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

Clinical article

Restricted access


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

* 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.



  • View in gallery

    Axial fMRIs showing brain areas activated by healthy controls' right hand grasping movement. The right hand movement generated strong signal changes in the contralateral (left) primary motor area (M1) and the SMA. A CH2 template of human brain was used as underlying structure images.

  • View in gallery

    Axial fMRIs showing brain areas activated by patients' affected (right) hand grasping movement. Movement of the patient's affected hand more than 5 years after surgery was associated with a bilateral network activity, but the laterality index was positive, which implied that the main activated areas were located in the contralateral cortex. A CH2 template of human brain was used as underlying structure images.


  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 9

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

  • 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

  • 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


Cited By



All Time Past Year Past 30 Days
Abstract Views 121 121 26
Full Text Views 146 146 0
PDF Downloads 74 74 0
EPUB Downloads 0 0 0


Google Scholar