Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Jan 2009
ReviewFrom the battlefront: peripheral nerve surgery in modern day warfare.
Warfare historically causes a large number of peripheral nerve injuries. During the current global war on terror, an increased use of advanced regional anesthesia techniques appears to have significantly reduced pain syndromes that have been previously reported with missile-induced nerve injuries. Additionally, a new program has been established to develop advanced prosthetic devises that can interface with neural tissue to obtain direct neural control. As this technology matures, the functional restoration gained from these new generation prosthetic devices may exceed that which can be obtained by standard nerve repair techniques.
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The concept of the nerve tube has been a major topic of research in the field of peripheral nerve regeneration for more than 25 years. The first nerve tubes are currently available for clinical use. This article gives an overview of the experimental and clinical data on nerve tubes for peripheral nerve repair and critically analyzes the data on which the step from laboratory to clinical use is based. In addition, it briefly discusses the different modifications to the common single lumen nerve tubes that may improve the results of generation.
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Neurosurg. Clin. N. Am. · Jan 2009
Review Case ReportsBrachial plexus injury: the London experience with supraclavicular traction lesions.
In this article, the author details the experiences of his hospital and other London hospitals in treating brachial plexus injury. As noted, important advances have been made in methods of diagnosis and repair. Myelography was replaced by CT scan and later by MRI. ⋯ This is part of a Point-Counterpoint discussion with Dr. David G. Kline's presentation of "A Personal Experience."
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This article is a presentation of personal experience and resultant views by the author on the timing of surgery for nerve injury, especially that for brachial plexus injuries. The author presents arguments for early and delayed surgery based on the type of injury encountered and examines how early nerve repair on all might preclude spontaneous recovery. ⋯ This is part of a Point-Counterpoint discussion with Dr. Rolfe Birch's presentation of "The London Experience."
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Neurosurg. Clin. N. Am. · Jan 2009
ReviewNeurostimulation techniques for painful peripheral nerve disorders.
Disorders of the peripheral nervous system often present a unique challenge to the clinician or surgeon, because the neuropathic pain associated with them can be extremely resistant to typical pain treatments. Painful peripheral nerve disorders often have pain in a particular peripheral nerve distribution, and thus an optimal treatment modality is one that delivers targeted relief to the precise distribution of the pain. ⋯ In this article, PNS techniques are described in detail for the stimulation of the occipital and trigeminal nerves for intractable craniofacial pain, as well as emerging techniques for the selective stimulation of spinal nerve roots and subcutaneous peripheral nerve stimulation. The increasing spectrum of disorders and pain syndromes amenable to PNS also is discussed.