BACKGROUND: In the first part of this report, the European Association of Neurosurgical Societies' section of peripheral nerve surgery presented a systematic literature review and consensus statements on anatomy, classification, and diagnosis of thoracic outlet syndrome (TOS) along with a subclassification system of neurogenic TOS (nTOS). Because of the lack of level 1 evidence, especially regarding the management of nTOS, we now add a consensus statement on nTOS treatment among experienced neurosurgeons. OBJECTIVE: To document consensus and controversy on nTOS management, with emphasis on timing and types of surgical and nonsurgical nTOS treatment, and to support patient counseling and clinical decision-making within the neurosurgical community. METHODS: The literature available on PubMed/MEDLINE was systematically searched on February 13, 2021, and yielded 2853 results. Screening and classification of abstracts was performed. In an online meeting that was held on December 16, 2021, 14 recommendations on nTOS management were developed and refined in a group process according to the Delphi consensus method. RESULTS: Five RCTs reported on management strategies in nTOS. Three prospective observational studies present outcomes after therapeutic interventions. Fourteen statements on nonsurgical nTOS treatment, timing, and type of surgical therapy were developed. Within our expert group, the agreement rate was high with a mean of 97.8% (± 0.04) for each statement, ranging between 86.7% and 100%. CONCLUSION: Our work may help to improve clinical decision-making among the neurosurgical community and may guide nonspecialized or inexperienced neurosurgeons with initial patient management before patient referral to a specialized center.

• MeSH
• chirurgická dekomprese škodlivé účinky   MeSH
• lidé MeSH
• neurochirurgické výkony škodlivé účinky   MeSH
• periferní nervy chirurgie   MeSH
• pozorovací studie jako téma MeSH
• prospektivní studie MeSH
• syndrom horní hrudní apertury * diagnóza   chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• systematický přehled MeSH

Peripheral nerve injuries of the lower extremities are not frequent. The most common are traction injury of the peroneal nerve at the knee level or iatrogenic trauma of the pelvic nerves during abdominal surgery. Civil sharp injuries are rare.Indications for surgical revision follow the general rules of nerve surgery. Sharp injury should be treated as soon as possible, ideally within 72 hours. Closed lesions are indicated for surgery if a complete denervation remains unchanged three months after the injury. Best results can be achieved within six months from the injury. Irritations caused by bone fragments or scarring or by iatrogenic injury (clamps, cement, screws, etc.) may be revised later. However, the most important is early clinical examination in a specialized neurosurgical department.

• Klíčová slova
• nerve suture., neurolysis, peripheral nerve injury,
• MeSH
• bérec inervace   MeSH
• lidé MeSH
• neurochirurgické výkony metody   MeSH
• periferní nervy chirurgie   MeSH
• poranění dolní končetiny chirurgie   MeSH
• poranění periferního nervu chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: Many experimental studies have confirmed collateral sprouting of axons after end-to-side neurorrhaphy and its possible clinical application. There is still controversy about how the surgical method should be carried out. The aim of the present study was to quantitatively evaluate collateral sprouting of motor and sensory axons after end-to-side neurorrhaphy with and without the perineurial window. METHODS: End-to-side neurorrhaphy of the distal stump of transected musculocutaneous nerve with intact ulnar nerve with or without a perineurial window was performed in a rat model. Collateral sprouts were quantitatively evaluated by counting of motor and sensory neurons following their retrograde labeling by Fluoro-Ruby and Fluoro-Emerald applied to the ulnar and musculocutaneous nerves, respectively. RESULTS: Our results show that significantly more motor and sensory axons sent their collateral branches into the recipient nerve in the group with a perineurial window. Some axons were injured during preparation of the perineurial window; the injured axons reinnervated directly into the recipient nerve to contribute to results of functional reinnervation. CONCLUSION: The authors conclude that it is necessary to create a perineurial window when using end-to-side neurorrhaphy in clinical practice, especially in brachial plexus reconstruction.

• MeSH
• anastomóza chirurgická MeSH
• axony MeSH
• krysa rodu Rattus MeSH
• motorické neurony cytologie   MeSH
• nervové receptory cytologie   MeSH
• nervus musculocutaneus cytologie   růst a vývoj   chirurgie   MeSH
• nervus ulnaris cytologie   růst a vývoj   MeSH
• péče o zevnějšek u zvířat fyziologie   MeSH
• periferní nervy cytologie   chirurgie   MeSH
• potkani Wistar MeSH
• spinální ganglia cytologie   MeSH
• zvířata MeSH
• Check Tag
• krysa rodu Rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

• MeSH
• axila inervace   MeSH
• dospělí MeSH
• lidé MeSH
• neurochirurgické výkony metody   MeSH
• neuropatie brachiálního plexu chirurgie   MeSH
• periferní nervy chirurgie   MeSH
• poranění periferního nervu chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Peripheral neuropathic pain (PNP) frequently occurs as a consequence of nerve injury and may differ depending upon the type of insult and the individual patient. Progress in our knowledge of PNP induction mechanisms depends upon the utilization of appropriate experimental models in rodents based on various types of peripheral nerve lesions. In this review, we draw attention to current knowledge on basic cellular and molecular events in various experimental models used to induce the PNP symptoms. Spontaneous ectopic activity of axotomized and non-axotomized primary sensory neurons, the bodies of which are located in the dorsal root ganglion (DRG), seems to be a key mechanism of PNP induction. The primary sensory neurons are directly affected by nerve injury or indirectly by activated satellite glial cells and adjoining immune cells that release a variety of molecules changing the microenvironment of the neurons. Recently, it has become clear that molecules produced during Wallerian degeneration play an important role not only in axon-promoting conditions distal to nerve injury but also in initiation of neuropathic pain. The molecules, transported by the blood, influence afferent neurons and their axons not only in DRG associated, but also those not directly associated with the injured nerve (i.e., in the contralateral DRG or at different spinal segments). Generally, all experimental PNP models based on a partial injury of peripheral nerve segments contain mechanisms initiated by signal molecules of Wallerian degeneration.

• MeSH
• axony fyziologie   MeSH
• axotomie MeSH
• bolest patofyziologie   MeSH
• modely nemocí na zvířatech MeSH
• nemoci periferního nervového systému patofyziologie   MeSH
• neurony fyziologie   MeSH
• periferní nervy patofyziologie   chirurgie   MeSH
• rychlost toku krve MeSH
• spinální ganglia krevní zásobení   patofyziologie   MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

OBJECTIVES: The authors present their results of 44 microsurgical procedures of 47 nerves in 44 patients subjects over a period of 19 years, from 1985 to 2003. STUDY GROUP SUBJECTS AND METHODS: 44 patients with injuries to peripheral nerves of the upper extremities underwent reconstructions of 47 nerves using autotransplants. The procedures effectivity results were analysed using the following indicators: the injury to the procedure time, the patient's age, the autotransplant length, the injury type, the injury site, the injured nerve type. RESULTS: The best results were reached: in young patients up to the age of 20, in cases of early operations up to 3 months, in cases when grafts up to 5 cm were used. Clean, for instance incision injury, has much better prospects for successful nerve graft autotransplantation than others, more complicated injuries (e.g. lacerated injury or contusion).

• MeSH
• dospělí MeSH
• horní končetina inervace   MeSH
• lidé MeSH
• neurochirurgické výkony MeSH
• obnova funkce MeSH
• periferní nervy chirurgie   transplantace   MeSH
• poranění periferního nervu * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

We present three cases of subcutaneous tumors with hybrid features of schwannoma-perineurioma (one case) and neurofibroma-perineurioma (two cases), which occurred in two women aged 50 and 52 years and one man aged 52. Locations included the scapular area, skin overlying breast and knee area. The tumors were 1.5, 4 and 5 cm in largest diameter. None of the patients had signs of neurofibromatosis. All tumors were surgically removed, and patients remained disease-free for 1 to 4 years. The classification of the lesion into schwannoma-perineurioma and neurofibroma-perineurioma rested on histopathological and immunohistochemical findings. An ultrastructural study was performed in one case of neurofibroma-perineurioma. All cases were studied for mutation of the NF2 gene, and in one case (neurofibroma-perineurioma) a point mutation was detected in exon 15 of the gene.

• MeSH
• bodová mutace MeSH
• DNA nádorová analýza   MeSH
• imunoenzymatické techniky MeSH
• lidé středního věku MeSH
• lidé MeSH
• mnohočetné primární nádory chemie   patologie   chirurgie   MeSH
• molekulární sekvence - údaje MeSH
• mutační analýza DNA MeSH
• nádorové biomarkery analýza   MeSH
• nádory měkkých tkání chemie   patologie   chirurgie   MeSH
• nádory nervové pochvy chemie   patologie   chirurgie   MeSH
• neurilemom chemie   patologie   chirurgie   MeSH
• neurofibrom chemie   patologie   chirurgie   MeSH
• periferní nervy chemie   patologie   chirurgie   MeSH
• přežití bez známek nemoci MeSH
• sekvence nukleotidů MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• DNA nádorová MeSH
• nádorové biomarkery MeSH

AIM: This study presents the results of the brachial plexus and the peripheral extremities nerves neurolyses conducted in our clinic for 18 years from 1985 to 2003. SUBJECTS AND METHODOLOGY: 92 patients were treated surgically using neurolyses. Out of this number, 10 of them concerned brachial plexi, 49 nerves of the upper extremities and 33 nerves of the lower extremities. Out of the total patient number, 67 were males and 25 females, aged 30 years on average. The average time gap between the injury and the surgical procedure was 6.9 months. An extremely long time gap (over 12 months) was recorded in 5 cases. The operations were conducted in patients who suffered from a complete or persisting neurological deficits. In 92 patients, external neurolysis was conducted, out of them in 7 cases also internal neurolysis was conducted. Cases which required resection of the fascicles and reconstruction using autotransplants, as well as cases which had already undergone reconstruction procedures, have not been included in this study. The results analysis has been conducted with respect to the time gap between the surgical procedure and the injury, to the patient's age, to the type of the injured nerve and to the peroperatively detected degree of fibrotic changes. RESULTS: The best results were observed in patients under 20 years of age, in cases of early treatment, in distal injuries and in neurolyses of the tibial and radial nerves. CONCLUSION: When indicated, the early surgical treatment is the main factor determining the results of the surgical procedures.

• MeSH
• dospělí MeSH
• končetiny inervace   MeSH
• lidé MeSH
• neurochirurgické výkony * MeSH
• periferní nervy chirurgie   MeSH
• plexus brachialis zranění   chirurgie   MeSH
• poranění periferního nervu * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

AIM: This study presents our results of 34 operations in 33 patients undergoing treatment of nerves of the lower extremities, using the method of neurolysis, during an eighteen-year-period, from 1985 to 2003. METHODOLOGY: Thirty three patients underwent superficial neurolysis, five patients underwent both, superficial and internal neurolysis. The surgical procedures were conducted on patients, who suffered from complete or persisting neurological deficits. The cases, which required resection of the fascicles and reconstruction using autografts, as well as the cases, which had already had reconstructional procedures done, were not included in this study. The surgical procedure's efficacy was analysed considering the time delay of the operation after the injury, the patient's age and the type of the injured nerve. RESULTS AND CONCLUSION: Good and excellent results were reported in patients up to the age of 20 and in operations within 3 months after the injury. In all cases of the tibial nerve neurolyses excellent results were reported.

• MeSH
• bérec inervace   MeSH
• dospělí MeSH
• lidé MeSH
• periferní nervy chirurgie   MeSH
• poranění periferního nervu * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

These days injuries to the peripheral nerves of the upper extremity that necessitate total or partial lesion are very common in the household and working environment. With regard to the majority of these injuries, not only plastic surgeons or neurosurgeons must have knowledge of their correct treatment, but general surgeons as well. The principles of reconstruction of the peripheral nerves of the upper extremity are described. The authors refer to immediate and delayed nerve repair, free nerve grafting, free vascularised nerve grafting, tendon transfer for a paralyzed hand, pedicled muscle transfer, functioning free muscle transplantation and neurotization.

• MeSH
• chirurgické laloky MeSH
• kosterní svaly transplantace   MeSH
• lidé MeSH
• paralýza etiologie   rehabilitace   MeSH
• paže inervace   chirurgie   MeSH
• periferní nervy chirurgie   transplantace   MeSH
• poranění paže chirurgie   MeSH
• poranění periferního nervu * MeSH
• přenos šlachy MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH