Matthew R Kaufman1, Andrew I Elkwood2, Michael I Rose2, Tushar Patel2, Russell Ashinoff2, Adam Saad3, Robert Caccavale4, Jean-Philippe Bocage4, Jeffrey Cole5, Aida Soriano6, Ed Fein7. 1. Department of Surgery, Institute for Advanced Reconstruction, Shrewsbury, NJ; Department of Surgery, Drexel College of Medicine, Philadelphia, PA. Electronic address: kaufmanmatthew@hotmail.com. 2. Department of Surgery, Institute for Advanced Reconstruction, Shrewsbury, NJ. 3. Department of Surgery, Drexel College of Medicine, Philadelphia, PA. 4. Thoracic Group, Somerset, NJ. 5. Kessler Institute for Rehabilitation, West Orange, NJ. 6. Somerset Pulmonary/Critical Care Asthma and Sleep Center, Somerset, NJ. 7. Robert Wood Johnson University Hospital, New Brunswick, NJ.
Abstract
BACKGROUND: Unilateral phrenic nerve injury often results in symptomatic hemidiaphragm paralysis, and currently few treatment options exist. Reported etiologies include cardiac surgery, neck surgery, chiropractic manipulation, and interscalene nerve blocks. Although diaphragmatic plication has been an option for treatment, the ideal treatment would be restoration of function to the paralyzed hemidiaphragm. The application of peripheral nerve surgery techniques for phrenic nerve injuries has not been adequately evaluated. METHODS: Twelve patients presenting with long-term, symptomatic, unilateral phrenic nerve injuries following surgery, chiropractic manipulation, trauma, or anesthetic blocks underwent a comprehensive evaluation, including radiographic and electrophysiologic assessments. Surgical treatment was offered following a minimum of 6 months of conservative management. Operative planning was based on preoperative and intraoperative testing using one or more established nerve reconstruction techniques (neurolysis, interpositional grafting, or neurotization). RESULTS: Measures of postoperative improvement included pulmonary function testing, fluoroscopic sniff testing, and a standardized quality-of-life survey, from which it was determined that eight of nine patients who could be completely evaluated experienced improvements in diaphragmatic function. CONCLUSIONS: Based on the favorable results in this small series, we suggest expanding nerve reconstruction techniques to phrenic nerve injury treatment and propose an algorithm for treatment of unilateral phrenic nerve injury that may expand the current limitations in therapy.
BACKGROUND:Unilateral phrenic nerve injury often results in symptomatic hemidiaphragm paralysis, and currently few treatment options exist. Reported etiologies include cardiac surgery, neck surgery, chiropractic manipulation, and interscalene nerve blocks. Although diaphragmatic plication has been an option for treatment, the ideal treatment would be restoration of function to the paralyzed hemidiaphragm. The application of peripheral nerve surgery techniques for phrenic nerve injuries has not been adequately evaluated. METHODS: Twelve patients presenting with long-term, symptomatic, unilateral phrenic nerve injuries following surgery, chiropractic manipulation, trauma, or anesthetic blocks underwent a comprehensive evaluation, including radiographic and electrophysiologic assessments. Surgical treatment was offered following a minimum of 6 months of conservative management. Operative planning was based on preoperative and intraoperative testing using one or more established nerve reconstruction techniques (neurolysis, interpositional grafting, or neurotization). RESULTS: Measures of postoperative improvement included pulmonary function testing, fluoroscopic sniff testing, and a standardized quality-of-life survey, from which it was determined that eight of nine patients who could be completely evaluated experienced improvements in diaphragmatic function. CONCLUSIONS: Based on the favorable results in this small series, we suggest expanding nerve reconstruction techniques to phrenic nerve injury treatment and propose an algorithm for treatment of unilateral phrenic nerve injury that may expand the current limitations in therapy.
Authors: Carlos S Duque; Juan P Dueñas; Marcela Marulanda; Diana Pérez; Andres Londoňo; Soham Roy; Mai Al Khadem Journal: Updates Surg Date: 2017-02-13
Authors: Matthew R Kaufman; Thomas Bauer; Raymond P Onders; David P Brown; Eric I Chang; Kristie Rossi; Andrew I Elkwood; Ethan Paulin; Reza Jarrahy Journal: Interact Cardiovasc Thorac Surg Date: 2021-05-10