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

Clinical article

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Object

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.

Methods

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.

Results

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.

Conclusions

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.

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Figures

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    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.

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    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.

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