Publications by authors named "Gonzalo Bonilla"
Article Synopsis
- - The study aimed to compare brain plasticity between two groups with brachial plexus palsies: newborns (NBPP) and adults (NNBPP) who underwent nerve transfers, using the plasticity grading scale (PGS).
- - A total of 153 NNBPP patients and 35 NBPP babies were included, revealing that babies scored higher on the PGS after surgery compared to adults, indicating better brain rewiring in infants.
- - The results showed that while both groups had similar rehabilitation compliance, newborns displayed significantly greater potential for brain plasticity than adults, making them more capable of recovering function after nerve transfers.
Article Synopsis
- Ulnar and median nerve transfers to the musculocutaneous nerve (MCN) are performed to help restore elbow flexion in patients with severe brachial plexus injuries, but the impact of patient age on brain plasticity during recovery is unclear.
- In a study with 66 patients divided into neonatal (NBPP) and nonneonatal (NNBPI) groups, the results showed that all NBPP patients achieved a high level of control (PGS grade of 4), while only 47.7% of NNBPI patients reached the same level.
- Age was found to be a significant predictor of plasticity, indicating that younger patients (like those with NBPP)
Objective: After brachial plexus injuries (BPIs), nerve transfers are used to restore lost muscle function. Brain plasticity underlies the process of regaining volitional control, which encompasses disconnection of the original donor nerve-related programs and reconnection to acceptor nerve programs. To the authors' knowledge, the levels of disconnection and reconnection have never been studied systematically.
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- This study revisits the technique of joint flexion during nerve suturing, which had been largely abandoned, reporting its effectiveness in a case series with eight patients.
- The method involved intraoperative joint flexion, followed by immobilization and close monitoring through ultrasounds and physiotherapy to ensure proper healing and identify early complications.
- Results indicated a high rate of nerve rupture (50%), but those with preserved sutures showed significant recovery, highlighting the importance of monitoring and the potential benefits of this multimodal approach.
Objective: To perform measurements in normal brain imaging studies from the free edge of the falx cerebri to the genu and the body of the corpus callosum and perform a statistical analysis based on age, type of study, and sex highlighting potential surgical implication of these measurements.
Methods: In 193 normal brain imaging studies, 3 anatomical points of the corpus callosum were used to measure the distance to the falx cerebri. Horos and RadiAnt DICOM Viewer software were used to perform the measurements.
Background: Traumatic brachial plexus injuries cause long-term maiming of patients. The major target function to restore in complex brachial plexus injury is elbow flexion.
Objective: To retrospectively analyze the correlation between the length of the nerve graft and the strength of target muscle recovery in extraplexual and intraplexual nerve transfers.
Article Synopsis
- The study aimed to compare elbow flexion strength fatigue after re-innervation from two donor nerves: the phrenic nerve (PN) and the spinal accessory nerve (SAN) in patients with brachial plexus palsy.
- Researchers reviewed 28 patients who had undergone nerve transfers and measured their strength and endurance using weights and a dynamometer.
- Results indicated that patients with SAN transfers experienced less muscular fatigue than those with PN transfers, demonstrating significantly longer durations for holding weights, highlighting a need for further studies on strength endurance.
Comparison Between Supraclavicular Versus Video-Assisted Intrathoracic Phrenic Nerve Section for Transfer in Patients With Traumatic Brachial Plexus Injuries: Case Series.
Oper Neurosurg (Hagerstown)
September 2020
Article Synopsis
- * A total of 60 patients were analyzed, revealing that those who underwent supraclavicular phrenic nerve transfer showed significantly better recovery of elbow flexion strength compared to those in the thoracoscopic group.
- * The findings suggest that supraclavicular nerve sectioning offers superior outcomes, but further large-scale prospective studies are needed to fully understand the long-term benefits of these nerve transfer techniques.
A Comparison of Patients from Argentina and Germany to Assess Factors Impacting Brachial Plexus and Brain Injury.
J Brachial Plex Peripher Nerve Inj
January 2019
Traumatic brachial plexus injuries (BPIs) represent a major cause of disability in young patients. The purpose of this study was to compare two populations (from Argentina and Germany) who suffered a traumatic BPI after a motorcycle accident to identify predictors of BPI and brain injury severity. Univariate and multivariable intergroup comparisons were conducted, and odds ratios were calculated to assess the associations between the different demographic, morphometric, and trauma-related variables, and the type and severity of patients' injuries.
View Article and Find Full Text PDFPeripheral nerve and brachial plexus injuries typically cause severe impairment in the affected limb. The incidence of neuropathic pain is high, reaching up to 95% of cases, especially if cervical root avulsion has occurred. Neuropathic pain results from damage to the somatosensory system, and its progression towards chronicity depends upon disruptions affecting both the peripheral and central nervous system.
View Article and Find Full Text PDFObjective: In this study, the authors sought to identify the relationship between breathing and elbow flexion in patients with a traumatic brachial plexus injury (TBPI) who undergo a phrenic nerve (PN) transfer to restore biceps flexion. More specifically, the authors studied whether biceps strength and the maximal range of active elbow flexion differ between full inspiration and expiration, and whether electromyography (EMG) activity in the biceps differs between forced maximum breathing during muscular rest, normal breathing during rest, and at maximal biceps contraction. All these variables were studied in a cohort with different intervals of follow-up, as the authors sought to determine if the relationship between breathing movements and elbow flexion changes over time.
View Article and Find Full Text PDFBackground: Among other factors, like the time from trauma to surgery or the number of axons that reach the muscle target, a patient's age might also impact the final results of brachial plexus surgery.
Objective: To identify (1) any correlations between age and the 2 outcomes: elbow flexion strength and shoulder abduction range; (2) whether childhood vs adulthood influences outcomes; and (3) other baseline variables associated with surgical outcomes.
Methods: Twenty pediatric patients (under age 20 yr) who had sustained a traumatic brachial plexus injury were compared against 20 patients, 20 to 29 yr old, and 20 patients, 30 yr old or older.
Article Synopsis
- The study compares the effectiveness of three nerve transfer techniques (hemihypoglossal-to-facial with grafts, hemihypoglossal-to-facial without grafts, and masseteric-to-facial nerve transfers) in treating facial nerve palsies when the facial nerve is inaccessible.
- A total of 77 patients were analyzed, revealing that surgeries without grafts (HFD) and masseteric transfers (MF) had better recovery outcomes compared to those with grafts (HFG), although HFD was statistically superior.
- Delaying surgery beyond two years after the injury negatively impacted outcomes, highlighting the importance of technique and timing in surgical intervention for facial reinnervation.
Background: Controversy exists surrounding the use of the phrenic nerve for transfer in severe brachial plexus injuries. The objectives of this study are: (1) to present the experience of the authors using the phrenic nerve in a single institution; and (2) to thoroughly review the existing literature to date.
Methods: Adult patients with C5-D1 and C5-C8 lesions and a phrenic nerve transfer were retrospectively included.
Article Synopsis
- Body Mass Index (BMI) has been recently identified as an important factor in predicting outcomes for shoulder surgery, and this study investigates its relevance for elbow reconstruction as well.
- The study analyzed 40 patients who underwent nerve transfer surgery for shoulder palsy and compared their recovery to 18 others who had elbow reconstruction, finding that BMI did not impact strength recovery or overall outcomes in either group.
- The findings indicate that while BMI may affect recovery in proximal muscle reconstruction (like shoulders), it is less significant for distal muscle recovery (like elbows), highlighting the need to consider BMI in surgical planning.
Article Synopsis
- The study investigates how body mass index (BMI) affects functional recovery after surgery for severe brachial plexus injuries, specifically looking at shoulder abduction following nerve transfer.
- Researchers analyzed 18 male patients who had spinal accessory to suprascapular nerve transfer, finding a significant negative correlation between higher BMI and post-operative shoulder abduction range.
- While BMI was identified as a negative predictor of recovery, the time between trauma and surgery was determined to be an even more crucial factor in determining outcomes.
Background: In recent years, distal nerve transfers have become a valid tool for nerve reconstruction. Though grafts remain the gold standard for proximal median nerve injuries, a new distal transfer of flexor carpi ulnaris branches of the ulnar nerve to selectively restore anterior interosseous nerve function, concomitant with median nerve graft repair, could enhance outcomes. The objective of this paper is to anatomically analyze a technique to selectively reinnervate the thumb and index flexors.
View Article and Find Full Text PDFBackground: Peripheral nerve lesions usually are associated with neuropathic pain. In the present paper, we describe a simple scale to quantify pain after brachial plexus injuries and apply this scale to a series of patients to determine initial outcomes after reconstructive surgery.
Methods: Fifty-one patients with traumatic brachial plexus avulsion injuries were treated over the period of one calendar year at one center by the same surgical team.