Yeoh Stewart, Warner Wesley S, Merchant Samer S, Hsu Edward W, Agoston Denes V, Mahan Mark A
Department of Neurosurgery, University of Utah, Salt Lake City, Utah, United States.
Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, United States.
Front Surg. 2022 Apr 20;9:862478. doi: 10.3389/fsurg.2022.862478. eCollection 2022.
Peripheral nerve injury is a significant public health challenge, with limited treatment options and potential lifelong impact on function. More than just an intrinsic part of nerve anatomy, the vascular network of nerves impact regeneration, including perfusion for metabolic demands, appropriate signaling and growth factors, and structural scaffolding for Schwann cell and axonal migration. However, the established nerve injury classification paradigm proposed by Sydney Sunderland in 1951 is based solely on hierarchical disruption to gross anatomical nerve structures and lacks further information regarding the state of cellular, metabolic, or inflammatory processes that are critical in determining regenerative outcomes. This review covers the anatomical structure of nerve-associated vasculature, and describes the biological processes that makes these vessels critical to successful end-organ reinnervation after severe nerve injuries. We then propose a theoretical framework that incorporates measurements of blood vessel perfusion and inflammation to unify perspectives on all mechanisms of nerve injury.
周围神经损伤是一项重大的公共卫生挑战，治疗选择有限，且可能对功能产生终身影响。神经的血管网络不仅是神经解剖结构的固有部分，还会影响神经再生，包括满足代谢需求的灌注、适当的信号传导和生长因子，以及施万细胞和轴突迁移的结构支架。然而，悉尼·桑德兰1951年提出的既定神经损伤分类范式仅基于大体解剖神经结构的分级破坏，缺乏关于细胞、代谢或炎症过程状态的进一步信息，而这些过程对于确定再生结果至关重要。本综述涵盖了与神经相关的脉管系统的解剖结构，并描述了使这些血管对于严重神经损伤后成功的终末器官再支配至关重要的生物学过程。然后，我们提出了一个理论框架，该框架纳入了血管灌注和炎症的测量，以统一对神经损伤所有机制的看法。
