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Neurological picture
FMRI evidence for a new therapeutic option for deafferentiated muscles
  1. R Beisteiner1,2,3,
  2. I Höllinger1,2,3,
  3. R Schmidhammer4,5
  1. 1Study Group Clinical fMRI, Medical University of Vienna, Vienna, Austria
  2. 2Department of Neurology, Medical University of Vienna, Vienna, Austria
  3. 3MR Center of Excellence, Medical University of Vienna, Vienna, Austria
  4. 4Millesi Center, Center for Peripheral Nerve and Brachial Plexus Surgery, Reconstructive Surgery, Vienna, Austria
  5. 5Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Austrian Cluster for Tissue Regeneration, Vienna, Austria
  1. Correspondence to Professor Roland Beisteiner, Study Group Clinical fMRI, Department of Neurology, MR Center of Excellence, Medical University of Vienna, Austria, Währinger Gürtel 18–20/ Ebene 6, 1090 Vienna, Austria, Europe; roland.beisteiner{at}meduniwien.ac.at

https://doi.org/10.1136/jnnp.2009.190942

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    Seven years ago, a patient aged 50 suffered from a complete traumatic lesion (rupture and avulsion of spinal roots) of the left brachial plexus resulting in complete arm palsy. For restoration of elbow flexion, the musculocutaneous nerve may be connected to a donor nerve. Classical nerve reconstruction techniques perform end-to-end coaptation of a donor nerve with the receptor nerve, thereby sacrificing the function of the donor nerve. Neurophysiological investigations indicated that cortical reorganisation but no spinal reorganisation occurs with these patients.1 Recently, a new therapeutic option for deafferentiated muscles was suggested, which allows preservation of the donor nerve function: end-to-side coaptation.2 With our patient, a nerve graft was connected to the left phrenic nerve using end-to-side coaptation (and end-to-end coaptation of the nerve graft to the diseased musculocutaneous nerve). The end-to-side coaptation at the phrenic nerve allows …

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    Footnotes

    • Funding Funding was provided by the Austrian Science Fund (P18057). Austrian Science Fund (FWF), Haus der Forschung, Sensengasse 1, 1090 Vienna, Austria, Europe.

    • Competing interests None.

    • Ethics approval Ethics approval was provided by the Ethics committee of the Medical University of Vienna, Austria.

    • Provenance and peer review Not commissioned; externally peer reviewed.