Name:
10.3171/2022.10.FOCVID22110
Description:
10.3171/2022.10.FOCVID22110
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/bcd6c79a-ae7d-49af-8f8f-2dd52e0870ea/videoscrubberimages/Scrubber_383.jpg
Duration:
T00H10M29S
Embed URL:
https://stream.cadmore.media/player/bcd6c79a-ae7d-49af-8f8f-2dd52e0870ea
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/bcd6c79a-ae7d-49af-8f8f-2dd52e0870ea/10. 22-110.mp4?sv=2019-02-02&sr=c&sig=vxOhsdLovXfEmDo%2Ff296fsVY81CZvYPu2wTKUuE%2B%2BYU%3D&st=2025-10-02T00%3A05%3A34Z&se=2025-10-02T02%3A10%3A34Z&sp=r
Upload Date:
2022-11-17T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
[MUSIC PLAYING]
SPEAKER: Distal nerve transfer--pronator teres to anterior interosseous nerve and supinator to posterior interosseous nerve--for regaining hand function in C8, T1 root injury following extirpation of the right C8, T1 schwannoma. The indications for distal nerve transfers are following: upper brachial plexus palsy, C5-C6; lower brachial plexus palsy, C8-T1; isolated axillary nerve lesion; isolated proximal extensive radial nerve lesion; isolated muscocutaneous nerve lesion; isolated proximal extensive median nerve lesion; isolated proximal ulnar nerve lesion.
SPEAKER: The 48-year-old female patient was admitted to our department due to the hand weakness as a consequence of C8, T1 root injury. Eight months earlier, the patient was treated by a pulmonary surgeon due to the expansive lesion near apex of the right lung. Postoperative pathological findings indicated that the lesion was nerve schwannoma. At the admission, clinical findings included right lower brachial plexus palsy and pain in the C8 and T1 dermatomes of the right thorax and arm.
SPEAKER: Electromyography revealed acute axonal lesion in the C8 and T1 myotomes on the right arm. Magnetic resonance imaging, MRI, showed a lesion of the C8 and T1 roots at the level of the right transversal process of the T1 vertebra. The patient was placed in a supine position. The S-shaped incision was made at the volar side of the forearm.
SPEAKER: Exploration was started by dissection of the soft tissue layer by layer. The antebrachial fascia is dissected.
SPEAKER: The deep radial nerve branch was identified and marked with a red catheter. The anatomical landmarks for deep radial nerve branch exploration are noted: 1) the brachioradial muscle; 2) the lateral compartment extensors, extensor carpi radialis brevis and longus; and 3) the supinator muscle and the arcade of Frohse. The fascia from the bicep distal insertion is dissected.
SPEAKER:
SPEAKER: The median nerve was identified and marked with a blue catheter. The anatomical landmarks for the median nerve exploration are noted, the arcade of the flexors and the pronator teres muscle. Further exploration include identification of the terminal side branches: 1) branch for pronator teres, 2) anterior interosseous nerve, 3) superficial sensory radial nerve, 4) posterior interosseous nerve, 5) branches of the supinator.
SPEAKER: The nerves and the branches of interest for this procedure in this individual patient are marked. By direct stimulation, the donor branches, for supinator and frontal teres muscles, and recipient nerve branches, posterior interosseous nerve and anterior interosseous nerve, were verified.
SPEAKER: Preparation for the first recipient branch, the posterior interosseous nerve. The application of bends infused with an adrenaline solution for preventing significant bleeding at the nerve stump. Preparation of the branches for supinator muscle in order to provide a first donor branch. The proper positioning of the recipient and donor branches is necessary so there is no tension over suture line.
SPEAKER:
SPEAKER: The epineurial suture provides positioning of the branches with minimal damage to the tissue.
SPEAKER: Combination of one up to two sutures with 1 ml of fibrin glue provides stabilization of the suture line without tension. The same process was repeated to make the second transfer.
SPEAKER: Following the nerve transfer, the adrenaline-infused bands were carefully removed.
SPEAKER: The layered closure technique included cutaneous and subcutaneous sutures of the dissected tissue.
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