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End-to-side nerve neurorrhaphy: critical appraisal of experimental and clinical data

  • Conference paper
Book cover How to Improve the Results of Peripheral Nerve Surgery

Part of the book series: Acta Neurochirurgica Supplementum ((NEUROCHIRURGICA,volume 100))

Abstract

End-to-side neurorrhaphy (ESN) or terminolateral neurorraphy consists of connecting the distal stump of a transected nerve, named the recipient nerve, to the side of an intact adjacent nerve, named the donor nerve, “in which only an epineurial window is performed”. This procedure was re introduced in 1994 by Viterbo, who presented a report on an experi mental study in rats. Several experimental and clinical studies followed this report with various and sometimes conflicting results.

In this paper we present a review of the pertinent literature. Our personal experience using a sort of end-to-side nerve anastomosis, in which the donor nerve is partially transected, is also presented and compared with ESN as defined above.

When the proximal nerve stump of a transected nerve is not available, ESN, which is claimed to permit anatomic and functional preservation of the donor nerve, seems an attractive technique, though yet not proven to be effective. Deliberate axotomy of the donor nerve yields results that are proportional to the entity of axotomy, but such technique, though resembling ESN, is an end-to-end neurorrhaphy.

Neither experimental or clinical evidence support liberalizing the clinical use of ESN, a procedure with only an epineurial window in the donor nerve and without deliberate axotomy. Much more experimental investigation needs to be done to explain the ability of normal, intact nerves to sprout laterally. Such procedure appears justified only in an investigational setting.

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Authors and Affiliations

  1. Institute of Neurosurgery, Catholic University School of Medicine, Largo Agostino Gemelli 8, 00168, Rome, Italy

    E. Fernandez, L. Lauretti, T. Tufo, M. D’Ercole, A. Ciampini & F. Doglietto

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  1. E. Fernandez
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  2. L. Lauretti
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  3. T. Tufo
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  4. M. D’Ercole
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  5. A. Ciampini
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  6. F. Doglietto
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Editors and Affiliations

  1. Wiener Privatklinik, Vienna, Austria

    H. Millesi  & R. Schmidhammer  & 

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© 2007 Springer-Verlag

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Fernandez, E., Lauretti, L., Tufo, T., D’Ercole, M., Ciampini, A., Doglietto, F. (2007). End-to-side nerve neurorrhaphy: critical appraisal of experimental and clinical data. In: Millesi, H., Schmidhammer, R. (eds) How to Improve the Results of Peripheral Nerve Surgery. Acta Neurochirurgica Supplementum, vol 100. Springer, Vienna. https://doi.org/10.1007/978-3-211-72958-8_17

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  • DOI: https://doi.org/10.1007/978-3-211-72958-8_17

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-72955-7

  • Online ISBN: 978-3-211-72958-8

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