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PubMed1984

Nerve growth factor-mediated induction of choline acetyltransferase in PC12 cells: evaluation of the site of action of nerve growth factor and the involvement of lysosomal degradation products of nerve growth factor.

In previous experiments it has been demonstrated that nerve growth factor (NGF), subsequent to its binding to specific membrane receptors, is internalized. Ultrastructurally, this internalized NGF is localized in membrane-confined compartments which ultimately fuse with lysosomes. The present experiments were designed, first, to evaluate whether a very small but functionally important portion of the internalized NGF might reach the free cytoplasm (and subsequently the nuclear chromatin) and might be responsible for the induction of choline acetyltransferase (ChAT) in PC12 cells. Second, we investigated whether a lysosomal proteolytic degradation product of NGF might act as a second messenger in the NGF-mediated ChAT induction. In one series of experiments, guinea pig erythrocyte ghosts, loaded with NGF (or NGF antibodies), fluorescein isothiocyanate-coupled bovine serum albumin, and/or horseradish peroxidase (HRP) were fused with PC12 pheochromocytoma cells. Electron microscopy showed that [125I]NGF and HRP reaction product were located throughout the cytoplasm and the nucleus but did not penetrate membrane compartments such as the endoplasmic reticulum, the Golgi complex, the perinuclear space, or mitochondria. Biochemically, NGF injected into the cytoplasm did not produce an induction of ChAT, whereas NGF acting via cell surface receptors resulted in a 2-fold increase in ChAT. Conversely, injection of NGF antibodies did not prevent the receptor-mediated ChAT induction. In a second series of experiments, the half-life of internalized NGF was increased from 40 min to 24 hr by the administration of leupeptin, a protease inhibitor which is accumulated in lysosomes. However, the NGF-mediated ChAT induction was not affected by this treatment. It is concluded that NGF itself does not act directly on cytoplasmic or nuclear target sites, nor is a proteolytic degradation product of NGF responsible for the NGF-mediated ChAT induction. Thus, NGF must act via a second messenger mechanism, the nature of which remains to be established.

Choline O-Acetyltransferase↗
PubMed2006

Lack of topographic specificity in nerve fiber regeneration of rat forelimb mixed nerves.

Multiple nerve repair by means of a Y-shaped nerve guide represents a good model for studying the specificity of peripheral nerve fiber regeneration. Here we have used it for investigating the specificity of axonal regeneration in mixed nerves of the rat forelimb model. The left median and ulnar nerves, in adult female rats, were transected and repaired with a 14-mm Y-shaped conduit. The proximal end of the Y-shaped conduit was sutured to the proximal stump of either the median nerve or the ulnar nerve. Ten months after surgery, rats were tested for functional recovery of each median and ulnar nerve. Quantitative morphology of regenerated myelinated nerve fibers was then carried out by the two-dimensional disector technique. Results showed that partial recovery of both median and ulnar nerve motor function was regained in all experimental groups. Performance in the grasping test was significantly lower when the ulnar nerve was used as the proximal stump. Ulnar test assessment showed no significant difference between the two Y-shaped repair groups. The number of regenerated nerve fibers was significantly higher in the median nerve irrespectively of the donor nerve, maintaining the same proportion of myelinated fibers between the two nerves (about 60% median and 40% ulnar). On the other hand, nerve fiber size and myelin thickness were significantly larger in both distal nerves when the median nerve was used as the proximal donor nerve stump. G-ratio and myelin thickness/axon diameter ratio returned to normal values in all experimental groups. These results demonstrate that combined Y-shaped-tubulization repair of median and ulnar nerves permits the functional recovery of both nerves, independently from the proximal donor nerve employed, and that tissue, and not topographic, specificity guides nerve fiber regeneration in major forelimb mixed nerves of rats.

Animals↗
PubMed2003

Lingual nerve damage due to inferior alveolar nerve blocks: a possible explanation.

BACKGROUND: An explanation for the predominance of injuries to lingual nerves over those to inferior alveolar nerves as a result of inferior alveolar nerve blocks may be due to the nerves' fascicular pattern. A unifascicular nerve may be injured more easily than a multifascicular nerve. METHODS: The authors unilaterally dissected lingual and inferior alveolar nerves from 12 cadavers. They cut the specimens 2 millimeters above the lingula for both the lingual nerve and inferior alveolar nerve and opposite the site of the middle of the third molar for the lingual nerve, and they counted the number of fascicles at each site. RESULTS: For the lingual nerve at the lingula, the mean number of fascicles was three (range, one to eight). Four of the 12 nerves (33 percent) were unifascicular at this point. Opposite the third molar, the lingual nerve had a mean of 20 fascicles (range, six to 39). In every case, there were more fascicles in the third molar region than above the lingula in the same nerve. At the lingula, the inferior alveolar nerve had a mean of 7.2 fascicles (range, three to 14). CONCLUSION: This study may explain the observation that when an inferior alveolar nerve block causes permanent nerve impairment, the lingual nerve is affected about 70 percent of the time and the inferior alveolar nerve is affected only 30 percent of the time. In 33 percent of cases, the lingual nerve had only one fascicle at the lingula; a unifascicular nerve may be injured more easily than a multifascicular one. CLINICAL IMPLICATIONS: There is no known way to avoid the remote possibility of nerve damage resulting from an inferior alveolar nerve block. The lingual nerve may be predominantly affected because of its fascicular pattern.

Anesthesia, Dental↗
PubMed2003

Promoting nerve regeneration through long gaps using a small nerve tissue graft.

BACKGROUND: If nerve tissue is capable of inducing regeneration, as suggested by the neurotropism theory, then even small pieces of nerve tissue should have the potential to induce nerve regeneration. Therefore, long gaps might presumably be bridged via the neurotrophic potential of small pieces of nerve tissue grafted into the middle of the nerve gap. It is necessary to confirm the validity of the neurotropism theory and to also explore the potential usefulness of small nerve grafting through long gaps. METHODS: A small piece of nerve tissue was grafted into a silicone tube bridging a relatively long nerve gap in an attempt to promote nerve regeneration. A 15-mm gap was created in the left sciatic nerve of 31 Wistar rats (8 weeks of age). The experimental groups included one with nonvascularized nerve tissue grafted into a silicone tube with no distal nerve suturing (NV-A), another with vascularized nerve tissue grafted into a silicone tube with no distal nerve suturing (V-A), a third group with nonvascularized nerve tissue grafted into a silicone tube with distal nerve suturing (NV-P), a fourth group with vascularized nerve tissue grafted into a silicone tube with distal nerve suturing (V-P), and a group with no nerve segment grafted into the silicone tube (control). Electrophysiologic and histologic examinations were performed 10 weeks after the operation. RESULTS: No regeneration was obtained in the control group. Nerve regeneration was evident at the proximal end of the tube in the NV-A, V-A, NV-P, and V-P groups, and at the distal end in the NV-P and V-P groups. The degree of distal regeneration was extremely slight in the NV-A and V-A groups. An electrophysiologic examination performed in the NV-P and V-P groups revealed better results in the latter group. CONCLUSION: Small nerve grafts are capable of inducing nerve regeneration even over a long nerve gap, by grafting nerve tissue into the middle of the lesion using a silicone tube.

Animals↗
PubMed1990

Peripheral nerve pathways to neurons in the guinea pig inferior mesenteric ganglion determined electrophysiologically after chronic nerve section.

Peripheral synaptic pathways to neurons in the guinea pig inferior mesenteric ganglion (IMG) were studied. Nerve trunks innervating neurons in the ganglion were surgically sectioned and intracellular electrical responses to nerve stimulation were measured 6-8 days after surgery. In all animals ganglia were decentralized by removal of the lumbar sympathetic chain ganglia L2 through L4 and in addition two peripheral nerves were sectioned leaving the ganglion innervated by only one peripheral nerve. Fast and slow excitatory postsynaptic potential (EPSP) were evoked with electrical stimulation of each of the nerve trunks and with distension of the colon. The thresholds to evoke fast EPSPs and the amplitude of slow EPSPs were compared for each nerve trunk among the different surgical groups including sham-operated controls and completely denervated ganglia. Both fast and slow EPSPs could be evoked electrically from each intact peripheral nerve trunk after the other three nerve trunks had been sectioned, which demonstrates that nerve fibers with cell bodies in the regions innervated by the peripheral nerves make functional synaptic connections with neurons in the inferior mesenteric ganglion. In general, nerve sections increased the threshold for evoking fast EPSPs and decreased the amplitude of electrically-evoked slow EPSPs compared to control ganglia. Synaptic potentials could also be evoked with stimulation of cut nerve trunks, demonstrating that branches of nerve fibers from peripheral nerves enter other nerve trunks. The hypogastric nerve was unique in that branches of axons eliciting fast but not slow synaptic potentials in the ganglion entered this nerve trunk. Distension-induced fast and slow EPSPs were present only if the lumbar colonic nerve was intact and they were not altered by section of the other nerve trunks. In contrast, the slow EPSPs evoked with electrical stimulation of the lumbar colonic nerve were significantly smaller when at least one other nerve trunk was sectioned suggesting that the axon branches from other nerve trunks which enter the lumbar colonic nerve are not activated by distension. These studies demonstrate that neurons eliciting either fast or slow synaptic potentials with cell bodies in regions innervated by the peripheral nerve trunks make functional synaptic connections with neurons of the inferior mesenteric ganglion. The results also suggest that the majority of mechanosensory neurons mediating excitatory synaptic responses to colon distension are neurons with a peripheral cell body.

Action Potentials↗
PubMed1997

Value of nerve action potentials in the surgical management of traumatic nerve lesions.

OBJECTIVE: The goals of the study were to investigate the value of intraoperative electrically evoked nerve action potentials (NAPs) in the surgical treatment of traumatic peripheral nerve injuries (nerve lesions in continuity). METHODS: Sixty-four patients with 76 traumatic nerve lesions in continuity were investigated intraoperatively by stimulating and recording NAP from the whole nerve across the suspected lesion site. Among the 76 nerves (nerve lesions) were 43 with incomplete and 33 with complete loss of function. In cases (nerves) with complete loss of function (n = 33), the surgical procedure (external neurolysis, internal neurolysis, or nerve repair) was performed according to the microscopic aspect of the nerve and the result of the intraoperative electrophysiological testing. In cases (nerves) with incomplete loss of function (n = 43), the surgical procedure was performed solely according to the microscopic aspect of the nerve and independently from the result of the intraoperative electrophysiological testing. RESULTS: Of 43 nerves with incomplete loss of function, we were able to record reproducible NAPs in 41 (95%) across the lesion site, thus demonstrating a high reliability of the method. Of 33 nerves with complete loss of function, a reproducible NAP could be recorded only in 3. Assuming an axonotmetic lesion in regeneration, we did nothing else on the nerve with excellent clinical results (full recovery). Of the remaining nerves with no NAP, 24 showed a caliber shift of the nerve (in 20 cases a thickening of the nerve, suggesting a neuroma in continuity). A grafting procedure was performed, and the histological evaluation revealed a neurotmetic lesion. However, in six patients with no NAP, there was no clear caliber shift of the nerve. The epineurium was opened and an internal neurolysis performed showing fascicles in continuity. Three patients had good and three had partial (but useful) recovery. CONCLUSIONS: In nerve lesions in continuity with complete loss of nerve function, intraoperative NAPs are able to detect axonotmetic lesions in regeneration. Thus, unnecessary further surgical procedures can be avoided. On the other end of the spectrum, no recordable NAP together with a caliber shift of the nerve (suggesting a neuroma in continuity) may facilitate the surgeon's decision for a grafting procedure without a time-consuming internal neurolysis. But there is also evidence from our data that not every nerve lesion in continuity without a NAP needs to be grafted.

Action Potentials↗
PubMed1988

Spinal nerve root origins of the cutaneous nerves of the canine pelvic limb.

The spinal nerve root origins of the cutaneous nerves innervating the canine pelvic limb were determined in 12 barbiturate-anesthetized, healthy dogs by stimulating the dorsal roots L1-S3 and recording the evoked-action potentials from each cutaneous nerve. The dogs were then euthanatized, identification of each dorsal root and cutaneous nerve was verified by dissection, and the type of lumbosacral plexus (prefixed, median fixed, or postfixed) was determined. With one exception, the dorsal cutaneous branches and lateral cutaneous branches of L1-L3 originated only from their corresponding spinal nerve roots. The genitofemoral nerve received afferent fibers predominantly from L3-L4 nerve roots. The lateral cutaneous femoral nerve originated from L3-L5 nerve roots, and the saphenous nerve from L4-L6 nerve roots. The proximal caudal cutaneous sural nerve originated from L6-S1. The lateral cutaneous sural nerve originated from L5-S1; the deep and superficial fibular nerves arose primarily from L6-L7. The distal caudal cutaneous sural nerve originated predominantly from L7-S1, and the medial cutaneous tarsal nerve originated from L6-S1. The medial plantar nerve originated predominantly from L6-S1 roots, whereas the lateral plantar nerve originated from L6-S2 roots. The middle clunial nerve received afferent fibers primarily from S1-S2; the caudal clunial nerve received fibers from S1-S3. The caudal cutaneous femoral nerve originated predominantly from L7-S2. The dorsal nerve of the penis originated predominantly from S1-S2, and the superficial perineal nerve originated from S1-S3. One dog had a prefixed plexus, 8 dogs had median-fixed plexuses, and 1 dog had a postfixed plexus.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1996

Peripheral nerve explants grafted into the vitreous body of the eye promote the regeneration of retinal ganglion cell axons severed in the optic nerve.

We have conducted experiments in the adult rat visual system to assess the relative importance of an absence of trophic factors versus the presence of putative growth inhibitory molecules for the failure of regeneration of CNS axons after injury. The experiments comprised three groups of animals in which all optic nerves were crushed intra-orbitally: an optic nerve crush group had a sham implant-operation on the eye; the other two groups had peripheral nerve tissue introduced into the vitreous body; in an acellular peripheral nerve group, a frozen/thawed teased sciatic nerve segment was grafted, and in a cellular peripheral nerve group, a predegenerate teased segment of sciatic nerve was implanted. The rats were left for 20 days and their optic nerves and retinae prepared for immunohistochemical examination of both the reaction to injury of axons and glia in the nerve and also the viability of Schwann cells in the grafts. Anterograde axon tracing with rhodamine-B provided unequivocal qualitative evidence of regeneration in each group, and retrograde HRP tracing gave a measure of the numbers of axons growing across the lesion by counting HRP filled retinal ganglion cells in retinal whole mounts after HRP injection into the optic nerve distal to the lesion. No fibres crossed the lesion in the optic nerve crush group and dense scar tissue was formed in the wound site. GAP-43-positive and rhodamine-B filled axons in the acellular peripheral nerve and cellular peripheral nerve groups traversed the lesion and grew distally. There were greater numbers of regenerating fibres in the cellular peripheral nerve compared to the acellular peripheral nerve group. In the former, 0.6-10% of the retinal ganglion cell population regenerated axons at least 3-4 mm into the distal segment. In both the acellular peripheral nerve and cellular peripheral nerve groups, no basal lamina was deposited in the wound. Thus, although astrocyte processes were stacked around the lesion edge, a glia limitans was not formed. These observations suggest that regenerating fibres may interfere with scarring. Viable Schwann cells were found in the vitreal grafts in the cellular peripheral nerve group only, supporting the proposition that Schwann cell derived trophic molecules secreted into the vitreous stimulated retinal ganglion cell axon growth in the severed optic nerve. The regenerative response of acellular peripheral nerve-transplanted animals was probably promoted by residual amounts of these molecules present in the transplants after freezing and thawing. In the optic nerves of all groups the astrocyte, microglia and macrophage reactions were similar. Moreover, oligodendrocytes and myelin debris were also uniformly distributed throughout all nerves. Our results suggest either that none of the above elements inhibit CNS regeneration after perineuronal neurotrophin delivery, or that the latter, in addition to mobilising and maintaining regeneration, also down regulates the expression of axonal growth cone-located receptors, which normally mediate growth arrest by engaging putative growth inhibitory molecules of the CNS neuropil.

Animals↗
PubMed2000

Results of nerve transfers to the musculocutaneous and axillary nerves.

OBJECTIVE: Nerve transfers in cases of brachial plexus traction injuries with avulsion of spinal nerve roots or irreparable proximal lesions of spinal nerves have been attempted using a variety of donor nerves. The purpose of this study was to analyze the results of nerve transfers to the musculocutaneous and axillary nerves, using collateral branches of the brachial plexus, upper intercostal nerves, or the accessory nerve. METHODS: This study included 62 patients with brachial plexus traction injuries who were surgically treated using various nerve transfer techniques. The follow-up periods were at least 3 years. Analysis of motor recovery was performed according to the type of donor nerve, the age of the patient, and the timing of surgery. RESULTS: The rates of recovery for the musculocutaneous and axillary nerves were 50% and 63.2% with intercostal nerve transfers, 65% and 75% with accessory nerve transfers, and 90.4% and 86.9% with nerve transfers of collateral branches, respectively. Despite the obviously better outcomes with the latter technique, a significant difference was found only in comparison with intercostal nerve transfers for the musculocutaneous nerve (P = 0.007). With respect to the quality of recovery, we found a significant difference between the latter type and the other two types of nerve transfers only for the musculocutaneous nerve (P = 0.027 for intercostal nerve transfers and P = 0.05 for accessory nerve transfers). There was no significant difference in results obtained using the thoracodorsal and medial pectoral nerves as donors. CONCLUSION: Our findings suggest that nerve transfer of collateral branches when possible, such as in cases involving upper brachial plexus palsy, may be the method of choice, yielding better results.

Accessory Nerve↗
PubMed1994

Locations of postganglionic nerve cells whose axons enter nerves originating from prevertebral ganglia.

Major nerve trunks that supply abdominal viscera contain axons of postganglionic neurons that originate in the coeliac ganglion, superior mesenteric ganglion, inferior mesenteric ganglia, hypogastric nerve ganglia and the sympathetic chain ganglia. Using the retrogradely transported neuronal marker Fast Blue, we mapped the distribution of labelled nerve cells after application of the dye to either the superior coeliac nerves, inferior coeliac nerves, superior mesenteric nerve, colonic nerves or hypogastric nerves. Distinctive patterns of nerve cell locations were associated with each nerve trunk. Within the coeliac ganglion, nerve cells that projected into the superior coeliac nerves were almost exclusively lateral, whilst neurons in the medial part of the coeliac ganglion and in the rostral pole of the superior mesenteric ganglion tended to project into the inferior coeliac nerves. Nerve cells located around the emerging superior mesenteric nerve in the superior mesenteric ganglion contributed the majority of axons to that nerve. Cells in both poles of the inferior mesenteric ganglia contributed the majority of postganglionic axons to the colonic nerves, but some cells in the caudal pole of the superior mesenteric ganglion also projected into the colonic nerves. Postganglionic axons in the hypogastric nerves originated from cells predominantly located in the caudal pole of the inferior mesenteric ganglion; however, cells in the rostral pole of the inferior mesenteric ganglia, the superior mesenteric, coeliac and hypogastric nerve ganglia also contributed some axons. Nerve cells of sympathetic chain ganglia projected into each of the nerve trunks; they were distributed rostro-caudally according to the nerve injected.

Animals↗
PubMed2003

Chronic response of the rat sciatic nerve to the flat interface nerve electrode.

The chronic effects of a reshaping nerve electrode, the flat interface nerve electrode (FINE), on sciatic nerve physiology, histology, and blood-nerve barrier (BNB) are presented. The FINE electrode applies a small force to a nerve to reshape the nerve and fascicles into elongated ovals. This increases the interface between the nerve and electrode for selective stimulation and recording of peripheral nerve activity. The hypothesis of this study is that a small force applied noncircumferentially to a nerve can chronically reshape the nerve without effecting nerve physiology, histology, or the blood-nerve barrier permeability. Three FINE electrode designs were implanted on rat sciatic nerves to examine the nerve's response to small, moderate, and high reshaping forces. The chronic reshaping, physiology, and histology of the nerve were examined at 1, 7, and 28 days postimplant. All FINEs significantly reshape both the nerve and the fascicles compared to controls. FINEs that applied high forces caused a neurapraxia type injury characterized by changes in the animal's footprint, nerve histology, and the BNB permeability. The physiological changes were greatest at 7 days and fully recover to normal by 14 days postimplant. The moderate force FINE did not result in changes in the footprint or BNB permeability. Only a minor decrease in axon density without accompanying evidence of axon demyelination or regeneration was observe for the moderate force. The small force FINE does not cause any change in nerve physiology, histology, or BNB permeability compared to the sham treatment. An electrode that applies a small force that results in an estimated intrafascicular pressure of less than 30 mm Hg can reshape the nerve without significant changes in the nerve physiology or histology. These results support the conclusion that a small force chronically applied to the nerve reshapes the nerve without injury.

Animals↗
PubMed1997

Ultrastructural changes in the nerve fiber population of anastomosed vagal and spinal accessory nerves in the sheep.

BACKGROUND: The ultrastructure of the vagal and spinal accessory nerves was studied 1) in normal sheep and 2) in sheep in which an experimental crossed-nerve anastomosis had been made by sectioning the supranodose vagal and spinal accessory nerves, then suturing the distal end of the vagal nerve to the distal end of the spinal accessory nerve, and allowing time for regeneration to occur. This study was carried out in order to analyze the modifications liable to occur when this technique is used and to specify the origin and the nature of the fibers that colonize the spinal accessory nerve. METHODS: The study was performed in 4- to 5-month-old-sheep. After the surgical procedure, the animals were housed indoors during 1 year until their sacrifice by fixative perfusion. Then, nerve samples were dissected out, processed for electron microscopy, examined, and systematically photographed. After printing, the diameters of the nerve fibers were determined. RESULTS: In sheep, the ratios of nonmyelinated to myelinated fibers (NF/MF) in the infranodose and supranodose vagal nerve and accessory spinal nerve were 1.21, 1.67, and 3.21, respectively. In both parts of the vagal nerve, the myelinated fibers had a unimodal diameter distribution around a peak of 4 microns; whereas, in the spinal accessory nerve, they were distributed bimodally, and 53% had values of 15-18 microns. After making the above anastomosis, the centrifugal vagal fibers degenerated, and the NF/MF ratios increased in the centripetal infranodose vagal nerve, in the reinnervating supranodose vagal nerve, and in the reinnervated spinal accessory nerve (approximately 1.87, 1.72, and 6.04, respectively). In all of these nerves, the myelinated fibers had a unimodal distribution with a peak at 4 microns, as in the vagal nerve of normal sheep. CONCLUSIONS: These results reveal the large part taken by the nonmyelinated fibers in the nerve fiber population of the vagal nerve and support the vagal origin of the fibers reinnervating the spinal accessory nerve.

Accessory Nerve↗
PubMed1999

Anatomic basis of vascularised nerve grafts: the blood supply of peripheral nerves.

The present study was carried out on 30 cadavers (5 fresh, 20 preserved adult and 5 fresh stillborn) following injection of red latex through the subclavian and common iliac arteries. The blood supply to the peripheral nerves was studied in general, together with the vascular pedicles to the ulnar, saphenous, sural, deep and superficial peroneal nerves, and the superficial branch of the radial nerve. The nutrient arteries supplying the peripheral nerves came from either the adjacent axial artery or the fasciocutaneous or muscular arteries. They formed anastomotic channels in the epineurium and penetrated it to form a continuous longitudinal artery. Based on the presence of absence of dominant arterial pedicles, five patterns of blood-supply to the nerves could be identified. I: no dominant arterial pedicle; II: only one dominant artery (e.g. artery with a diameter more than 0.8 mm and accompanying the nerve for most of its length); III: only one dominant vessel that divided into ascending and descending branches to supply the nerve; IV: multiple dominant pedicles; V: multiple dominant arterial pedicles forming a continuous artery that accompanied the nerve. The arterial pedicles to the ulnar, saphenous and deep peroneal nerves and the superficial branch of the radial n. had mean diameters of over 0.8 mm, thus being suitable for microvascular anastomosis. Those to the sural nerve were not present in two thirds of the dissected cadavers. In 10% of the cadavers the superficial peroneal nerve had an arterial pedicle that accompanied the nerve for less than two cm with a mean diameter less than 0.8 mm. The ulnar nerve could be very suitable as a donor vascularized nerve graft as it had a dominant vascular pedicle in all the cases studied; however, its use should be restricted to C8 and T1 root damage of the brachial plexus. The superficial branch of the radial n. might be suitable for vascularized nerve grafting, but this is difficult in practice since the radial artery is a major limb artery. The saphenous nerve had a dominant arterial pedicles in all the cadavers dissected and could be the most suitable as a donor vascularized nerve graft, unlike the sural nerve which did not have a dominant arterial pedicle in two-thirds of the specimens. The deep and superficial peroneal nerves may also be unsuitable since the former is accompanied by a major limb vessel while the latter had a dominant vascular pedicle that accompanied the nerve for only a short distance in 10% of the dissected cadavers.

Aged↗
PubMed2002

The harvest and clinical application of the superficial peroneal sensory nerve for grafting motor and sensory nerve defects.

Potential donor nerves for autografting are finite and usually limited to cutaneous nerves of the extremities. The superficial peroneal nerve is the major lateral branch of the common peroneal nerve that innervates the peroneus longus and brevis muscles and provides sensation to the lateral aspect of the lower leg and the dorsal foot. It has generally been overlooked as a potential donor of nerve autografts. Cadaver dissections were performed on 10 fresh lower extremity specimens to investigate the anatomic characteristics of the superficial peroneal nerve and to refine a harvesting technique for the nerve. Thirty-one patients underwent nerve grafting of 39 upper and lower extremity nerves using the superficial peroneal donor. There were nine median nerves, four ulnar nerves, two radial nerves, two brachial plexus lesions, 16 digital nerves, and six lower extremity nerves grafted. The superficial peroneal nerve provided a consistently long donor, comparable in length to the sural nerve. The anatomic pattern is consistent, the patient positioning is simple, the surgical harvesting technique is straightforward, and the donor defect is acceptable. The superficial peroneal nerve provides a safe and valuable donor nerve, particularly in cases where multiple or very long nerve grafts are required.

Adolescent↗
PubMed2001

External laryngeal nerve in thyroid surgery: is the nerve stimulator necessary?

OBJECTIVE: To find out the incidence and type of external laryngeal nerves during operations on the thyroid, and to assess the role of a nerve stimulator in detecting them. DESIGN: Prospective, non-randomised study. SETTING: Teaching hospital, Malaysia. SUBJECTS: 317 patients who had 447 dissections between early January 1998 and late November 1999. MAIN OUTCOME MEASURES: Number and type of nerves crossing the cricothyroid space, and the usefulness of the nerve stimulator in finding them. RESULTS: The nerve stimulator was used in 206/447 dissections (46%). 392 external laryngeal nerves were seen (88%), of which 196/206 (95%) were detected with the stimulator. However, without the stimulator 196 nerves were detected out of 241 dissections (81%). The stimulator detected 47 (23%) Type I nerves (nerve > 1 cm from the upper edge of superior pole); 86 (42%) Type IIa nerves (nerve < 1 cm from the upper edge of superior pole); and 63 (31%) Type IIb nerves (nerve below upper edge of superior pole). 10 nerves were not detected. When the stimulator was not used the corresponding figures were 32 (13%), 113 (47%), and 51 (21%), and 45 nerves were not seen. If the nerve cannot be found we recommend dissection of capsule close to the medial border of the upper pole of the thyroid to avoid injury to the nerve. CONCLUSION: Although the use of the nerve stimulator seems desirable, it confers no added advantage in finding the nerve. In the event of uncertainty about whether a structure is the nerve, the stimulator may help to confirm it. However, exposure of the cricothyroid space is most important for good exposure in searching for the external laryngeal nerve.

Adolescent↗