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Wen-qing Huang, Shi-ju Zheng, Qing-sheng Tian, Jian-qing Huang, Yu-xia Li, Qing-zhong Xu, Zi-jun Liu and Wen-cui Zhang

✓ The authors present a statistical survey of the general incidence, age distribution, and preferential sites of 25,122 tumors of the central nervous system (CNS), from 12 centers in China. Of these tumors, 22,457 were intracranial and the rest intraspinal.

Of the 22,457 intracranial neoplasms collected, tumors of neuroepithelial tissue comprised 43.85%, meningiomas 16.58%, tumors of nerve sheath cells 9.5%, pituitary adenoma 9.52%, congenital tumors 8.46%, secondary tumors 6.8%, vascular malformations and tumors 3.82%, and primary sarcomas 0.72%. Neuroepithelial and meningeal tumors occurred first and second in all series, but the other tumors varied in frequency. There was a higher incidence of nerve-sheath tumors in southern than in northern regions. The age distribution of Chinese patients with tumors of the CNS was lower than that of Caucasians: nearly two-thirds (64.57%) had the clinical onset of their tumor between the ages of 31 and 40 years, with the peak incidence at 35 years. Nearly 20% of tumors of the CNS occurred before 20 years of age. The male:female ratio was 1.53:1; the only tumor with a definite preponderance of females over males was the meningioma.

Intraspinal tumors derived from nerve sheaths comprised 47.13% of all tumors within the spinal canal. Meningiomas were second with an incidence of 14.06%, then followed congenital tumors (12.06%) and neoplasms of neuroepithelial tissue (10.83%). Secondary tumors, vascular malformations and neoplasms, and sarcoma were next in order of frequency with 4.6%, 4.5%, and 4.16%, respectively.

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Guo-Bao Wang, Ai-Ping Yu, Chye Yew Ng, Gao-Wei Lei, Xiao-Min Wang, Yan-Qun Qiu, Jun-Tao Feng, Tie Li, Qing-Zhong Chen, Qian-Ru He, Fei Ding, Shu-Sen Cui, Yu-Dong Gu, Jian-Guang Xu, Su Jiang and Wen-Dong Xu

OBJECTIVE

Contralateral C7 (CC7) nerve root has been used as a donor nerve for targeted neurotization in the treatment of total brachial plexus palsy (TBPP). The authors aimed to study the contribution of C7 to the innervation of specific upper-limb muscles and to explore the utility of C7 nerve root as a recipient nerve in the management of TBPP.

METHODS

This was a 2-part investigation. 1) Anatomical study: the C7 nerve root was dissected and its individual branches were traced to the muscles in 5 embalmed adult cadavers bilaterally. 2) Clinical series: 6 patients with TBPP underwent CC7 nerve transfer to the middle trunk of the injured side. Outcomes were evaluated with the modified Medical Research Council scale and electromyography studies.

RESULTS

In the anatomical study there were consistent and predominantly C7-derived nerve fibers in the lateral pectoral, thoracodorsal, and radial nerves. There was a minor contribution from C7 to the long thoracic nerve. The average distance from the C7 nerve root to the lateral pectoral nerve entry point of the pectoralis major was the shortest, at 10.3 ± 1.4 cm. In the clinical series the patients had been followed for a mean time of 30.8 ± 5.3 months postoperatively. At the latest follow-up, 5 of 6 patients regained M3 or higher power for shoulder adduction and elbow extension. Two patients regained M3 wrist extension. All regained some wrist and finger extension, but muscle strength was poor. Compound muscle action potentials were recorded from the pectoralis major at a mean follow-up of 6.7 ± 0.8 months; from the latissimus dorsi at 9.3 ± 1.4 months; from the triceps at 11.5 ± 1.4 months; from the wrist extensors at 17.2 ± 1.5 months; from the flexor carpi radialis at 17.0 ± 1.1 months; and from the digital extensors at 22.8 ± 2.0 months. The average sensory recovery of the index finger was S2. Transient paresthesia in the hand on the donor side, which resolved within 6 months postoperatively, was reported by all patients.

CONCLUSIONS

The C7 nerve root contributes consistently to the lateral pectoral nerve, the thoracodorsal nerve, and long head of the triceps branch of the radial nerve. CC7 to C7 nerve transfer is a reconstructive option in the overall management plan for TBPP. It was safe and effective in restoring shoulder adduction and elbow extension in this patient series. However, recoveries of wrist and finger extensions are poor.