Contralateral C7 Transfer for Treatment of Brachial Plexus Root Avulsion

Abstract

Since the first report of the clinical application of contralateral C7 transfer, this procedure has become widely accepted and is used in the treatment of brachial plexus root avulsion injuries. The technique of this procedure has been markedly improved during the past years. The prespinal route may lead to a shorter nerve graft or even to direct coaptation. The results differ a lot from the different studies. There are many factors affecting the results of contralateral C7 transfer, such as age, time for regeneration and techniques of contralateral C7 transfer. Although dividing C7 will not cause a permanent loss in sensory and motor function of the healthy limb, it is worth pointing out that the C7 transection level should not be too distal, otherwise the fibers from the upper and lower trunk could be injured and permanent motor and sensory deficits may occur. Also, the surgeons should balance the risks and benefits for the patient before making the decision to operate in this manner.

Zusammenfassung

Seit dem ersten Bericht von der klinischen Anwendung stellt der kontralaterale C7-Transfer mittlerweile ein weithin akzeptiertes Verfahren zur Behandlung von Avulsionsverletzungen des Plexus brachialis dar. Die Operationstechnik wurde in den vergangenen Jahren deutlich verbessert. Die präspinale Route ermöglicht die Verwendung eines kürzeren Nerventransplantats oder sogar eine direkte Koaptation. Die Resultate der verschiedenen Studien differieren erheblich. Es gibt vielen Faktoren, die die Ergebnisse des kontrala­teralen C7-Transfers beeinflussen, wie z. B. Alter, Regenerationszeit und die Technik des kontrala­teralen C7-Transfers.

Obwohl die C7-Teilung zu keinem bleibenden Verlust der sensiblen und motorischen Funktion der gesunden Extremität führt, ist es erwäh­nenswert, dass die Höhe der C7-Durchtrennung nicht zu weit distal erfolgen sollte, da sonst die Fasern des oberen und unteren Truncus verletzt werden und dauerhafte sensible und motorische Defizite auftreten könnten.

Auch sollten Chirurgen die Risiken und Vorteile für den Patienten abwägen, bevor die Entscheidung zu dieser Operation getroffen wird.

Key words

plexus surgery in infants - nerve regeneration - denervation - surgery of the peripheral nerves - motor substitution ­operation

Schlüsselwörter

Plexuschirurgie bei ­Säuglingen/Kleinkindern - Nervenregeneration - Denervierung - Chirurgie der peripheren Nerven - motorische Ersatzoperation

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