Contralateral Spinal Accessory Nerve: A Suitable “New” Donor Nerve For Heterotopic Nerve Transfer In Total Brachial Plexus Palsy

Abstract

Patients with complete brachial plexus palsy with avulsion of 4–5 roots often have a paucity of suitable donor nerves to provide for a proper functional recovery of the upper extremity. The spinal accessory nerve is routinely employed ipsilaterally for nerve transfer to the suprascapular nerve. The purpose of this paper is to describe the clinical use of the contralateral spinal accessory nerve as a donor nerve for brachial plexus surgery. Since 2005 the contralateral spinal accessory nerve has been used for neurotization of the axillary nerve in selected cases of total brachial plexus injuries. In this paper total plexus palsy surgical strategies, technical details and preliminary functional outcomes of a group of 6 consecutive patients with a minimum follow-up of 30 months (76–31, average 55) are described. The preliminary results are encouraging: the functional outcome of the deltoid muscle, evaluated according to the British Medical Research Council grading system, was M4 in 1 patient, M3 in 1 patient, M2 in 2 patients, M1 in 1 patient, and M0 in 1 patient. In conclusion, the use of the contralateral spinal accessory nerve shows good results in terms of functional recovery and the simplicity of the procedure.

Zusammenfassung

Patienten mit vollständiger Lähmung des Plexus brachialis durch Abriss oder Ausriss von 4 bis 5 Wurzeln haben oft einen Mangel an geeigneten Spendernerven für eine befriedigende funktionelle Wiederherstellung der oberen Extremität. Der ipsilaterale N. accessorius wird in den meisten Zentren routinemäßig auf den N. suprascapularis transferiert. Ziel der vorliegenden Arbeit ist es, die klinische Anwendung des kontralateralen N. accessorius als Spendernerv für Neurotisationen des Plexus brachialis zu beschreiben. Seit 2005 wird der kontralaterale N. accessorius für die Neurotisation des N. axillaris in ausgewählten Fällen kompletter Plexus brachialis Verletzungen verwendet. Wir stellen chirurgische Strategien, technische Details und vorläufige funktionelle Ergebnisse an Hand von 6 konsekutiven Fällen mit einem durchschnittlichen Follow-up von 55 (30 bis 76) Monaten vor. Die vorläufigen Resultate sind insgesamt ermutigend. Die Muskelkraft des M. deltoideus-Zielmuskels ausgewertet nach Angaben des britischen Medical Research Council Beurteilungs-System lag bei einem Patienten bei M4, M3 bei einem Patienten, bei 2 Patienten M2, M1 bei einem Patienten und M0 bei einem weiteren Patienten. Zusammenfassend zeigt die Verwendung des kontralateralen N. accessorius gute Ergebnisse in Bezug auf die funktionelle Erholung und bei einer relativen Einfachheit des Verfahrens.

Key words

peripheral nerve surgery - neurotization - brachial plexus injury - nerve transfer

Schlüsselwörter

Chirurgie peripherer Nerven - Neurotisation - Plexus brachialis Verletzung - Nerventransfer

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