Li Dezhi, Wan Hong, Feng Jie, Wang Shiwei, Su Diya, Hao Shuyu, Schumacher Michael, Liu Song
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China; China National Clinical Research Center for Neurological Diseases, Beijing 100050, China.
Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, China; Beijing Key Laboratory of Central Nervous System Injury, Beijing 100050, China.
J Neurol Sci. 2014 Dec 15;347(1-2):235-41. doi: 10.1016/j.jns.2014.10.006. Epub 2014 Oct 12.
The aim of this study was to determine the effectiveness of hypoglossal-facial nerve "side"-to-end (HemiHN-FN) and accessory-facial nerve end-to-end (AN-FN) neurorrhaphy using a predegenerated nerve graft (PNG) for reanimating facial paralysis in a rat FN injury model. A total of 25 rats with complete unilateral facial paralysis resulting from section of the right FN were divided into 5 groups (n=5 each) that were submitted to immediate, delayed (3 months after FN injury) or no (control) FN reconstruction procedures involving HemiHN-FN or AN-FN neurorrhaphy. Approximately 3 months after FN reconstruction, cholera toxin subunit B conjugate Alexa 555 (CTB-Alexa 555) was injected into the ipsilateral whisker pad muscle and CTB-Alexa 555-labeled neurons were observed in the hypoglossal or accessory nuclei of all the FN reconstruction rats, but none of these neurons were found in the controls. There were numerous myelinated and nonmyelinated axons in both PNG and repaired FN of the FN reconstruction rats. No differences were found for these numbers between the two neurorrhaphy methods for each of the treatment time points, indicating the equal effectiveness of axon regeneration. However, a significantly higher number of CTB-Alexa 555-labeled neurons was observed in the hypoglossal nucleus of the immediate HemiHN-FN neurorrhaphy-treated rats when compared to that in the accessory nucleus of the immediate AN-FN neurorrhaphy-treated rats, consistent with the surface values of the recorded MAPs at the whisker pad muscle while electro-stimulating the FN. These results suggest that HemiHN-FN neurorrhaphy produces more efficient innervation of the paralyzed facial muscles than AN-FN neurorrhaphy without sacrificing ipsilateral hypoglossal function. Taking into consideration the clinical relevance of these findings for postoperative complications and functional reanimation in relation to the central plasticity, we suggest that HemiHN-FN neurorrhaphy may be the preferable facial reanimation procedure after an FN injury.
本研究的目的是确定使用预变性神经移植物(PNG)进行舌下神经-面神经“侧”端对端(HemiHN-FN)和副神经-面神经端对端(AN-FN)神经缝合术在大鼠面神经损伤模型中恢复面瘫的有效性。将25只因右侧面神经切断导致完全性单侧面瘫的大鼠分为5组(每组n = 5),分别接受涉及HemiHN-FN或AN-FN神经缝合术的即刻、延迟(面神经损伤后3个月)或不进行(对照)面神经重建手术。面神经重建后约3个月,将霍乱毒素B亚基缀合物Alexa 555(CTB-Alexa 555)注入同侧触须垫肌肉,并在所有面神经重建大鼠的舌下或副神经核中观察到CTB-Alexa 555标记的神经元,但在对照组中未发现这些神经元。面神经重建大鼠的PNG和修复的面神经中均有大量有髓和无髓轴突。在每个治疗时间点,两种神经缝合方法之间的这些数量没有差异,表明轴突再生的效果相同。然而,与即刻AN-FN神经缝合术治疗的大鼠副神经核相比,即刻HemiHN-FN神经缝合术治疗的大鼠舌下神经核中观察到的CTB-Alexa 555标记的神经元数量明显更多,这与电刺激面神经时触须垫肌肉记录的MAP表面值一致。这些结果表明,HemiHN-FN神经缝合术在不牺牲同侧舌下神经功能的情况下,比AN-FN神经缝合术能更有效地支配瘫痪的面部肌肉。考虑到这些发现与术后并发症和与中枢可塑性相关的功能恢复的临床相关性,我们建议HemiHN-FN神经缝合术可能是面神经损伤后更可取的面部恢复手术。