Abstract
One of the most sought-after applications of neuroengineering is the communication between the arm and an artificial prosthetic device for the replacement of an amputated hand or the treatment of peripheral nerve injuries. For that, an electrode is placed around or inside the median nerve to serve as interface for recording and stimulation of nerve signals coming from the fascicles that innervate the muscles responsible for hand movements. Due to the lack of a standard procedure, the electrode implantation by the surgeon is strongly based on intuition, which may result in poor performance of the neuroprosthesis because of the suboptimal location of the neural interface. To provide morphological data that can aid the neuroprosthetic surgeon with this procedure, we investigated the fascicular topography of the human median nerve along the forearm and upper arm. We first performed a description of the fascicular content and branching patterns along the length of the arm. Next we built a 3D reconstruction of the median nerve so we could analyze the fascicle morphological features in relation to the arm level. Finally, we characterized the motor content of the median nerve fascicles in the upper arm. Collectively, these results indicate that fascicular organization occurs in a short segment distal to the epicondyles and remains unaltered until the muscular branches leave the main trunk. Based on our results, overall recommendations based on electrode type and implant location can be drawn to help and aid the neuroprosthetic procedure. Invasive interfaces would be more convenient for the upper arm and the most proximal third of the forearm. Epineural electrodes seem to be most suitable for the forearm segment after fascicles have been divided from the main trunk.
Highlights
A neuroprosthesis is an artificial system that provides direct communication with the nervous system
The branching pattern of the median nerve in the forearm was analyzed in five fixed samples
This study provides a topographical description of the human median nerve for its application in neuroprosthetic surgery
Summary
A neuroprosthesis is an artificial system that provides direct communication with the nervous system. Many of such devices have been successfully used for decades in the treatment of hearing impairment or Parkinson’s disease, for example. One of most important factors that limit currently the use of hand neuroprostheses is the poor performance. To achieve a natural control of the hand movement, the selective function of these three nerves and their fascicles should be properly replaced by the neuroprosthesis. The location of the interface at the end of the implantation procedure is the factor that influences most selectivity
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