Nerve Root Research Articles

Characteristics of anti-contactin1 antibody positive autoimmune nodopathies combined with membranous nephropathy

BackgroundAutoimmune nodopathy (AN) is a very rare new disease entity, especially when combined with membranous nephropathy (MN). MethodsAntibodies against nodal-paranodal cell adhesion molecules in the serum were detected using cell-based assays. Antibody subtypes against contactin-1 (CNTN1) were confirmed. Cases of anti-CNTN1 antibody-positive AN with and without MN were retrieved through a literature search to compare clinical and electrophysiological characteristics. ResultsA 65-year-old male patient with MN developed limb numbness and weakness, along with walking instability. Serum CNTN1 antibodies were positive, primarily those of the IgG4 subtype. Electromyography showed prominent demyelination patterns in both the proximal and distal segments of the nerves compared to the middle nerve trunk. Magnetic resonance imaging revealed enlargement of the bilateral brachial and lumbosacral plexuses and local hyperintensity of the right C5-C6 nerve roots. Thirty-five cases with anti-CNTN1 antibody-positive AN with MN and 51 cases with anti-CNTN1 antibody-positive AN without MN were compared. Furthermore, the proportion of patients with MN combined with AN presenting with acute or subacute onset was higher than that observed in the MN without AN group. Nevertheless, no substantial differences were noted between the two groups concerning the clinical and electrophysiological characteristics, which were mainly elderly men, manifested as sensory ataxia, IgG4 antibody subtype, electrophysiological demyelination, and a certain effect on immunotherapy. ConclusionIn cases of electrophysiological manifestation of demyelinating peripheral neuropathy, especially in distal and poximal segments of nerves, AN should be considered, and further screening for renal function should be performed. Concomitant MN does not aggravate or alleviate peripheral nerve symptoms.

Infectious meningitis. Why are the leptomeninges preferentially involved? Electron microscopic insights.

In infectious meningitis, pathogens preferentially attack the leptomeninges (pia mater and arachnoid) rather than the pachymeninges (dura mater). This study aims to provide ultra-anatomical insights from our extensive collection of electron microscopy images and propose mechanisms, highlighting structures that favor the introduction, adherence, colonization, and proliferation of microorganisms leading to spinal meningitis. Over several years, we analyzed an extensive collection of transmission and scanning electron microscopy images of human spinal meninges captured in our laboratories. Upon examining 378 of those images, we identified potential sites for the iatrogenic or hematogenic introduction and adherence of microorganisms, as well as sites for their colonization and proliferation. These included the outer surface of the spinal dural sac, structures within the epidural space, and the spinal dural sac itself, which comprises compact dura mater with interwoven collagen fibers and tightly bound arachnoid cells. Also, the subdural (extra-arachnoid) compartment, consisting of fragile neurothelial cells prone to rupture under force, formed an acquired spinal subdural space, a new subarachnoid compartment, limited by arachnoid trabeculae, that surrounded the nerve roots and spinal cord and the pia mater. Macrophages, fibroblasts, mast cells, and plasma cells were also observed within the dura mater, arachnoid layer, arachnoid trabeculae, and pia mater. These images illustrate how the characteristics of the meningeal layers could contribute to bacterial adhesion and proliferation at various locations, inducing selective inflammation during (iatrogenic) spinal meningitis. In addition, the images help to explain why magnetic resonance imaging enhancement appears preferentially at specific sites.

The Cervical Intervertebral Foramen: Microanatomy, Pathology, and Clinical Implications.

This is an evidence-based narrative review article. We hope to provide a primer on cervical intervertebral foramen (cIVF) anatomy for spine surgeons, interventionalists, and physiatrists who regularly treat cervical spine pathology, and encourage further exploration of this topic. This corridor for exiting cervical nerve roots is characterized by its intricate microanatomy involving ligamentous, nervous, and vascular structures. Degenerative changes such as facet hypertrophy and disc herniations alter these relationships, potentially leading to nerve root compression and cervical radiculopathy. This review synthesizes existing knowledge on the cIVF. Key imaging, cadaveric, and clinical studies serve as a foundation for this anatomic review. We explore topics such as dynamic changes that affect foraminal size and their implications for nerve root compression, the relationship of the dorsal root ganglion to the cervical foramen, and the function and clinical significance of foraminal ligaments, arteries, and veins. Changes in the cIVF are frequently the basis of cervical degenerative pathologies. A comprehensive understanding of its microanatomical structure will allow the practitioner to better treat the underlying disease process causing their symptoms and signs.

“Urological Claudication”: Blind ending ureteric remnant in a bifid ureteric system causing neurological claudication—Case report with brief review of the literature

BackgroundA blind ending ureteric remnant in a duplicated urinary system is extremely rare, and most of these anomalies go unrecognized as they are asymptomatic. We describe a unique case of a blind ending ureteric remnant presenting with neurological claudication in the lower limb secondary to sacral nerve root radiculopathy which was managed by robotic excision.Case presentationA 61-year-old male presented with radiating pain in the left gluteal region for the past 2 years, which persisted despite multiple conservative treatments. Extensive evaluation for the pain revealed a blind ending ureteric remnant in a partially duplicated system, which contained multiple calculi and caused the compression of the adjacent sacral nerve roots. The patient was subsequently taken up for excision of the remnant, which was performed robotically, after which the symptoms resolved completely.ConclusionBlind ending ureteric duplications are rare anomalies that mostly go unrecognized as they are asymptomatic. Rarely, these anomalies may produce clinically relevant symptoms and result in diagnostic dilemmas, meriting intervention.

Individualized C1-2 intra-articular three-dimensional printed porous titanium alloy cage for craniovertebral deformity

BackgroundCongenital craniovertebral deformity, including basilar invagination (BI) and atlantoaxial instability (AAI), are often associated with three-dimensional (3D) deformity, such as C1-2 rotational deformity, craniocervical kyphosis, C1 lateral inclination, among other abnormalities. Effective management of these conditions requires the restoration of the 3D alignment to achieve optimal reduction. Recently, 3D printing technology has emerged as a valuable tool in spine surgery, offering the significant advantage of allowing surgeons to customize the prosthesis design. This innovation provides an ideal solution for precise 3D reduction in the treatment of craniovertebral deformities.ObjectiveThis study aims to describe our approach to individualized computer-simulated reduction and the design of C1-2 intra-articular 3D printed porous titanium alloy cages for the quantitative correction of craniovertebral junction deformities.MethodsA retrospective analysis was conducted on patients with craniovertebral deformities treated at our institution using individualized 3D-printed porous titanium alloy cages. Preoperative CT data were used to construct models for 3D realignment simulations. Cage designs were tailored to the simulated joint morphology following computer-assisted realignment. Preoperative and postoperative parameters were statistically analyzed.ResultsFourteen patients were included in the study, with a total of 28 3D-printed porous titanium alloy cages implanted. There were no cases of C2 nerve root resection or vertebral artery injury. All patients experienced symptom relief and stable implant fixation achieved in all cases. No implant-related complications were reported.ConclusionThe use of individualized computer-simulated reduction and the design of C1-2 intra-articular 3D printed porous titanium alloy cage facilitates precise 3D realignment in patients with craniovertebral deformities, demonstrating effectiveness in symptom relief and stability.

Treatment of refractory diffuse large B-cell lymphoma involving the central nervous system with polatuzumab vedotin-based regimen: a case report and literature review

Polatuzumab vedotin (Pola) is a novel antibody-drug conjugate targeting CD79b, which has been shown to be effective in treating newly diagnosed and relapsed/refractory diffuse large B cell lymphoma (DLBCL) during clinical trials. This study aims to conduct a retrospective analysis of the clinical characteristics, diagnosis, and treatment of a patient with refractory secondary central nervous system lymphoma at Beijing Hospital, alongside a review of relevant literature. This study included a 79-year-old female patient who was diagnosed with DLBCL affecting the ilium, sacrum, spinal cord, and nerve roots and had an IPI score of 5 and a high-risk score according to MSKCC. She showed a geriatric comprehensive assessment (IACA) score of 2, which was categorized under the unfit group. Her initial treatment comprised chemo-free therapy and radiotherapy, followed by progression. In the second-line treatment, a Pola-based regimen was applied, and the patient achieved a complete response, suggesting that this regimen may be a therapeutic option for patients with DLBCL involving the central nervous system.

Effectiveness of Neural Mobilization Technique in Subjects with Lumbar Radiculopathy: A Randomized Controlled Trial

BACKGROUND AND OBJECTIVE: Radicular low back pain is a disorder involving the dysfunction of the lumbosacral nerve roots. Clinical rehabilitation approaches for Radicular LBA include kinesiotherapy, and physical therapy procedures: rest, heat, ultrasound, TENS, but evidences regarding their effectiveness are lacking. Previous studies found that neural mobilization is more effective in reducing pain. The aim of the study is to determine the effectiveness of Neural Mobilization on pain in subjects with lumbar radiculopathy. METHODS: 30 subjects were selected by simple random sampling and assigned into Experimental group (n=15) & Control group (n=15). The subjects in Experimental group were given Neural Mobilization in addition to traditional therapy and control group were given traditional therapy alone. All the participants were assessed with NPRS. RESULTS: After the analysis, the results were found to be effective in improvement of pain in both groups NPRS score (p<0.0001). But there is a high significance in Experimental group when compared to control group. CONCLUSION: This study concluded that Neural Mobilization along with traditional therapy is more effective in reducing pain in subjects with lumbar radiculopathy. Keywords: Neural Mobilization, Low back ache, Numerical pain rating scale.

Automatic generation of diffusion tensor imaging for the lumbar nerve using convolutional neural networks

【Purpose】Diffusion Tensor Imaging (DTI) with tractography is useful for the functional diagnosis of degenerative lumbar disorders. However, it is not widely used in clinical settings due to time and health care provider costs, as it is performed manually on hospital workstations. The purpose of this study is to construct a system that extracts the lumbar nerve and generates tractography automatically using deep learning semantic segmentation. 【Methods】We acquired 839 axial diffusion weighted images (DWI) from the DTI data of 90 patients with degenerative lumbar disorders, and segmented the lumbar nerve roots using U-Net, a semantic segmentation model. Using five architectural models, the accuracy of the lumbar nerve root segmentation was evaluated using a Dice coefficient. We also created automatic scripts from three commercially available software tools, including MRICronGL for medical image viewing, Diffusion Toolkit for reconstruction of the DWI data, and Trackvis for the creation of the tractography, and compared the time required to create the tractography, and evaluated the quality of the automated tractography was evaluated. 【Results】Among the five models, the architectural model Resnet34 performed the best with a Dice = 0.780. The creation time for the automatic lumbar nerve tractography was 191 s, which was significantly shorter by 235 s than the manual time of 426 s (p < 0.05). Furthermore, the agreement between manual and automated tractography was 3.67 ± 1.53 (satisfactory). 【Conclusions】Using deep learning semantic segmentation, we were able to construct a system that automatically extracted the lumbar nerve and generated lumbar nerve tractography. This technology makes it possible to analyze lumbar nerve DTI and create tractography automatically, and is expected to advance the clinical applications of DTI for the assessment of the lumbar nerve.

Downregulation of chloride voltage-gated channel 7 contributes to hyperalgesia following spared nerve injury

Alterations in anion balance potential, along with the involvement of cation–chloride cotransporters, play pivotal roles in the development of hyperalgesia after peripheral nerve injury (PNI). Chloride voltage-gated channel 7 (CLCN7) is the predominant member of the CLC protein family. Investigations on CLCN7 have focused primarily on its involvement in osteosclerosis and lysosomal storage disorders; nevertheless, its contribution to neuropathic pain (NP) has not been determined. In this investigation, we noted high expression of CLCN7 in neurons situated within the spinal dorsal horns (SDHs) and dorsal root ganglions (DRGs). Immunofluorescence analysis revealed that CLCN7 was predominantly distributed among IB4-positive and CGRP-positive neurons. Furthermore, the expression of CLCN7 was observed to be mainly reduced in neurons within the SDHs and in small and medium-sized neurons located in the DRGs of spared nerve injury (SNI) mice. Knockdown of CLCN7 via siRNA in the DRGs resulted in increased mechanical and thermal hyperalgesia in naïve mice. Furthermore, the excitability of cultured DRG neurons in vitro was augmented upon treatment with CLCN7 siRNA. These findings suggested that CLCN7 downregulation following SNI was crucial for the manifestation of mechanical and thermal hyperalgesia, highlighting potential targeting strategies for treating NP.

Surgical Anatomy and Intrapelvic Course of Obturator Nerve

Study ObjectiveThe aim of this study is to reveal the anatomy of the obturator nerve (ON) and its important relationship in pelvic surgery with the surrounding anatomical structures. DesignProspective observational study. InterventionsParameters from the left and right ON's to relevant anatomical landmarks were measured and statistical analysis was performed. SettingThe current study was planned in Department of Anatomy Ankara University School of Medicine and then conducted at the Forensic Medicine Institute, Ankara Group Presidency after receiving the approval of the Institute for Forensic Medicine. ParticipantsThe study was performed in 40 fresh or fresh-frozen and female cadavers bilaterally. Measurements and Main ResultsThe mean distances of the midpoint of the left ON to the highest point of the fundus of uterus and isthmus of the uterus, cervico-uterine junction, and highest point of the promontory were 55.1 ± 10.4, 52.9 ± 12.4, 54.8 ± 11.3, and 58.5 ± 15.2 mm, respectively, and 58.7 ± 8.1, 52.5 ± 13.1, 61.4 ± 17.8, and 62.2 ± 19.7 mm on the right side, respectively (p > .05 for all values). The mean distance between the nerve root of the left ON and highest point of the promontory was 59.1 ± 28.4 mm, it was 59.7 ± 26.2 mm on the right side (p > .05). There were significant positive correlations between the distance between the left and right anterior superior iliac spines and the distances between the midpoint of the ON to the isthmus of the uterus on both the left and right sides of the pelvis (r = 0.546, p = .019, r = 0.896, p < .001, respectively). ConclusionsIntraoperative ON injury in gynecological procedures is a complication that may be minimized with good anatomical knowledge. Careful dissection should be performed to decrease the ON injury. The safe surgical zone was established for pelvic procedures by creating a topographical map of the ON. This research may improve pelvic surgery precision, aiding the development of better treatments and reducing ON-related complications.

How to Set Working Cannula in Endoscopic-Assisted Transforaminal Lumbar Interbody Fusion: A Morphometric Analysis Based on Computed Tomography.

There is a high risk of nerve root injury during endoscopic-assisted transforaminal lumbar interbody fusion (Endo-TLIF). This study used computed tomography (CT) imaging to assess the relationship between the exiting nerve root and its surroundings, and the corresponding intervertebral disc. We also measured the approximate position and angle for the placement of the working cannula to reduce the risk of nerve root injury during Endo-TLIF procedures in the Chinese population. This retrospective study was conducted at our institution between December 2021 and December 2022. A total of 115 patients suffering from low back pain were recruited for the study. For each participant, three-dimensional (3D) vertebral models of the lumbar segments from L3 to S1 were constructed based on their CT images. The nerve root-disc distance, cannula insertion bypass distance and angle, foraminal height and width, exiting nerve root height, and nerve root-pedicle distance were measured. A paired t-test was used to compare measurements between the left and right sides, while inter- and intraobserver reproducibility was assessed using the intraclass correlation coefficient (ICC). From L3/4 to L5/S1 segments, the ideal cannula insertion distance range was 37.51 ± 4.91-120.38 ± 37.71 mm at L3/4; 42.38 ± 5.29-116.25 ± 27.22 mm at L4/5; and 37.78 ± 4.86-69.26 ± 12.64 mm at L5/S1. The appropriate cannula insertion angle range was 30.86° ± 5.05°-62.59° ± 6.66° at L3/4; 34.30° ± 4.73°-60.88° ± 7.34° at L4/5; and 35.89° ± 4.18°-47.65° ± 7.38° at L5/S1. The height of the intervertebral foramen (IVF) gradually decreased, and the width steadily increased. The exiting nerve root height and the nerve root-pedicle distance slightly decreased caudally. From L3/4 to L5/S1, the range of working cannula insertion distance and angle gradually decreased, and the exiting nerve root height occupying the IVF gradually increased. Our measurement can reduce the risk of nerve root injury caused by inserting the working cannula during Endo-TLIF.

Magnetic resonance neurography in the diagnosis of neurological subtypes of thoracic outlet syndrome.

Neurological thoracic outlet syndrome (TOS) can be challenging to diagnose, particularly given its described subtypes of neurogenic TOS (NTOS) and disputed TOS (DTOS) that exhibit variable clinical presentations and etiologies. The diagnostic workup of TOS often includes magnetic resonance neurography (MRN) of the brachial plexus. Specific MRN imaging modifications for TOS evaluation are required to maximize spatial and contrast resolution to increase the conspicuity of nerve segments and their relationships to surrounding osseous structures. Dynamic assessment with arm positioning is used to evaluate outlet narrowing and compression of the plexus. Individual nerve segments are interrogated for their longitudinal and cross-sectional morphologies and signal characteristics. In patients with NTOS, MRN may reveal focal impingement of the C8/T1 nerve roots and/or lower trunk with accompanying abnormal T2-weighted signal hyperintensity. Predisposing anatomical entities include cervical ribs, rib synostoses, hypertrophic callous following clavicular fracture, remnant first thoracic rib from prior incomplete resection, and variable perineural scarring. In comparison, DTOS patients frequently demonstrate signal hyperintensity and enlargement of the mid plexus (trunk and division level), with narrowing of the costoclavicular interval. Following comprehensive diagnostic workup that frequently includes electrodiagnostic testing, patients are directed to different management pathways. Nonsurgical management is considered for all cases of DTOS; all patients with NTOS or DTOS who fail conservative treatment warrant referral for a surgical opinion. If surgery is pursued, MRN can be helpful in preoperative planning.

Epidural lumbar pneumocysts and radiculopathy: description of a clinical case of diagnosis and treatment

Epidural pneumocysts are a rare but significant cause of severe low back pain in patients. A clinical case of diagnosis and treatment of this disease, which often remains poorly studied in the literature, is presented. It should be noted that descriptions of nerve root compression by a gas bubble are found in both domestic and foreign publications, but they are rare, which makes the problem relevant and interesting for the medical community.

TÉCNICAS CIRÚRGICAS MINIMAMENTE INVASIVAS VERSUS CONVENCIONAIS NA ABORDAGEM DA RADICULOPATIA LOMBAR POR HÉRNIAS DISCAIS: UMA REVISÃO SISTEMÁTICA DA LITERATURA

Radiculopathies are defined as neurological conditions characterized by nerve root dysfunction. Among its main causes is compression due to a herniated disc. The involvement can be the target of surgical approaches whose objectives focus mainly on decompressing the root, through the removal of the herniated disc. The primary surgical technique for lumbar disc herniation is open discectomy or microdiscectomy. However, there are surgical alternatives whose technique involves partial removal of the nucleus pulposus in a minimally invasive manner. The present study is based on a systematic review of the literature, based on a collection of randomized clinical studies, selected due to greater methodological rigor, with a total inclusion of 1293 participants. Comparative analysis of the evidence suggests that non-invasive surgical techniques may not be inferior to microdiscectomies/open discectomies in terms of clinical parameters, mainly in the assessment of pain and orthopedic disability index scores. Despite longer operative times, certain surgical parameters, such as lower estimated blood loss and complication rate, probably tend to be favorable to minimally invasive discectomies. Therefore, future decisions about performing lumbar discectomy should consider, when there are robust indications, patients’ preferences for a given treatment, as well as its social and economic burden.

Traumatic lateral spondyloptosis and lateraloptosis with partial improvement through posterior surgical approach: a review based on a case report

Introduction. Spondyloptosis or grade V of spondylolisthesis, spinal injury that involve 100 % mobilization of the vertebral body, is rare to find. Lateraloptosis, displacement of vertebral bodies, is even more rare a catastrophic.The aim of this study to introduce readers to this rare form of traumatic lumbar spine injury as well as to review current available therapeutic approaches.Case report. A 22-year-old male was admitted to the emergency room due to a fall from a moving truck. Physical examination revealed neurological deficit in the lower extremities, with muscle strength 0/5, and an ASIA B classification. Computed tomography study showed a complete lateroloptosis at the L3 –L4 level. The patient is admitted to the operating room for surgical treatment through a posterior approach. Successful arthrodesis and spinal alignment are achieved. Immediate postoperative period, showed no complications and the patient’s neurological function in the lower extremities was classified as ASIA C. In the posterior follow-up, the patient maintains the motor neurological function and recover the autonomic control of bladder function. With mild disability according to the Barthel Index of 90 points.Discussion. of the traumatic spinal injuries, spondyloptosis is the most infrequent and occurs secondary to high-energy mechanisms. It presents an incidence of complete neurological deficit in 80 % of patients. The objectives in surgical treatment are decompression of neurovascular structures, reduction of fracture dislocation to improve alignment in the sagittal and coronal plane, and instrumentation that allows stability. The posterior surgical approach offers advantages over the anterior approach. In the posterior approach, the facet joints can be manipulated more safely, decompress the nerve roots and the dural sac more easily, as well as less operating time and greater care of vascular structures such as the iliac vessels.Conclusion. Complex traumatic spinal injuries are associated with irreversible neurological damage. Achieving spinal stability and alignment allows optimizing physical therapy and rehabilitation for greater recovery. Severe spinal injuries, especially lateroptosis, are difficult to treat by surgical approach, however, the main objective is vertebral stabilization to allow physical therapy and early rehabilitation.

Biomechanical study of spinal cord and nerve root in idiopathic scoliosis: based on finite element analysis

BackgroundCurrent research lacks comprehensive investigation into the biomechanical changes in the spinal cord and nerve roots during scoliosis correction. This study employs finite element analysis to extensively explore these biomechanical variations across different Cobb angles, providing valuable insights for clinical treatment.MethodsA personalized finite element model, incorporating vertebrae, ligaments, spinal cord, and nerve roots, was constructed using engineering software. Forces and displacements were applied to achieve Cobb angle improvements, designating T1/2-T4/5 as the upper segment, T5/6-T8/9 as the middle segment, and T9/10-L1/2 as the lower segment. Simulations under traction, pushing, and traction + torsion conditions were conducted, and biomechanical changes in each spinal cord segment and nerve roots were analyzed.ResultsThroughout the scoliosis correction process, the middle spinal cord segment consistently exhibited a risk of injury under various conditions and displacements. The lower spinal cord segment showed no significant injury changes under traction + torsion conditions. In the early correction phase, the upper spinal cord segment demonstrated a risk of injury under all conditions, and the lower spinal cord segment presented a risk of injury under pushing conditions. Traction conditions posed a risk of nerve injury on both sides in the middle and lower segments. Under pushing conditions, there was a risk of nerve injury on both sides in all segments. Traction + torsion conditions implicated a risk of injury to the right nerves in the upper segment, both sides in the middle segment, and the left side in the lower segment. In the later correction stage, there was a risk of injury to the upper spinal cord segment under traction + torsion conditions, the left nerves in the middle segment under traction conditions, and the right nerves in the upper segment under pushing conditions.ConclusionWhen the correction rate reaches 61–68%, particular attention should be given to the upper-mid spinal cord. Pushing conditions also warrant attention to the lower spinal cord and the nerve roots on both sides of the main thoracic curve. Traction conditions require attention to nerve roots bilaterally in the middle and lower segments, while traction combined with torsion conditions necessitate focus on the right-side nerve roots in the upper segment, both sides in the middle segment, and the left-side nerve roots in the lower segment.

Neurosarcoidosis of the trigeminal nerve: clinical accompaniments, radiographic findings, and association with neuralgia.

Cranial neuropathy is a principal disease manifestation of neurosarcoidosis, but many forms remain poorly described, including trigeminal nerve disease despite its frequency in reported cohorts (5-12%). Herein, we characterize the clinical course of patients with neurosarcoidosis involving the trigeminal nerve. A single-center retrospective cohort analysis of patients with biopsy-proven sarcoidosis involving the trigeminal nerve was conducted between 1/1/2000-3/7/2023. The trigeminal nerve was affected in 14/245 (5.7%) patients, being clinically symptomatic in 5/245 (2.0%) and asymptomatic with radiographic involvement in 9/245 (3.7%). 14/14 (100.0%) patients had systemic sarcoidosis. In the symptomatic group, trigeminal neuropathy was an inaugural feature in 4/5 (80.0%), unilateral in 5/5 (100.0%) with the V1 subdivision most affected (4/5, 80.0%), and associated with neuralgia in 2/5 (40.0%). On MRI, the cisternal nerve roots (9/14, 64.3%), Meckel's cave (7/14, 50.0%), and cavernous sinus (5/14, 35.7%) were most commonly affected, and 14/14 (100.0%) patients had extra-trigeminal neuroinflammation on cranial MRI. CSF was abnormal in at least one dimension in 11/12 (91.7%) tested. All three treated patients with symptomatic trigeminal neuropathy responded to immunomodulatory treatment, and symptomatic treatments for trigeminal neuralgia were helpful in two patients. After a median follow-up period of 63 months, the median modified Rankin scale score was 1 for both subgroups. Neurosarcoidosis may involve any portion of the trigeminal apparatus, and when affected, it frequently demonstrates a mismatch in radiographic involvement from its clinical manifestations of facial numbness and pain, and typically occurs in association with other clinical or radiographic manifestations of neurosarcoidosis.

Shoulder Traction as a Possible Risk Factor for C5 Palsy in Anterior Cervical Surgery: A Cadaveric Study.

Background and Objectives: Many risk factors for postoperative C5 palsy (PC5P) have been reported regarding a "cord shift" after a posterior approach. However, there are few reports about shoulder traction as a possible risk factor of anterior cervical surgery. Therefore, we assessed the stretched nerve roots when shoulder traction was applied on cadavers. Materials and Methods: Eight cadavers were employed in this study, available based on age and the presence of foramen stenosis. After dissecting the sternocleidomastoid muscle of the cadaver, the shoulder joint was pulled with a force of 2, 5, 8, 10, 15, and 20 kg. Then, the stretched length of the fifth nerve root was measured in the extra-foraminal zone. In addition, the same measurement was performed after cutting the carotid artery to accurately identify the nerve root's origin. After an additional dissection was performed so that the superior trunk of the brachial plexus could be seen, the stretched length of the fifth and sixth nerve roots was measured again. Results: Throughout the entire experiment, the fifth nerve root stretched out for an average of 1.94 mm at 8 kg and an average of 5.03 mm at a maximum force of 20 kg. In three experiments, the elongated lengths of the C5 nerve root at 8 kg and 20 kg were 1.69/4.38 mm, 2.13/5.00 mm, and 0.75/5.31 mm, respectively, and in the third experiment, the elongated length of the C6 nerve root was 1.88/5.44 mm. Conclusions: Although this was a cadaveric experiment, it suggests that shoulder traction could be the risk factors for PC5P after anterior cervical surgery. In addition, for patients with foraminal stenosis and central stenosis, the risk would be higher. Therefore, the surgeon should be aware of this, and the patient would need sufficient explanation.

Innervation of the muscles of the pelvic limb of the nutria (Myocastor coypus) by nerves originating from the lumbosacral plexus

Abstract Knowledge about the innervation of the pelvic limb is crucial in veterinary sciences, particularly in anesthesiology, diagnostics, and veterinary surgery, where precise knowledge of the nervous system enables effective treatment and interventions. With the growing interest of veterinarians in studies of the rodent, expanding knowledge of the neuroanatomy of these animals is key to improving veterinary care and treatment efficacy. The aim of our study was to analyze the innervation of the pelvic limb muscles in the nutria (Myocastor coypus). Our research demonstrated that these muscles are innervated by motor fibers from nerves such as the femoral nerve, the obturator nerve, the sciatic nerve, and the cranial and caudal gluteal nerves. We also determined the origin of these nerves, indicating that they stem from the ventral roots of the spinal nerves from L3 to S1, knowing that the nutria has six lumbar vertebrae. Conclusions from such analyses can contribute to a deeper understanding of the evolutionary anatomy of the nervous system in various mammal groups and the development of more precise diagnostic and therapeutic methods in veterinary medicine.

TRPV1 and mast cell involvement in repeated variate stress-induced urinary bladder dysfunction in adult female mice.

The etiology of interstitial cystitis/bladder pain syndrome (IC/BPS) is unknown but likely multifactorial. IC/BPS symptoms can be exacerbated by psychological stress, but underlying mechanisms remain to be defined. Transient receptor potential vanilloid 1 (TRPV1) channels, expressed on nerve fibers, have been implicated in bladder dysfunction and colonic hypersensitivity with stress in rodents. Histamine/H1R activation of TRPV1+ nerves increases bladder afferent fiber sensitivity to distension. TRPV1 channels are also expressed on mast cells, previously implicated in contributing to IC/BPS etiology and symptoms. We have examined the contribution of TRPV1 and mast cells to bladder dysfunction after repeated variate stress (RVS). RVS increased (P ≤ 0.05) serum and fecal corticosterone expression and induced anxiety-like behavior in wild-type (WT) mice. Intravesical instillation of the selective TRPV1 antagonist capsazepine (CPZ) rescued RVS-induced bladder dysfunction in WT mice. Trpv1 knockout (KO) mice did not increase voiding frequency with RVS and did not exhibit increased serum corticosterone expression despite exhibiting anxiety-like behavior. Mast cell-deficient mice (B6.Cg-Kitw-sh) failed to demonstrate RVS-induced increased voiding frequency or serum corticosterone expression, whereas control (no stress) mast cell-deficient mice had similar functional bladder capacity to WT mice. TRPV1 protein expression was significantly increased in the rostral lumbar (L1-L2) spinal cord and dorsal root ganglia (DRG) in WT mice exposed to RVS, but no changes were observed in lumbosacral (L6-S1) spinal segments or DRG. These studies demonstrated TRPV1 and mast cell involvement in RVS-induced increased voiding frequency and suggest that TRPV1 and mast cells may be useful targets to mitigate stress-induced urinary bladder dysfunction.NEW & NOTEWORTHY Using pharmacological tools and transgenic mice in a repeated variate stress (RVS) model in female mice, we demonstrate that transient receptor potential vanilloid 1 (TRPV1) and mast cells contribute to the increased voiding frequency observed following RVS. TRPV1 and mast cells should continue to be considered as targets to improve bladder function in stress-induced bladder dysfunction.