PeiYang Li1, Yundong Shen1, Jing Xu1, Chunmin Liang2, Su Jiang1, Yanqun Qiu3, Huawei Yin1, Juntao Feng1, Tie Li1, Jun Shen1, Guobao Wang1, Baofu Yu1, Xuan Ye1, Aiping Yu1, Gaowei Lei1, Zeyu Cai1, Wendong Xu4,5,6,7,8. 1. Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China. 2. Department of Anatomy, Histology & Embryology, Shanghai Medical College, Fudan University, Shanghai, China. 3. Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Shanghai, China. 4. Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China. wendongxu@fudan.edu.cn. 5. Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Shanghai, China. wendongxu@fudan.edu.cn. 6. State Key Laboratory of Medical Neurobiology, Collaborative Innovation Center of Brain Science, Fudan University, Shanghai, China. wendongxu@fudan.edu.cn. 7. Priority Among Priorities of Shanghai Municipal Clinical Medicine Center, Shanghai, China. wendongxu@fudan.edu.cn. 8. National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China. wendongxu@fudan.edu.cn.
Abstract
BACKGROUND: We proposed contralateral cervical seventh nerve transfer for spastic arm paralysis after central neurological injury in the New England Journal of Medicine (NEJM) in 2018. In this surgery, we applied a new surgical route for nerve transfer, the Huashan prespinal route. The objective of this study was to elaborate our new surgical technique, clarify its relationship to the vertebral artery, and provide anatomical data on this novel method. METHODS: The effectiveness and safety of the Huashan prespinal route in contralateral C7 nerve transfer were evaluated anatomically. Nine cadavers (4 males, 5 females) were available for this study. Among these, anatomical parameters of the vertebral artery were obtained from 6 cadavers, and the anastomosis of the bilateral cervical seventh nerve was observed on 3 cadavers undergoing contralateral C7 nerve transfer via the Huashan prespinal route. RESULTS: Tension-free anastomosis of the bilateral cervical seventh nerve was achieved through the Huashan prespinal route. The tilt angle of the vertebral artery to the sagittal plane (with thyroid cartilage as the origin) was 25.5 ± 4.5°, at 22.5 ± 1.6° and 28.7 ± 4.3° on the left and right side, respectively. The safe drilling angle to penetrate through the longus colli muscles for the creation of a longus colli muscle tunnel to avoid injury to the vertebral artery in our surgical technique was above 33.2°. CONCLUSIONS: The cadaveric study confirms that the presented technique allowed simple, effective, and safe contralateral C7 nerve transfer. This technique can be used in the treatment of hemiplegia and brachial plexus injury. There is a safe scope of drilling angle for creating the longus colli muscle tunnel required for this surgical route. The anatomical parameters obtained in this study will be helpful for the performance of this operation.
BACKGROUND: We proposed contralateral cervical seventh nerve transfer for spastic arm paralysis after central neurological injury in the New England Journal of Medicine (NEJM) in 2018. In this surgery, we applied a new surgical route for nerve transfer, the Huashan prespinal route. The objective of this study was to elaborate our new surgical technique, clarify its relationship to the vertebral artery, and provide anatomical data on this novel method. METHODS: The effectiveness and safety of the Huashan prespinal route in contralateral C7 nerve transfer were evaluated anatomically. Nine cadavers (4 males, 5 females) were available for this study. Among these, anatomical parameters of the vertebral artery were obtained from 6 cadavers, and the anastomosis of the bilateral cervical seventh nerve was observed on 3 cadavers undergoing contralateral C7 nerve transfer via the Huashan prespinal route. RESULTS: Tension-free anastomosis of the bilateral cervical seventh nerve was achieved through the Huashan prespinal route. The tilt angle of the vertebral artery to the sagittal plane (with thyroid cartilage as the origin) was 25.5 ± 4.5°, at 22.5 ± 1.6° and 28.7 ± 4.3° on the left and right side, respectively. The safe drilling angle to penetrate through the longus colli muscles for the creation of a longus colli muscle tunnel to avoid injury to the vertebral artery in our surgical technique was above 33.2°. CONCLUSIONS: The cadaveric study confirms that the presented technique allowed simple, effective, and safe contralateral C7 nerve transfer. This technique can be used in the treatment of hemiplegia and brachial plexus injury. There is a safe scope of drilling angle for creating the longus colli muscle tunnel required for this surgical route. The anatomical parameters obtained in this study will be helpful for the performance of this operation.
Entities:
Keywords:
Central neurological injury; Contralateral cervical seventh nerve transfer; Prespinal route; Spastic arm paralysis