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Jayme A. Bertelli and Marcos F. Ghizoni

T he treatment of avulsion injuries to the brachial plexus remains a clinical challenge. To reinnervate upper limb muscles, several kinds of nerve transfers have been tried. Some results are encouraging, but they are far from satisfactory. 17 In traction injuries to the brachial plexus, surgeons generally wait at least 3 months before making the decision to operate, to exclude spontaneous regeneration because of neurapraxic lesions. Nevertheless, as early as 2 months after avulsion injuries to the nerve roots, a 60% motor neuron loss is often demonstrated. 10

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Haodong Lin, Duanqing Lv, Chunlin Hou and Desong Chen

authors: Hou. This article contains some figures that are displayed in color online but in black and white in the print edition. References 1 Belzberg AJ , Dorsi MJ , Storm PB , Moriarity JL : Surgical repair of brachial plexus injury: a multinational survey of experienced peripheral nerve surgeons . J Neurosurg 101 : 365 – 376 , 2004 2 Bertelli JA , Ghizoni MF : Selective motor hyperreinnervation by using contralateral C-7 motor rootlets in the reconstruction of an avulsion injury of the brachial plexus. Case report . J Neurosurg 90

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Thomas Carlstedt, V. Peter Misra, Anastasia Papadaki, Donald McRobbie and Praveen Anand

spinal cord after spinal root avulsion injury was first reported in 1995. 5 This type of spinal cord surgery, in which motor but not sensory conduits are reconstructed, is currently performed in patients with complete or subtotal brachial plexus avulsion injuries, with a good outcome in terms of hand function. 2 , 4 Recent studies of CNS activities in patients with restored motor function without sensation have demonstrated cortical plasticity and the use of preinjury-established cortical sensory programs for motor performance. 6 Several attempts to restore

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Allan H. Friedman, James A. Nunley II, Richard D. Goldner, W. Jerry Oakes, J. Leonard Goldner and James R. Urbaniak

avulsion injuries by transposing intercostal nerves to the musculocutaneous nerve in 16 patients and to a free flap of gracilis muscle in four patients. In this communication we describe the results of these procedures. Clinical Material and Methods Patient Population The series included 19 males and one female with ages ranging from 7 to 43 years ( Table 1 ). Fifteen patients were injured in motor-vehicle accidents, one in an airplane crash, and four in falls. The time interval between the initial injury and the patients' reconstructive surgery varied from 3

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Keisuke Takai and Makoto Taniguchi

P ain in the upper extremities due to root avulsion injury is caused by the hyperexcitability of deafferentated neurons related to pain conduction in the posterior horn of spinal gray matter. Pain due to root avulsion injury is defined as neuropathic pain in the CNS and is intractable and refractory to various types of medical and surgical treatments. 3 Dorsal root entry zone (DREZ) lesioning, i.e., coagulation of the DREZ by a thermocoagulation electrode 4 , 8 or microsurgical bipolar coagulation, 9 was developed in the 1970s and has been the most effective

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Rahul K. Nath, Andrew B. Lyons and Gabriel Bietz

D enervation of the biceps muscle is an inevitable consequence of severe upper root or trunk injuries of the brachial plexus. These high nerve injuries result in challenging reconstructive issues for the surgeon. The relatively slow rate of peripheral nerve regeneration and the inexorable pace of motor endplate loss create physiological limitations to restoring extremity function using high nerve anatomical reconstruction. 3 Avulsion injuries can be addressed with nerve transfers in the hopes of restoring biceps muscle function. Using the nerve transfer

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Wen-Dong Xu, Jiu-Zhou Lu, Yan-Qun Qiu, Su Jiang, Lei Xu, Jian-Guang Xu and Yu-Dong Gu

T he treatment of complete BPAI is a demanding and difficult surgery in the upper extremity. Currently, nerve transfer is the main method of treating BPAI. 22 However, the traditional means of nerve transfer lead to poor functional recovery of hand prehension, mainly attributable to the long distance between the nerve anastomosis site and the reinnervated antebrachial muscle. TABLE 1 Complete brachial plexus avulsion injury in 3 patients treated with full-length PN transfer to the medial root of the median nerve

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KaiMing Gao, Jie Lao, Xin Zhao and YuDong Gu

performed. Intraoperative Findings of the Involved Brachial Plexus All patients underwent supraclavicular exploration of the involved brachial plexus, as previously described. 8 Total brachial plexus root avulsion injuries were confirmed in all cases. Surgical Technique and Reconstruction Methods Each patient was placed in the supine position with the affected upper extremity abducted on an arm table. The sterile field included the bilateral upper extremities, both sides of the neck up to the mandible, and the anterior and posterior chest to the midline. The

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Wenjun Li, Shufeng Wang, Jianyong Zhao, M. Fazlur Rahman, Yucheng Li, Pengcheng Li and Yunhao Xue

the shortest route, and it allows for transfer of the C-7 root to a position in which direct coaptation to the lower trunk 12 or the C-5 and C-6 nerve roots 11 on the injured side is feasible. However, this method is not devoid of complications. We studied these complications in a series of 425 patients who underwent systematic transfer of the opposite C-7 nerve root by the prespinal route for root avulsion injuries of the brachial plexus. FIG. 1. Schematic of the cC-7 nerve root transfer via the prespinal route: 1 = our modified prespinal route; 2

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Aaron A. Cohen-Gadol, William E. Krauss and Robert J. Spinner

Chronic subarachnoid hemorrhage may cause deposition of hemosiderin on the leptomeninges and subpial layers of the neuraxis, leading to superficial siderosis (SS). The symptoms and signs of SS are progressive and fatal. Exploration of potential sites responsible for intrathecal bleeding and subsequent hemosiderin deposition may prevent disease progression. A source of hemorrhage including dural pathological entities, tumors, and vascular lesions has been previously identified in as many as 50% of patients with SS. In this report, the authors present three patients in whom central nervous system SS developed decades after brachial plexus avulsion injury. They believe that the traumatic dural diverticula in these cases may be a potential source of bleeding. A better understanding of the pathophysiology of SS is important to develop more suitable therapies.