves during reverse end-to-side transfers (RETS) is not well-established.
- Understanding this depth is crucial for maximizing nerve regeneration efficiency.
Purpose of the Study:
- To investigate how the depth of connective tissue disruption influences donor axonal regeneration in RETS.
- To determine the most effective surgical approach for enhancing nerve repair outcomes.
Main Methods:
- Utilized Sprague-Dawley rats undergoing obturator to femoral nerve RETS, divided into three groups based on epineurium and perineurium opening.
- Employed triple retrograde labeling to quantify regenerated motor neurons and Thy1-GFP rats with light sheet fluorescence microscopy to visualize axon pathways.
Main Results:
- Significantly higher numbers of regenerated motor neurons were observed in the group with both epineurium and perineurium opened (group 3) compared to groups with only epineurium opening or no opening.
- Immunohistochemistry confirmed varying degrees of connective tissue disruption, while optical clearing revealed axons predominantly within fascicles in group 3, and outside fascicles in groups 1 and 2.
Conclusions:
- Creating a perineurial window in recipient nerves is essential for robust donor axonal regeneration in RETS.
- This finding supports nerve surgeons in performing a deeper window during RETS procedures to optimize nerve regeneration and functional recovery.
