Three‐dimensional reconstruction and visualization of the median nerve from serial tissue sections

The purpose of this study was to definitively implement the three‐dimensional visualization of sensory and motor fascicles in the human median nerve by means of acetylcholinesterase (AChe) histochemical staining and under the assistance of the computer technology. One fresh human median nerve was harvested from a male adult cadaver. The median nerve was fixed at a special holder. Then, the whole holder was embedded and rapidly frozen in the liquid nitrogen. The processed median nerve was then cut coronally every 100 μm at a 20 μm thickness along its long axis in a sliding freezing microtome. The total number of sections was 4,650 slices. All sections were stained with the AChe histochemical method. The stained sections were scanned and saved as Joint Photographic Experts Group files. These images with positively and negatively stained sections were acquired to an Intel dual Pentium computer. The Adobe Photoshop CS2 software was used to compare the reference points of images before and after staining. The two‐dimensional intraneural microstructure database of median nerve was then acquired. A software of 3D nerve visualization system was developed. With the 3D nerve visualization system, the 3D visualization result of intraneural microstructure of median nerve was created. The findings may provide more accurate and detailed anatomic information for nerve repairs, specifically for the fascicular nerve repairs. The 3D nerve visualization technique may have potential for future studies of topography of peripheral nerve. © 2009 Wiley‐Liss, Inc. Microsurgery, 2009.     

Mixed nerve suture facilitated by enzyme-staining techniques

Identification of motor and sensory fascicles to correctly match the motor and sensory fascicles helps surgeons to correctly align nerve stumps. Motor fibers, with their high cholinesterase activity, can be differentiated from sensory fibers. I developed a new modification that requires less than 1 hour and shows clearer differentiation compared with other histochemical techniques. In my clinical research, proximal stumps can be stained as long as 16 months after injury, however, distal stumps cannot be stained after 5 days. After 5 days, this staining could provide useful proximal information and distal fascicles may be identified by anatomic or topographical knowledge. I think this staining is especially useful in proximal nerve lesions and nerve injuries that require nerve graft within 4 days after injury. Also, this technique is useful in functioning muscle transfer to find motor fascicles and, in a sensate flap, to identify the sensory fascicle.     

Carbonic anhydrase activity of human peripheral nerves: a possible histochemical aid to nerve repair

The return of usable function after injury of peripheral nerves depends upon the appropriate regeneration of axons to their end organs. Debridement trimmings of severed nerves harvested during surgery were stained to demonstrate carbonic anhydrase activity. This histochemical method can be accomplished within 3 to 4 hours of receiving the tissue. Nerve fascicles were readily discriminated from one another by the individual staining patterns of their constituent axons. Axoplasmic staining was predominantly a feature of sensory fibers, and myelin staining was characteristic of skeletal motor axons. Carbonic anhydrase histochemistry may provide a means of accurately matching fascicles in cut nerve ends.     

臂丛神经显微结构的计算机三维重建

目的：重建臂丛神经的外轮廓及其内部神经束的精细三维行径，同时探索一种臂丛神经显微结构计算机三维重建的实用方法。方法：取健康成年尸体的臂丛神经标本2例(从神经根管出口至正中神经交叉处，平均长20cm)，作好标记，以女性头发作为定位线，采用连续组织切片后胆碱脂酶组织化学染色，高分辨率数码摄像系统获取二维数码信息后对臂丛神经显微结构进行三维重建。结果：三维重建真实地再现臂丛神经的三维立体结构及其内部各神经束的三维立体行径，并可显示臂丛神经中神经束的任意断面及其全长的解剖结构与相互关系，形象地展示臂丛神经内部神经束的复杂重组过程。重建结构均能单独或搭配显示，还能任意角度显示：在臂丛的五个根中，C6-C8内部神经束数目较C5、T1多。在C6-C8中，又以C7神经根内部神经束数目最多。结论：臂丛神经内部神经束结构相当复杂，相互间不断交叉重组，形成独特的神经束网络结构。臂丛神经显微结构三维重建由于采用了较为精确的定位材料和方法，三维图像显示效果较好，是一种较为实用的方法。     

人体尺神经显微结构三维可视化研究

目的 将人体尺神经行连续冰冻组织切片,经染色、扫描后获取尺神经连续断面二维图像信息,通过3D Nerve三维可视化软件系统勾画出完整的尺神经干三维解剖图谱.方法 取自愿捐献死亡3 h内38岁男性左侧尺神经全长(自臂丛内侧束至腕横韧带)标本1例,长约50cm,经定位、包埋、连续冰冻组织切片、乙酰胆碱脂酶组织化学染色,获取尺神经连续二维图像信息,应用3D Nerve三维可视化软件系统对尺神经内部结构进行三维重建.结果 尺神经在不同断面神经束的数量、位置及内部神经纤维的性质均有变化.应用尺神经3D Nerve三维可视化软件系统可在任意断面、任意角度观察尺神经内部的显微结构,追踪各神经束的立体行径,动态地展示尺神经内部神经束的复杂结构.结论 尺神经的3D Nerve三维可视化软件系统可真实地再现尺神经干全长及其内部各神经束的三维立体行径,为医学教学与临床修复尺神经损伤提供精确的神经任意断面三维立体解剖图像,有助于提高神经修复的疗效.     

Radioisotope technique to evaluate the motor functional status of donor nerve for upper extremity reconstruction

A rapid and precise method of nerve fascicle identification based on measurement of choline acetyltransferase activity using radioisotope technique was used intraoperatively during upper extremity reconstruction. This technique can be used to evaluate the motor function of donor fascicles directly and quantitatively. This technique is useful to evaluate the motor functional status of donor fascicles during functioning free muscle transfer, to distinguish between preganglionic and postganglionic injuries in brachial plexus injury, and to differentiate between motor and sensory fascicles during nerve grafting procedures.     

Neuroanatomy of the brachial plexus: the missing link in the continuity between the central and peripheral nervous systems

The brachial plexus is a complex network of nerves which extends from the neck to the axilla and which supplies motor, sensory, and sympathetic fibers to the upper extremity. Generally it is formed by the union of the ventral primary rami of the spinal nerves, C5-C8 and T1, the so-called "roots" of the brachial plexus. The goal here is to examine the neural architecture of the brachial plexus. The most constant arrangement of nerve fibers will be delineated, and then the predominant variations in neural architecture will be defined, particularly the prefixed and postfixed plexus, as well as the microanatomy and anatomy of the major terminal branches of the plexus. Multiple tracts connect many parts of the nervous system, and multiple ascending and descending tracts connect the peripheral nervous system (PNS) and lower spinal centers with the brain. This reflects that the nervous system is able to extract different pieces of sensory information from its surroundings and encode them separately, and that it is able to control specific aspects of motor behavior using different sets of neurons. Examination of the major sensory or motor pathways reveals a highly and tightly organized nervous system. In particular, at each of many levels, we see fairly exact maps of the world within the brain. In an effort to understand the functional neuroanatomy of the brachial plexus, this paper will focus briefly on the nervous connections of the nerves of the upper extremity with the brain. The goal here is to better understand "what the brain sees" after nerve injury and repair.     

不同浓度罗哌卡因用于臂丛神经感觉与运动分离阻滞的效果

目的 探讨不同浓度罗哌卡因用于臂丛神经感觉与运动分离阻滞的效果.方法 择期上肢手术患者90例,ASA分级Ⅰ～Ⅲ级,年龄16～75岁,体重40～85 kg.均在超声引导联合神经刺激器辅助定位下行腋路臂丛神经阻滞,根据不同罗哌卡因浓度分为3组(n=30):0.15%罗哌卡因组(A组),0.10%罗哌卡因组(B组),0.05%罗哌卡因组(C组).于注射局麻药后10、30、60、240 min(T1～4)时记录感觉与运动分离阻滞情况、感觉阻滞完善情况和臂丛神经阻滞成功情况,术毕时评定麻醉效果.记录手术时间、镇痛时间.结果 与A组比较,B组T1.2时感觉阻滞完善率较低(P＜0.05),T3.4时感觉阻滞完善率差异无统计学意义(P＞0.05),感觉与运动分离阻滞率较高(P＜0.01),C组T1.2时感觉与运动分离阻滞率较低(P＜0.01),T3.4时感觉与运动分离阻滞率差异无统计学意义(P＞0.05),各时点感觉阻滞完善率较低(P＜0.01).与B组比较,C组各时点感觉阻滞完善率、感觉与运动分离阻滞率均较低(P＜0.01).A组麻醉效果优于B组,B组麻醉效果优于C组(P＜0.01),与A组和B组比较,C组臂丛神经阻滞成功率较低(P＜0.01),A组与B组差异无统计学意义(P＞0.05).结论 0.10%罗哌卡因用于臂丛神经阻滞可产生感觉与运动分离阻滞效果.     

Comparative study of different concentrations of prilocaine and ropivacaine for intraoperative axillary brachial plexus block

BACKGROUND AND OBJECTIVE: To compare the anaesthetic characteristics in terms of onset and offset times of the sensory and motor blocks of prilocaine 1% and ropivacaine 0.75% alone and in different combinations when used for brachial plexus anaesthesia in axillary perivascular blocks. METHODS: After informed consent 96 ASA I-III patients undergoing forearm or hand surgery participated in this prospective, randomized, double-blind study. Patients received either prilocaine 1% 40 mL (G1), prilocaine 1% 30 mL and ropivacaine 0.75% 10 mL (G2), prilocaine 1% 20 mL and ropivacaine 0.75% 20 mL (G3) or ropivacaine 0.75% 40 mL (G4) for axillary perivascular brachial plexus anaesthesia. Onset and duration of sensory and motor blocks in the distribution of the musculocutaneous, radial, median and ulnar nerves were assessed. RESULTS: The onset time of the sensory and motor blocks of the whole brachial plexus differed only between patients in G4 with ropivacaine 0.75% 40 mL demonstrating a later motor onset in comparison to all other groups and a later sensory onset in comparison to G1 and G2 (P < 0.01). The addition of ropivacaine resulted in longer offset times of the sensory and motor blocks. The median offset time of the motor block was 179.5 min in G1, 262 min in G2, 389.5 min in G3 and 745 min in G4 (P < 0.01). The median offset time of the sensory block was 163.5 min in G1, 277 min in G2, 383.5 min in G3 and 784 min in G4 (P < 0.01). There was no difference in onset and offset times between sensory and motor blocks within the groups. CONCLUSIONS: For axillary perivascular brachial plexus block prilocaine 1% alone and in combination with ropivacaine 0.75% was similar in terms of onset of sensory and motor blocks but different in duration of sensory and motor blocks without a differential sensory and motor offset.     

右美托咪啶对上肢手术患者罗哌卡因臂丛神经阻滞效果及上肢缺血再灌注损伤的影响

目的 探讨右美托咪啶对上肢手术患者臂丛神经阻滞及上肢缺血再灌注损伤的影响.方法 拟行腋路臂丛神经阻滞的上肢手术患者40例,性别不限,年龄18～55岁,体重45～80kg,ASA分级Ⅰ或Ⅱ级.采用随机数字表法,将患者随机分为2组(n=20),对照组(C组):神经阻滞用药为0.5%罗哌卡因30 ml;右美托咪啶组(D组):神经阻滞用药为0.5%罗哌卡因+右美托咪啶8 mg混合液30 ml.评价感觉阻滞和运动阻滞的效果,记录感觉阻滞和运动阻滞的起效时间和维持时间,于麻醉诱导前(T0)、松止血带后1、5和30 min(T1-3)时抽取术侧肘部静脉血样,测定血浆MDA和缺血修饰蛋白(IMA)的浓度,同时取术侧肘部动脉血样,行血气分析.记录术中恶心呕吐、呼吸抑制、头晕、心动过缓等并发症的发生情况.术中主诉疼痛的患者静脉注射舒芬太尼0.2μg/kg,仍因疼痛无法完成手术的患者则改为全身麻醉.结果 无一例患者使用补救用药,无一例患者更改麻醉方式,所有患者均未发生恶心呕吐、呼吸抑制、头晕、心动过缓等并发症.与C组比较,D组感觉阻滞、运动阻滞维持时间明显延长,血浆MDA和IMA的浓度明显降低,PaO2和BE升高(P＜0.05),感觉阻滞和运动阻滞的起效时间差异无统计学意义(P＞0.05);与T0时比较,两组T2、T3时血浆MDA和IMA的浓度升高,C组T1时pH值降低,两组T1时PaO2降低,T1、T2时BE降低(P＜0.05).结论 右美托咪啶不仅可增强上肢手术患者罗哌卡因臂丛神经阻滞效果,还可减轻止血带诱发的上肢缺血再灌注损伤.

Abstract：

Objective To investigate the effect of dexmedetomidine on brachial plexus block with ropivacaine and upper extremity ischemia-reperfusion (I/R) injury in patients undergoing upper extremity surgery. Methods Forty ASA Ⅰ or Ⅱ patients of both sexes, aged 18-55 yr, weighing 45-80 kg, scheduled forupper extremity surgery under brachial plexus block, were randomly divided into 2 groups ( n = 20 each): control group ( group C )and dexmedtomidine group (group D). In group C, brachial plexus block was performed using 0.5% ropivacaine 30 ml. In group D, brachial plexus block was performed with a mixture (30 ml) of 0.5% ropivacaine and 8 mg dexmedetomidine. The efficacy of motor and sensory block was evaluated and the onset time and duration of motor and sensory block were recorded. Venous blood samples were obtained from peripheral vein on the operated side before anesthesia induction (T0), and at 1, 5 and 30 min after tourniquet release (T1-3) to detect the plasma concentrations of MDA and ischemia-modified albumi (IMA). Arterial blood samples were also obtained at the same time points for blood gas analysis. The complications such as nausea and vomiting, respiratory depression, bradycardia and dizziness were recorded. Sufentanil 0.2 μg/kg was given as rescue medication. If the operation could not be completed, general anesthesia was used. Results There was no requirement for rescue analgesics and general anesthesia, and no complications occurred in all the patients. The duration of sensory and motor block was significantly longer, the plasma concentrations of MDA and IMA were significantly lower, and PaO2 and BE were significantly higher in group D than in group C ( P ＜ 0.05). The plasma concentrations of MDA and IMA were significantly higher at T2 and T3 in both groups, the pH value was significantly lower at T1 in group C, PaO2 at T1 and BE at T1 and T2 were significantly lower in both groups than those at T0 ( P ＜ 0.05). Conclusion Dexmedetomidine can not only enhance the efficacy of brachial plexus block with ropivacaine, but also reduce the upper extremity I/R injury caused by tourniquet in patients undergoing upper extremity surgery.     

罗哌卡因混合碳酸利多卡因与等效浓度罗哌卡因用于逆行锁骨下臂丛神经阻滞效果的比较

目的 比较罗哌卡因混合碳酸利多卡因与等效浓度罗哌卡因用于逆行锁骨下臂丛神经阻滞的效果.方法 择期行上肢手术患者60例,ASA分级Ⅰ或Ⅱ级,年龄18～64岁,体重49～ 98 kg,均在超声引导下行逆行锁骨下臂丛神经阻滞.采用随机数字表法,将患者随机分为2组(n＝30),A组应用0.35％罗哌卡因30ml,B组应用0.233％罗哌卡因和0.346％碳酸利多卡因混合液30 ml.于麻醉给药后每隔5 min记录臂丛神经各分支的阻滞效果(感觉阻滞效果评估采用针刺法,运动阻滞效果评估采用Bromage分级),记录感觉和运动阻滞起效时间、麻醉给药后30 min时感觉与运动阻滞有效情况和并发症的发生情况.结果 两组臂丛神经各分支的感觉和运动阻滞起效时间及阻滞有效率比较差异无统计学意义(P＞0.05).两组均未见严重并发症发生.结论 罗哌卡因混合碳酸利多卡因与等效浓度罗哌卡因行逆行锁骨下臂丛神经阻滞效果相似,提示碳酸利多卡因不能增强罗哌卡因的臂丛神经阻滞效应.     

Neurogenic motor evoked potentials: role in brachial plexus surgery. Case report

Peripheral nerve graft repair after severe brachial plexus injury is futile if there is degeneration of motor fibers in the proximal nerve stump to which the graft must be attached. Traditional intraoperative neurophysiological assessment methods like nerve action potential (NAP) and somatosensory evoked potential (SSEP) monitoring have been used to evaluate proximal nerve stump integrity, but these methods do not allow evaluation of the integrity of motor fibers back to the anterior horn cell. Consequently, the authors used transcranial electrical stimulation and recorded neurogenic motor evoked potentials (MEPs) directly from the brachial plexus in a patient undergoing surgical repair of a complete upper brachial plexus injury (Erb palsy) to assess the functional continuity of motor fibers. In addition, selected elements of the brachial plexus were directly stimulated, and NAPs were recorded. Finally, SSEPs were recorded from the scalp after stimulation of selected elements of the brachial plexus. Neurogenic MEPs were present from the medial cord of the brachial plexus, but not the middle or upper trunk; NAPs were present from the lateral and posterior cords after middle trunk stimulation, but absent after upper trunk stimulation; and SSEPs were present after medial cord stimulation but absent after stimulation of the upper and middle trunks. For the first time, neurogenic MEPs were coupled with NAPs and SSEPs to evaluate successfully the functional status of motor fibers back to the anterior horn cell for accurate localization of the lesion sites.     

Plexus brachialis Langanhaltendes neurologisches Defizit nach interskalenärer Blockade des Plexus brachialis (Winnie)

An interscalene block of the brachial plexus was combined with general anaesthesia for repair of a complex chronic lesion of the shoulder. The localisation of the plexus with electro-stimulation and the injection of Bupivacain 0.5% were accomplished easily and without painful sensations. 48 hours later the block was still partially present. Paraesthesia and a sensory and motor innervation deficit affected mainly the dorsal fascicle, but also areas innervated by the median and lateral fascicles. The deficit did not completely disappear for 18 month. The cause could have been due to direct traumatisation during blockade or operation, toxic action of the injected substance (Bupivacain 0.5%, 30 ml), distension of the plexus, a cervical syndrome or an aseptic plexitis, although a definite determination is not possible. However, the pattern of the lesion and the lack of pain during localisation of the plexus and injection favour traumatisation during the acromioplasty.     

Supraclavicular brachial plexus blocks: review and current practice

This article reviews the possible revival of the supraclavicular brachial plexus blockade due to the use of ultrasound guidance. The brachial plexus is a complex network of nerves, extending from the neck to the axilla, which supplies motor and sensory fibers to the upper extremity. Understanding the complexities of the formation and structure of the brachial plexus remains a cornerstone for effective regional anaesthesia. On the level of the supraclavicular fossa, the plexus is most compactly arranged. The supraclavicular approach of the brachial plexus has a high success rate including blockade of the ulnar and musculocutaneous nerve, which can be missed respectively with the interscalene and axillary approach. However, because of the proximity of the pleura, most anaesthesiologists have been reluctant to perform this supraclavicular approach. The introduction of ultrasound guidance techniques not only reduces the possible risk of pneumothorax but also allows a faster onset time of the block with a reduction of the local anaesthetic dose. This makes the supraclavicular approach a valuable alternative to the axillary, interscalene and infraclavicular approach for upper limb surgery.     

Sufentanil does not prolong the duration of analgesia in a mepivacaine brachial plexus block: a dose response study

To date, results of studies evaluating the efficacy of opioids and local anesthetic combinations in the brachial plexus are inconclusive. We examined whether increasing sufentanil in doses of 5, 10, and 20 microg decreased onset time or increased duration of an axillary brachial plexus block. Ninety-two patients scheduled for carpal tunnel release under axillary brachial plexus block were enrolled in the study. Patients were randomized to receive axillary plexus block with 40 mL 1.5% mepivacaine and saline (Group 1), sufentanil 5 microg (Group 2), 10 microg (Group 3), or 20 microg (Group 4). Onset and duration of sensory and motor block were measured. Opioid-related side effects were recorded. The addition of sufentanil did not improve speed of onset or increase the duration of sensory or motor block. Paradoxically, duration of sensory and motor block was longest in the control group: sensory, 241 min (188-284) and motor, 234 min (128-305), and decreased with increasing doses of sufentanil in Group 4: sensory, 216 min (115-315) and motor, 172 min (115-260) (P < 0.05). Side effects occurred in 55% of patients belonging to Groups 2 and 4, and in 60% of the patients in Group 3. In contrast, only 10% of the patients reported side effects in the control group. We conclude that sufentanil added to mepivacaine does not increase the onset or prolong the duration of an axillary plexus block. Furthermore, the addition of sufentanil was associated with a frequent incidence of side effects. IMPLICATIONS: This study demonstrates that the addition of sufentanil in a dose-dependent manner to 1.5% mepivacaine in the axillary plexus does not improve onset or duration of blockade, and that this admixture is associated with an increased incidence of side effects.     

右美托咪定与肾上腺素作为局部麻醉药佐剂对臂丛神经阻滞效果的对比

目的 对比常用剂量的右美托咪定(dexmedetomidine,Dex)和肾上腺素作为罗哌卡因的佐剂对锁骨上臂丛神经阻滞影响的差异. 方法 选择Colle's骨折患者60例,ASA分级Ⅰ、Ⅱ级,其中男性40例,女性20例;年龄44～68岁,体重50～75kg.采用随机数字表法分为3组(每组20例):生理盐水对照组(C组)、Dex组(D组)和肾上腺素组(E组).各组均在超声引导下行锁骨上臂丛神经阻滞.C组使用1 ml生理盐水,D组将0.75 μg/kg Dex稀释至1 ml,E组将盐酸肾上腺素100 μg稀释至1 ml.上述溶液分别加入10 ml 1％盐酸罗哌卡因和10 ml生理盐水配制的局部麻醉药物中.比较感觉及运动阻滞的起效时间、持续时间、开始静脉镇痛的时间,入室时(T0)及给药后10 min(T1)、20min(T2)、30 min(T3)、40 min (T4)、50 min(T5)、60 min(T6)的HR、MAP、SpO2、BIS以及麻醉并发症的情况. 结果 D组感觉、运动阻滞的起效时间比C、E组短,差异有统计学意义(P＜0.05),而C、E两组间差异无统计学意义(P＞0.05).D、E两组感觉、运动阻滞的持续时间、静脉镇痛的开始时间均比C组晚,差异有统计学意义(P＜0.05),但两组间差异无统计学意义(P＞0.05).MAP的组间比较,D组在T4～T5时段低于C组,在T3～T5时段低于E组,差异有统计学意义(P＜0.05).E组在T3时刻高于C组,差异有统计学意义(P＜0.05).HR的组间比较,D组在T3～T6时段低于C,E两组,E组在T3～T5时段显著高于C组,差异有统计学意义(P＜0.05).BIS值的组间比较,D组在T2～T6时段显著低于C、E组,差异有统计学意义(P＜0.05). 结论 与100 μg肾上腺素相比,0.75 μg/kg Dex具有类似的增强臂丛神经阻滞的作用,还具有镇静及降低心血管应激的作用,适用于肾上腺素禁忌证者.     

周围神经虚拟三维重建中神经束功能及形态定位的组织化学染色方法研究

目的探索周围神经虚拟三维重建中不同性质神经纤维与功能束的组织学水平的形态学定位方法。方法取自愿捐献新鲜成人尸体右侧正中神经作为样本进行连续冰冻切片,取形态完整标本切片30个,首先采用单纯Karnovsky-Roots法对神经切片染色(A组,n=30),再依次行甲苯胺蓝染色(B组,n=28)以及丽春红2R染色(C组,n=21)。每种染色完成后即于光学显微镜下分区显微摄影(×100)并拼接成全景图像,比较不同染色方法下全景图像的纹理特征、乙酰胆碱酯酶活性部位数量及平均灰度;并对比计算机自动获取神经束轮廓结果,以确立获取理想图像的染色方案。结果 A、B、C组乙酰胆碱酯酶活性位点数量分别为(21.63±4.06)×102、(20.64±3.51)×102、(20.54±5.71)×102个;平均灰度分别为(1.41±0.06)×102、(1.10±0.05)×102、(1.14±0.07)×102。各组间乙酰胆碱酯酶活性位点数量差异无统计学意义(F=0.64,P=0.54);与A组比较,B、C组平均灰度均较低,差异有统计学意义(P<0.001)。A组仅乙酰胆碱酯酶活性部位着色;B组髓鞘显示不满意;C组可同时显示神经纤维轴突及髓鞘染色,神经束和不同性质神经纤维纹理特征最显著,神经束边界轮廓最清晰,计算机处理时假阳性容易去除,图像分割最精确。结论 Karnovsky-Roots-甲苯胺蓝-丽春红2R三重复染方法不影响神经纤维乙酰胆碱酯酶阳性位点的表达,图像纹理清晰,较符合周围神经虚拟三维重建时在组织学水平分辨及获取神经束功能状态二维图像的相关要求,有望解决周围神经组织形态学表达方式这一技术难题。     

Neurinoma of the brachial plexus: 2 case reports

Neurinomas, also referred to as neurilemmomas and schwannomas, are rare benign tumours of the peripheral nerves. A small percentage of these lesions arise from the brachial plexus. The Authors report two cases of schwannoma arising from the brachial plexus. Such lesions, usually asymptomatic, may cause sensitivity alterations or, less frequently, motor deficits in the involved arm. Tumour enucleation, avoiding damage to any of the nervous fascicles, is the treatment of choice.     

臂丛神经损伤的多种神经电生理诊断

本文对96例臂丛神经损伤患者进行肌电图与运动神经传导速度检查,结果发现损伤神经支配的肌肉肌电图有纤颤电位、正相电位等神经原损害表现;受损的臂丛神经运动神经传导速度有不同程度的减慢或缺失。18例臂丛神经损伤的病人还同时测定了感觉神经动作电位和体感诱发电位,以判断臂丛神经损伤在节前或节后,并与手术发现作了对比。本文认为用多种神经电生理检查方法能客观、准确地诊断臂丛神经损伤的部位、程度,对确定治疗、估计预后有重要意义。     

The diagnostic value of intraoperative measurement of choline acetyltransferase activity during brachial plexus surgery

We used the measurement of choline acetyltransferase (CAT) activity to distinguish between preganglionic and postganglionic injuries of the spinal roots during brachial plexus surgery. This study includes ten spinal roots in six patients with traumatic brachial plexus injuries. The results of CAT activity were compared with myelographic findings, the operative findings and the intraoperative evoked spinal cord potentials. The results of CAT activity and the operative findings were consistent in all roots. Whereas CAT activity in fascicles in preganglionic injured roots was below 500 cpm, it was above 2000 cpm in postganglionic injured roots. This study shows that intraoperative measurement of CAT activity can provide useful information on the site and severity of brachial plexus injuries and the assessment of the motor function status of the injured spinal root, both directly and quantitatively.