Long-term ongoing cortical remodeling after contralateral C-7 nerve transfer

Clinical article

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Contralateral C-7 nerve transfer was developed for the treatment of patients with brachial plexus avulsion injury (BPAI). In the surgical procedure the affected recipient nerve is connected to the ipsilateral motor cortex, and the dramatic peripheral alteration may trigger extensive cortical reorganization. However, little is known about the long-term results after such specific nerve transfers. The purpose of this study was to investigate the long-term cortical adaptive plasticity after BPAI and contralateral C-7 nerve transfer.


In this study, 9 healthy male volunteers and 5 male patients who suffered from right-sided BPAI and had undergone contralateral C-7-transfer more than 5 years earlier were included. Functional MRI studies were used for the investigation of long-term cerebral plasticity.


The neuroimaging results suggested that the ongoing cortical remodeling process after contralateral C-7 nerve transfer could last for a long period; at least for 5 years. The motor control of the reinnervated limb may finally transfer from the ipsilateral to the contralateral hemisphere exclusively, instead of the bilateral neural network activation.


The authors believe that the cortical remodeling may last for a long period after peripheral rearrangement and that the successful cortical transfer is the foundation of the independent motor recovery.

Abbreviations used in this paper:BPAI = brachial plexus avulsion injury; fMRI = functional MRI; SMA = supplementary motor area.
Article Information

Contributor Notes

* Drs. Hua and B. Liu contributed equally to this work.Address correspondence to: Wen-Dong Xu, M.D., Ph.D., Department of Hand Surgery, Huashan Hospital, 12 Wulumuqi Middle Road, Shanghai 200040, People's Republic of China. email: wendongxu88@yahoo.com.cn.Please include this information when citing this paper: published online February 1, 2013; DOI: 10.3171/2012.12.JNS12207.

© AANS, except where prohibited by US copyright law.

  • 1

    Beaulieu JYBlustajn JTeboul FBaud PDe Schonen SThiebaud JB: Cerebral plasticity in crossed C7 grafts of the brachial plexus: an fMRI study. Microsurgery 26:3033102006

    • Search Google Scholar
    • Export Citation
  • 2

    Chuang DCWei FCNoordhoff MS: Cross-chest C7 nerve grafting followed by free muscle transplantations for the treatment of total avulsed brachial plexus injuries: a preliminary report. Plast Reconstr Surg 92:7177271993

    • Search Google Scholar
    • Export Citation
  • 3

    Gu YDZhang GMChen DSYan JGCheng XMChen L: Seventh cervical nerve root transfer from the contralateral healthy side for treatment of brachial plexus root avulsion. J Hand Surg Br 17:5185211992

    • Search Google Scholar
    • Export Citation
  • 4

    Lou LShou TLi ZLi WGu Y: Transhemispheric functional reorganization of the motor cortex induced by the peripheral contralateral nerve transfer to the injured arm. Neuroscience 138:122512312006

    • Search Google Scholar
    • Export Citation
  • 5

    Lundborg GRosén B: Hand function after nerve repair. Acta Physiol (Oxf) 189:2072172007

  • 6

    Malessy MJBakker DDekker AJVan Duk JGThomeer RT: Functional magnetic resonance imaging and control over the biceps muscle after intercostal-musculocutaneous nerve transfer. J Neurosurg 98:2612682003

    • Search Google Scholar
    • Export Citation
  • 7

    Narakas AO: Thoughts on neurotization or nerve transfers in irreparable nerve lesions. Clin Plast Surg 11:1531591984

  • 8

    Navarro XVivó MValero-Cabré A: Neural plasticity after peripheral nerve injury and regeneration. Prog Neurobiol 82:1632012007

    • Search Google Scholar
    • Export Citation
  • 9

    Shin HCWon CKJung SCOh SPark SSohn JH: Interhemispheric modulation of sensory transmission in the primary somatosensory cortex of rats. Neurosci Lett 230:1371391997

    • Search Google Scholar
    • Export Citation
  • 10

    Songcharoen PWongtrakul SMahaisavariya BSpinner RJ: Hemi-contralateral C7 transfer to median nerve in the treatment of root avulsion brachial plexus injury. J Hand Surg Am 26:105810642001

    • Search Google Scholar
    • Export Citation
  • 11

    Terzis JKKostopoulos VK: The surgical treatment of brachial plexus injuries in adults. Plast Reconstr Surg 119:73e 92e2007

  • 12

    Zuo CTHua XYGuan YHXu WDXu JGGu YD: Long-range plasticity between intact hemispheres after contralateral cervical nerve transfer in humans. Clinical article. J Neurosurg 113:1331402010

    • Search Google Scholar
    • Export Citation
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