Diffusion-Weighted Magnetic Resonance Imaging Improves the Accuracy of Differentiation of Benign from Malignant Peripheral Nerve Sheath Tumors.

OBJECTIVE: In patients with neurofibromatosis type 1 (NF1), it is important to accurately determine when plexiform neurofibroma (pNF) transforms to a malignant peripheral nerve sheath tumor (MPNST). The purpose of this study is to investigate the usefulness of diffusion-weighted imaging (DWI) in differentiating pNF and MPNST in NF1 patients. METHODS: Among the NF1 patients who were referred to our hospital between 1985 and 2015, 10 cases of MPNST and 19 cases of pNF were included. We evaluated features of standard magnetic resonance imaging according to the differentiation criteria of malignancy from benignancy as previously reported, apparent diffusion coefficient (ADC) value based on the DWI and the correlation between ADC value and benignancy/malignancy. ROC analysis was performed to determine the appropriate cutoff value of ADC. RESULTS: There were significant differences between MPNST and pNF in the size of the tumor (P = 0.009), peripheral enhancement pattern (P = 0.002), perilesional edema-like zone (P = 0.0008), and intratumoral cystic change (P = 0.02). The mean and minimum values of ADC were significantly lower in MPNST than those in pNF (P = 0.03 and P = 0.003, respectively). When we set a cutoff value of mean ADC as 1.85 × 10-3 mm2/s, the sensitivity and specificity were 80% and 74%, respectively. The area under the curve value improved by adding the Wasa score to the mean ADC evaluation. CONCLUSIONS: ADC values determined by DWI are useful in differentiating MPNST from pNF and adding ADC evaluation to standard MRI evaluation improved the diagnostic accuracy.

A Review of Recent Advances in Ultrasound, Placed in the Context of Pain Diagnosis and Treatment.

Ultrasound plays a significant role in the diagnosis and treatment of pain, with significant literature reaching back many years, especially with regard to diagnostic ultrasound and its use for guiding needle-based delivery of drugs. Advances in ultrasound over at least the last decade have opened up new areas of inquiry and potential clinical efficacy in the context of pain diagnosis and treatment. Here we offer an overview of the recent literature associated with ultrasound and pain in order to highlight some promising frontiers at the intersection of these two subjects. We focus first on peripheral application of ultrasound, for which there is a relatively rich, though still young, literature. We then move to central application of ultrasound, for which there is little literature but much promise.

Síndrome de cauda equina secundario a neurolinfomatosis: presentación de un caso y revisión de la literatura / Cauda equina syndrome secondary to neurolymphomatosis: Case report and literature review

La neurolinfomatosis es una entidad rara caracterizada por la presencia de linfocitos neoplásicos que infiltran las estructuras del sistema nervioso periférico. Dada su naturaleza y localización puede desarrollar una gran variedad de síntomas, suponiendo un reto diagnóstico. El tratamiento se basa en el uso de metotrexato, aunque, a día de hoy, existen diversos esquemas de quimioterapia para los pacientes con enfermedad sistémica. Presentamos el caso de un varón con neurolinfomatosis a nivel de la cauda equina y agrupamos los casos descritos hasta el momento

Neurolymphomatosis is a rare disorder characterised by infiltration of neoplastic lymphocytes into the peripheral nervous system. A wide variety of symptoms can manifest depending on its nature and location, making its diagnosis a real challenge. Treatment is based on methotrexate, although various chemotherapy regimens are currently available for patients with systemic disease. We present the case of a male patient with neurolymphomatosis of the cauda equina, together with a review of all cases published to date

Reparación de lesiones en nervios mediante el implante de prótesis obtenidas de segmentos acelulares de nervio isogénico / Repair of nerve injury by implanting prostheses obtained from isogenic acellular nerve segments

Introducción. Cuando se produce una sección nerviosa con separación significativa de los cabos es necesario utilizar una prótesis, a modo de puente, para suturarlos. La mejor prótesis es un segmento de nervio autógeno, pero presenta importantes inconvenientes. Nuestro objetivo es comparar la eficacia de la sutura simple con la tubulización para el implante de una prótesis de nervio isogénico descelularizado. Material y método. Se utilizan 4 grupos de ratas Wistar. Grupo 0: animales donantes de nervio ciático. Grupo 1: recibió el implante con sutura término-terminal. Grupo 2: recibió el implante dentro de un tubo de ??-caprolactona. Grupo 3: lo recibió en un tubo de poliláctico-co-glicólico. Se evaluó la función motora (índice ciático) y la extensión de la regeneración (estudio histológico) a las 3 semanas del implante. Resultados. La regeneración ha sido irregular en los 3 grupos experimentales. En todos hay implantes en los que las fibras nerviosas regeneran la longitud máxima estudiada (15mm) y otros en los que la regeneración es muy escasa. La longitud media de regeneración es mayor en el grupo de sutura directa (G1), aunque la velocidad es similar en los 3. El grupo 1 muestra el mayor porcentaje de regeneración, aunque la variabilidad de los resultados impide que esta diferencia alcance significación estadística. No hemos hallado diferencias significativas entre los dos grupos con tubos de diferentes polímeros. Conclusión. Para implantar prótesis de nervios isogénicos descelularizados es más eficaz, en nuestras condiciones experimentales, la sutura término-terminal que los tubos de polímeros biocompatibles (AU)

Introduction. When a nerve section with a significant gap occurs, it is necessary to use a prosthesis to suture it. To date an autologous nerve segment graft appears to be the best treatment; but it has several important disadvantages. Our goal is to study the effectiveness of an isogenic acellular nerve prosthesis comparing a simple suture with tubulisation. Material and method. Four groups of Wistar rats were used. The animals in Group 0 served as donors of nerve segments to graft. Group 1 received the implant with an end-to-end suture. In group 2, the implant was sutured inside an ??-caprolactone tube. Group 3 received it in a polylactic-co-glycolic acid tube. We evaluated the motor function (sciatic index and step test in motion), and the regeneration length by histological study of regeneration, after a maximum of 3 weeks. Results. Regeneration was uneven in the three groups. In all groups, there were implants with regenerated nerve fibres at the maximum studied length (15mm) and others where regeneration was scarce. The mean regeneration length was greater in the direct end-to-end suture group (G1), although the regeneration speed was similar in the three groups. Group 1 showed the highest percentage of regeneration, but the variability of results prevents this difference reaching statistical significance. We found no significant differences between the two groups with polymer tubes. Conclusion. For the implantation of isogenic acellular nerve prosthesis, under our experimental conditions, the direct end-to-end suture was more effective than when it isprotected with biopolymer tubes (AU)

Functional outcomes of Gartland III supracondylar humerus fractures with early neurovascular complications in children: A retrospective observational study.

This was a retrospective observational study. The aim of this study was to evaluate functional outcomes in children treated for Gartland III supracondylar humerus (SCH) fracture with neurovascular (NV) injuries using validated outcome measures. A secondary goal was to determine whether clinical parameters such as age at injury, sex, weight, fracture site, and/or direction of displacement could predict NV injury at the time of fracture or long-term functional outcomes in these patients.One hundred fifty-four patients of Gartland III SCH fractures between March 2004 and May 2013 were studied retrospectively. The patients were divided into 2 groups according to the presence of NV injury. Medical records and radiographs were reviewed to assess several parameters, including age, sex, weight, treatment intervention, the extremity involved, direction of fracture displacement, and NV injury. Functional outcome was assessed on final follow-up using the Pediatric Outcomes Data Collection Instrument (PODCI) and Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) outcome measures. Statistical analysis was used to determine the relationship between NV injury and functional outcomes.There were 33 cases with Gartland III SCH fracture associated with NV injuries (10 cases of vascular compromise, 14 cases of neural injury, and 9 cases involving both vascular compromise and neural injury). There were significant differences between the 2 groups in age (P  =  .048), weight (P  =  .009), and direction of displacement (P  =  .004). Vascular compromise and median nerve injury were most common in fractures with posterolateral displacement, and radial nerve injuries were common in fractures with posteromedial displacement. The mean global function score in the PODCI was 91.4 points, and the mean Quick DASH score was 11.7 points, with excellent functional outcomes. No differences in outcomes were identified based upon age, fracture site, sex, weight, direction of displacement, or operative technique in NV injury patients (P > .05).The majority of patients with Gartland III SCH fractures associated with NV injuries returned to a high functioning level after treatment of their injuries. NV injury does not appear to influence functional outcomes. Good functional results can be expected regardless of age, fracture site, sex, weight, direction of displacement, and operative technique.

Percutaneous Image-Guided Cryoablation for the Treatment of Phantom Limb Pain in Amputees: A Pilot Study.

PURPOSE: To prospectively evaluate percutaneous image-guided nerve cryoablation for treatment of refractory phantom limb pain (PLP) in a pilot cohort for purposes of deriving parameters to design a larger, randomized, parallel-armed, controlled trial. MATERIALS AND METHODS: From January 2015 to January 2016, 21 patients with refractory PLP underwent image-guided percutaneous cryoneurolysis procedures. Visual analog scale scores were documented at baseline and 7, 45, and 180 days after the procedure. Responses to a modified Roland Morris Disability Questionnaire were documented at baseline and 7 and 45 days after the procedure. RESULTS: Technical success rate of the procedures was 100%. There were 6 (29%) minor procedure-related complications. Disability scores decreased from a baseline mean of 11.3 to 3.3 at 45-day follow-up (95% confidence interval 5.8, 10.3; P < .0001). Pain intensity scores decreased from a baseline mean of 6.2 to 2.0 at long-term follow-up (95% confidence interval 2.8, 5.6; P < .0001). CONCLUSIONS: Image-guided percutaneous nerve cryoablation is feasible and safe and may represent a new efficacious therapeutic option for patients with phantom pains related to limb loss.

[Microsurgery in reanimation, lymphoedema and hand surgery].

Microsurgery is defined as surgery performed with the aid of ocular magnification. In Denmark, this is undertaken by four units. This review describes the history of microsurgery which evolved during the 1960s. Microsurgery in hand surgery is primarily replantation and revascularisation but also peripheral nerve surgery as well as brachial plexus surgery. Lymphoedema is being treated with super microsurgery on an experimental basis. Dynamic reconstruction of facial palsy is performed in a two-stage operation with cross-over nerve graft and a free microvascular muscle flap, typically gracilis.

Intraoperative mapping of roots, plexuses, and nerves.

The use of intraoperative mapping of neural structures has come to be an indispensable technique to prevent or minimize postoperative morbidity. In this article, I briefly mention its use in mapping nerve roots, plexuses, and peripheral nerves. The reader may find some mention of monitoring techniques, too, as monitoring and mapping are seldom done separately. I include the technical details of different mapping modalities, relevant anatomy, and clinical applications, as appropriate.

Parálisis del nervio mediano secundaria a lipofibrohamartoma en el túnel carpiano / Paralysis of the median nerve due to a lipofibrohamartoma in the carpal tunnel

Introducción. El lipofibrohamartoma es una rara entidad nosológica de etiología desconocida que puede afectar a cualquier nervio periférico, localizándose de forma preeminente en el nervio mediano en el interior del túnel carpiano. El lipofibrohamartoma se asocia con frecuencia a otras alteraciones como la macrodactilia, los síndromes de Proteus y Klippel-Trenaunay-Weber, y la exóstosis múltiple, entre otras. Casos clínicos. Los autores han tratado en 20 años 4 lipofibrohamartomas del nervio mediano, 2 de los cuales tenían parálisis mediana, motivo de este artículo. Estos pacientes se trataron con liberación simple del nervio mediano mediante apertura del ligamento anular del carpo y transposición tendinosa abductora con palmaris longus prolongado con la fascia palmar superficial (técnica de Camitz). En uno de los casos, multioperado previamente, se realizó también un colgajo interóseo posterior para mejorar la calidad de las partes blandas de la cara anterior de la muñeca. Discusión. Se hace una revisión de la literatura sobre el lipofibrohamartoma del nervio mediano desde 1964 hasta 2010. La revisión de la literatura sugiere que el tratamiento más recomendado es la liberación simple del túnel carpiano y se recomienda asociar una transposición tendinosa si hay parálisis del nervio mediano(AU)

Introduction. The lipofibrohamartoma is a rare entity of unknown origin that can affect any peripheral nerves, but mainly being found in the median nerve within the carpal tunnel. The lipofibrohamartoma is frequently associated with other conditions such as macrodactyly, the Proteus and Klippel-Trenaunay-Weber syndromes and multiple exostosis, among others. Clinical cases. Two cases of lipofibrohamartoma in the carpal tunnel with associated median nerve palsy are described in the present article. They were treated by simple decompression of the median nerve by releasing the transverse carpal ligament and a palmaris longus tendon transfer to improve the thumb abduction (Camitz procedure). In one of the cases (a previously multi-operated median nerve entrapment at the carpal tunnel), a posterior interosseous skin flap was employed to improve the quality of the soft tissues on the anterior side of the wrist. Discussion. A review of the literature is also presented on lipofibrohamartoma of the median nerve, covering articles from 1964 to 2010. The literature suggests that the most recommended treatment to manage this condition is simple release of the carpal tunnel, which should be associated with a tendon transfer when a median nerve palsy is noticed(AU)

Acute combined exposure to heavy metals (Zn, Cd) blocks memory formation in a freshwater snail.

The effect of heavy metals on species survival is well documented; however, sublethal effects on behaviour and physiology are receiving growing attention. Measurements of changes in activity and respiration are more sensitive to pollutants, and therefore a better early indicator of potentially harmful ecological impacts. We assessed the effect of acute exposure (48 h) to two heavy metals at concentrations below those allowable in municipal drinking water (Zn: 1,100 µg/l; Cd: 3 µg/l) on locomotion and respiration using the freshwater snail, Lymnaea stagnalis. In addition we used a novel assessment method, testing the ability of the snail to form memory in the presence of heavy metals in both intact snails, and also snails that had the osphradial nerve severed which connects a chemosensory organ, the osphradium, to the central nervous system. Aerial respiration and locomotion remained unchanged by acute exposure to heavy metals. There was also no effect on memory formation of these metals when administered alone. However, when snails were exposed to these metals in combination memory formation was blocked. Severing the osphradial nerve prevented the memory blocking effect of Zn and Cd, indicating that the snails are sensing these metals in their environment via the osphradium and responding to them as a stressor. Therefore, assessing the ability of this species to form memory is a more sensitive measure of heavy metal pollution than measures of activity, and indicates that the snails' ability to demonstrate behavioural plasticity may be compromised by the presence of these pollutants.

[Evaluation and management of adult peripheral nerve lesions]. / Evaluación y manejo de lesiones del nervio periférico en el adulto.

Adult peripheral nerve pathology is quite extensive, it comprises traumatic injuries (closed and open), compressive neuropathies and lesions secondary to other medical procedures. It is important to have a well established protocol for diagnosis, as in some lesions time is a key factor for recovery. This is important for the primary care physician that makes the diagnosis, regardless of who will treat the patient. When proposing a management plan it is important to set goals, as some lesions may be completely resolved, but in other cases all we can offer is palliative treatment due to the evolution and severity of the case.

Functional gait evaluation of collagen chitosan nerve guides for sciatic nerve repair.

The objective of this work was to use a functional gait analysis technique to evaluate sciatic nerve repair through tissue-engineered nerve guides in a rodent animal model. The nerve guides were fabricated by blending collagen with chitosan material and evaluated over a 12-week period for motor and sensory nerve recovery assessed by gait analysis and behavioral testing. Gastrocnemius muscle weight measurements were obtained at the end of each experimental time point and correlated to motor nerve recovery. Functional gait analysis studied both the stance and swing phase angle formations during a normal gait cycle. During the stance phase, functional results revealed that blended nerve guides promoted increased motor nerve recovery than unblended chitosan nerve guides. Similar results were obtained from behavioral tests, indicating that blended nerve guides created increased sensitivity to applied stimulus compared to unblended nerve guides. Muscle strength also correlated with functional recovery and was significantly higher when compared to the unblended nerve guides. From this study, we conclude that collagen-blended chitosan nerve guides enhanced motor and sensory nerve recovery assayed through gait and behavioral testing compared to unblended nerve guides.

Recent conclusions regarding the reconstructive microsurgery of peripheral nerves.

The introducing of reconstructive microsurgery has meant not only the addition of microsurgical microscopes and instruments, but a change, a progress towards a new concept, the concept of the microsurgical reconstruction of tissues. The microscope and the instruments themselves are only a means of utilizing this new concept to good effect since the mere use of the microscope and of the instruments according to the old concept of tissue reconstruction cannot be considered to be reconstructive microsurgery. From December 1979 through to December 2005, more than 3000 patients with peripheral nerve lesions were operated on by the same microsurgeon, the author Doina Ionescu-Dumitrescu. The conclusions are based on the following: A huge amount of work involved in carrying out microsurgical reconstructions of over 7500 peripheral nerves in over 3000 patients, 1800 of which were nerve transplants for defects of peripheral nerves of the extremities, for posttraumatic brachial plexus paralyses (91), for replantations and/or revascularizations following partial or complete amputations of the extremities (24 out of which 23 successful) or for free transfers of functional composite tissues (53). For a more accurate picture of such an effort one should consider the operation time that these types of reconstruction involve: between 3 and 12 hours for each patient under general anaesthesia and for both the anaesthetist and the microsurgeon. Experimental microsurgery on rabbit ears The results of the histopathological examination of 500 postoperative neuromas of peripheral nerves repaired traditionally. The Moberg test. Pre, intra and postoperative monthly observations of the patients until their full recovery according to the criteria set by the International Reconstructive Microsurgery Society (postoperative intervals of 6-12-24 months). Taking pictures and recording pre, intra and postoperative stages. The patients' professional, social and familial reintegration. The patients' state of mind; level of cooperation. Comparing results with those of classic and palliative repairs. Comparing the data resulting from this experience with the information provided by the specialist literature of the world. Completing the internationally defined reconstructive procedures with the personal ones, to produce a new concept.

[Construction and evaluation of the tissue engineered nerve of bFGF-PLGA sustained release microspheres].

OBJECTIVE: To study the outcomes of nerve defect repair with the tissue engineered nerve, which is composed of the complex of SCs, 30% ECM gel, bFGF-PLGA sustained release microspheres, PLGA microfilaments and permeable poly (D, L-lactic acid) (PDLLA) catheters. METHODS: SCs were cultured and purified from the sciatic nerves of 1-day-old neonatal SD rats. The 1st passage cells were compounded with bFGF-PLGA sustained release microspheres and ECM gel, and then were injected into permeable PDLLA catheters with PLGA microfilaments inside. In this way, the tissue engineered nerve was constructed. Sixty SD rats were included. The model of 15-mm sciatic nerve defects was made, and then the rats were randomly divided into 5 groups, with 12 rats in each. In group A, autograft was adopted. In group B, the blank PDLLA catheters with PBS inside were used. In group C, PDLLA catheters, with PLGA microfilaments and 30% ECM gel inside, were used. In group D, PDLLA catheters, with PLGA microfilaments, SCs and 30% ECM gel inside, were used. In group E, the tissue engineered nerve was applied. After the operation, observation was made for general conditions of the rats. The sciatic function index (SFI) analysis was performed at 12, 16, 20 and 24 weeks after the operation, respectively. Electrophysiological detection and histological observation were performed at 12 and 24 weeks after the operation, respectively. RESULTS: All rats survived to the end of the experiment. At 12 and 16 weeks after the operation, group E was significantly different from group B in SFI (P < 0.05). At 20 and 24 weeks after the operation, group E was significantly different from groups B and C in SFI (P < 0.05). At 12 weeks after the operation, electrophysiological detection showed nerve conduct velocity (NCV) of group E was bigger than that of groups B and C (P < 0.05), and compound amplitude (AMP) as well as action potential area (AREA) of group E were bigger than those of groups B, C and D (P < 0.05). At 24 weeks after the operation, NCV, AMP and AREA of group E were bigger than those of groups B and C (P < 0.05). At 12 weeks after the operation, histological observation showed the area of regenerated nerves and the number of myelinated fibers in group E were significantly differents from those in groups A, B and C (P < 0.05). The density and diameter of myelinated fibers in group E were smaller than those in group A (P < 0.05), but bigger than those in groups B, C and D (P < 0.05). At 24 weeks after the operation, the area of regenerative nerves in group E is bigger than those in group B (P < 0.05); the number of myelinated fibers in group E was significantly different from those in groups A, B, C (P < 0.05); and the density and diameter of myelinated fibers in group E were bigger than those in groups B and C (P < 0.05). CONCLUSION: The tissue engineered nerve with the complex of SCs, ECM gel, bFGF-PLGA sustained release microspheres, PLGA microfilaments and permeable PDLLA catheters promote nerve regeneration and has similar effect to autograft in repair of nerve defects.

Long-term results after microsurgical repair of traumatic nerve lesions of the upper extremities.

OBJECTIVE: Peripheral nerve injuries are still underestimated. This study examines the outcomes after surgical treatment of traumatic nerve lesions of the upper extremities. The different surgical techniques are analyzed with regard to the long-term outcome. METHODS: This retrospective study presents the data of 93 patients (female: 24; male: 69) who were operated on for peripheral nerve injuries of the upper extremities in our department between 1991 and 2003. Mean age was 31 years (range, 5-67 years). Altogether 100 traumatic nerve lesions (ulnar nerve: 20; radial nerve: 22; median nerve: 25; axillary nerve: 6; accessory nerve: 7; musculocutaneous nerve: 2; long thoracic nerve: 1; digital nerve: 3; combined nerves: 7) were surgically treated. Surgical management included primary nerve suture in 16, neurolysis in 25, and nerve grafting in 59 patients. RESULTS: 74 patients (80%) were available for follow-up examination. The mean follow-up period was 35 months (range, 18-132 months). All patients up to the age of 20 years demonstrated good or excellent sensorimotor recovery. A good functional outcome was observed in 79% of the patients older than 20 years. Overall, good to excellent improvements of motor function were achieved for lesions of the musculocutaneous, radial, accessory and axillary nerves (100%, 89%, 100%, 100% functional useful muscle innervation, muscle recovery grade 3 and more). The length of grafts, in cases of secondary nerve reconstruction, did not influence functional outcome. CONCLUSION: Generally, early surgical repair of a nerve lesion predicted a better outcome. A good functional motor recovery was dependent on the age of the patient. Traumatic nerve lesions, without signs of reinnervation, should be treated surgically within a period of three months after injury.

Uso da técnica de tubulização para o reparo de lesões do sistema nervoso periférico / Tubulization techniques for the repair of peripheral nervous system injuries

As primeiras cirurgias de nervos periféricos começaram a ser realizadas há mais de 150 anos e precocemente se observou que as suturas término-terminais, quando feitas sob tensão, resultavam em limitados resultados funcionais. A utilização de algum tipo de tecido interposto entre os cotos do nervo traumatizado foi logo idealizada como alternativa e, atualmente, o uso de enxertos neurais autólogos permanece como o "padrão-ouro" para o tratamento de lesões extensas do sistema nervoso periférico. Porém, a técnica apresenta algumas limitações,que resultam em morbidade para o paciente. Esses fatos motivaram o desenvolvimento de materiais alternativos para servir como condutor de enxertos, dando início às pesquisas das técnicas de tubulização. Os tubos biológicos, como veias ou de veias enriquecidas com músculo esquelético, demonstaram resultados favoráveis tanto em estudos clínicos quanto em experimentais. O uso de materiais sintéticos também foi alvo de avaliação, apresentando resultados animadores com os tubos de silicone e de ácido poliglicólico. Esta revisão objetiva descrever a evolução histórica e os resultados dos ensaios clínicos e experimentais obtidos com as técnicas de tubulização para o tratamento das lesões traumáticas do sistema nervoso periférico.

Nerve sparing laparoscopic radical prostatectomy: our technique.

PURPOSE: To describe our technique of nerve sparing laparoscopic radical prostatectomy (LRP). We present the oncological and functional results (potency and urinary continence). MATERIAL AND METHODS: LRP has become standard at our institution based on experience with more than 2800 consecutive cases operated on between 1997 and 2005. From May 2003 to March 2005 a total of 677 LRP were performed, 425 consecutive patients candidates for a nerve sparing technique have been operated using the intrafascial approach. The challenge of our technique is to remove the prostate without any thermic and mechanic traumatism, avoiding dissection of outer layer. Oncological data were assessed by pathological examination and post-operative PSA level. Functional results were assessed with a self questionnaire. RESULTS: By pathological stage, 2 pT2a specimens (7.4%), 7 pT2b specimens (21%), 44 pT2c specimens (24%), 63 pT3a specimens (43%), 11 pT3b specimens (46%) were found to have positive surgical margins (SMs). In 86 specimen (59%) positive SMs were focal inframillimetric. Median follow-up was 11 months (range 1-22). The continence rate (no leakage/no pad) was 95% at 6 months, confirmed at 12 months among 202 patients. For 137 patients, potency rate was 58.5% at 12 months. CONCLUSION: Intrafascial LRP provides satisfactory results in regard to recovery of continence and sexual function. Long-term progression and survival outcome are necessary before this procedure should be offered as a replacement for interfascial nerve sparing technique.

Video-gait analysis of functional recovery of nerve repaired with chitosan nerve guides.

Quantitative analysis of peripheral nerve regeneration using nerve guides is commonly evaluated through histomorphometry and walking track analysis. We conducted a unique assessment of functional sciatic nerve recovery treated with chitosan nerve guides. We used video-gait analysis to evaluate the extent of functional nerve recovery by measuring the ankle angle at different gait cycle phases. We also correlated the gastrocnemius muscle weight measurements and histological analysis to functional nerve recovery. The chitosan group showed increased functional improvement compared to the control groups at the end of a 12-week period ( p < 0.05). Although both control and chitosan angle measurements were lower than those recorded for presurgery animals, the angle measurements significantly improved over the 12-week period. Stance phase duration of the gait cycle was also recorded, which showed a significant increase over the 12-week time period. The muscle weight parameter indicated a significant decrease in muscle atrophy and restoration of functional strength. Histological analysis revealed that the chitosan nerve guide provided significantly increased axonal growth. The functional results indicated that chitosan nerve guides enhanced functional improvement over no repair processes.