Background: The treatment of large peripheral Nerve defect in scarred tissue is still a major challenge. Two- stage grafting with preparation of a smooth bed before grafting is a technique used for tendon or bone defects in the past. We are now reporting such a technique for large scarred gaps in the sciatic Nerves of rat.Methods: In each of the 20 female Wister rats, 15 centimeters of the sciatic Nerve was excised. The Nerve bed was then covered by tetracycline powder to induce scar tissue formation. In half of the rats a silicone tube was sutured into the Nerve ends to produce a smooth tunnel for a two- stage grafting. In the second group the cut Nerve ends were covered by silicone caps. After 4 weeks each rat received Nerve grafting of its sciatic Nerve defect from its bilateral median Nerves. 15 weeks following the grafting the rats were tested for their sciatic Nerve functions, then the Nerves were excised for histological evaluation of the Nerve regeneration and the scar tissue.Results: The motor and sensory motor function recovery of the Nerves, as measured by “External Postural Thrust”, and “Withdrawal Reflex Latency”, were greater in the group that had the grafts replacing the silicone tubes. The histological evaluation also confirmed the presence of more Nerve fibers and less scarring in the silicone tube treated group.Conclusions: Two- stage Nerve grafting in severely scarred bed can improve the functional results of a Nerve graft.

BACKGROUND: Considering the common origin of skin and peripheral nervous system, a tube of dermal layer of skin hypothetically can be an ideal conduit for Nerve reconstruction. An experimental study performed to evaluate the Nerve regeneration of efficacy into a dermal tube.METHODS: Sixty male Wistar rats were used. A 10 mm gap was produced in right sciatic Nerves. In group A the autogenous Nerve grafts were used to bridge the defects. In group B vein conduit were use to reconstruct the gaps. In group C dermal tube were used to bridge the defects. Morphologic studies were carried out after 3 month.RESULTS: The density of Nerve fibers was significantly higher in autogenous Nerve graft group. The efficacy of Nerve growth into the dermal tube group was significantly poor in comparison to other groups.CONCLUSIONS: In the present study, dermis was used as the Nerve conduit for the first time. This study indicates that the dermal tube is not a suitable conduit for Nerve regeneration till further studies to resolve the problems before clinical application.

Introduction: Peripheral Nerve injury is one of the most common damages that lead to physical disability. Considering the similarity between the coatings of skeletal muscles and Nerve fibers, we conducted this research to determine the effect of muscle graft with Nerve Growth Factor (NGF) and Laminin (L) on Nerve repair. Methods: We cut a 10-mm length of the sciatic Nerve from 42 female Wistar rats (Weight: 200± 250 g) and equally divided the rats into three groups. In the muscle graft+NGF+laminin group, the degenerated skeletal muscle was sutured with proximal and distal ends of the transected sciatic Nerve. Then, NGF (100 ng) and laminin (1. 28 mg/mL) were injected into the muscle graft. In the muscle graft group, normal saline was injected into the muscle graft. In the control group, 10 mm of the sciatic Nerve was removed without any treatment. Functional recovery was assessed based on Sciatic Functional Index (SFI). Also, tracing motor neurons and histological studies were performed to evaluate Nerve repair. The obtained data were analyzed by ANOVA test. Results: The Mean± SD SFI value significantly increased in the muscle graft+NGF+laminin (-76. 6± 2. 9) and muscle graft (-82. 1± 3. 5) groups 60 days after the injury compared to the control group. The Mean± SD number of labeled motor neurons significantly increased in the muscle graft+NGF+laminin (78. 6± 3. 1) and muscle graft (61. 3± 6. 1) groups compared to the control group (P<0. 001). The mean number of myelinated axons in the distal segments of the muscle graft+NGF+laminin increased significantly compared to the muscle graft group. Conclusion: These findings suggest that muscle graft followed by NGF and laminin administration have therapeutic effects on Nerve repair.

Ulnar Nerve involvement is the second most common local mononeuropathy. The ulnar Nerve consists of motor and sensory fibers that arise in C8-T1 roots and extends to the lower trunk and medial cord of brachial plexus. Manifestations of this Nerve involvement range from elbow pain and intermittent hand paresthesia to marked sensory loss, wasting and weakness of hand muscles and a claw hand. Ulnar Nerve lesion in the elbow region commonly follows surgery in which general anesthesia is used (particularly in patients with coronary artery bypass graft surgery). The patient presented in this article was a 56-year-old male who was involved in left ulnar Nerve lesion after undergoing coronary artery bypass graft. In electrodiagnostic study we noticed diffused demyelination lesion of the ulnar Nerve with dominancy in elbow region along with secondary axonal degeneration. Therefore, suitable positioning of elbow is recommended to avoid the nervous complications of these operations.    

Background: Fibrin glue can be used for Nerve repair. This study is to evaluate the repair of severed sciatic Nerve in rats done by fibrin glue, comparing with an untreated group.Methods: In an interventional case series study, 18 Sprague rats had their sciatic Nerve cut in the intervertebral canal.Fourteen rats were repaired by graft-repairing of Nerve using fibrin glue and single suture. Four rats were left untreated as controls. The recovery of motor function was assessed after 4 months.Results: Lower extremity muscle atrophy and absence of motor function recovery was observed in the untreated rats. Full functional recovery in lower limbs was observed in the 12 treated rats, while 2 rats walked with limp.Conclusion: The cut sciatic Nerve repair in rat's spinal canal, using fibrin glue and a microsurgical suture would result in good function motor recovery of lower extremity.

Background: Electrospun nanofibrous scaffolds are considered as promising candidates in neural tissue regeneration due to their ability to support neural cell attachment, spreading and proliferation. Methods: In this paper, various type of nanofibers scaffold based on polycaprolactone) (PCL) were fabricated using electrospinning. The main drawback of PCL scaffolds is their low bioactivity of scaffold surface. To overcome this surface and composition modification was used to enhanced hydrophilicity and bioactivity of scaffold. Results: The scanning electron microscopy (SEM) results indicate that fiber diameter entirely depends on the solvent system and added component of gelatin and chitosan which by adding gelatin and chitosan fiber diameter decreased. In vitro studies using PC12 cells revealed that the plasma surface modified and blended scaffold with chitosan and gelatin nanofibrous scaffold supports cell attachment, spreading and indicate a significant increase in proliferation of PC12 in the presence of chitosan. The results demonstrated that gelatin and chitosan caused a significant enhancement in the bioactivity of the scaffold, which confirmed by MTT assay and improved the cell spreading and proliferation of neural cell on the scaffolds. Conclusion: Based on the experimental results, the PCL/chitosan/PPy conductive substrate could be used as a potential scaffold for clinical research in the field of neural regeneration and healing.

Objective: To determine the efficacy and safety of optic Nerve fenestration in patient with pseudotumor cerebri with visual loss despite medical treatment. Design: Prospective; interventional case series. Patients &Methods: 13 eyes of 13 patients with PTC and visual field loss resistant to medical treatment underwent optic Nerve fenestration. Visual acuity, visual field, headache, intracranial pressures were checked before and after surgery. We defined visual field stability within 2db from mean deviation. Optic Nerve fenestration was performed with the patient under general anesthesia. A standard transconjunctival approach was used in all cases. Results: After optic Nerve fenestration visual field stabilized or improved in %85. Of 7 patients with acute papilledema, 6 patients improved, one patient worsened. Of 6 patients with chronic papilledema, 4 patients stabilized, one patient improved, one patient worsened. No significant difference was detected in MD (mean deviation) between operated eye from non operated eye after 1 week, 3 weeks, 2 months. The greatest improvement in visual field MD was detected between the first weeks to 3rd week after operation. Conclusion: Optic Nerve fenestration effectively stabilizes or improves visual function in the majority of patient with pseudotumor cerebri and visual loss.