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J Reconstr Microsurg
DOI: 10.1055/a-2483-5556
Original Article

Using Transcranial Magnetic Nerve Stimulation to Differentiate Motor and Sensory Fascicles in a Mixed Nerve: Experimental Rat Study

Kota Hayashi
1   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei, Linkou, Chang Gung University, Taoyuan, Taiwan
,
Tsung-Hsun Hsieh
2   School of Physical Therapy and Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan
3   Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
,
Yen-Lin Huang
4   School of Medicine, National Tsing-Hua University, Hsinchu, Taiwan
5   Department of Anatomic Pathology, Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
,
David Chwei-Chin Chuang
1   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei, Linkou, Chang Gung University, Taoyuan, Taiwan
› Institutsangaben Funding This research was supported by the grant of the Taiwan NMRP (National Medical Research Program) 111-2314-B-182A-129.
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Abstract

Background Accurately matching the correct fascicles in a ruptured mixed nerve is critical for functional recovery. This study investigates the use of transcranial magnetic stimulation (TMS) to differentiate motor and sensory fascicles in a mixed nerve.

Methods In all 40 rats, the median nerve in the left upper arm was evenly split into three segments. The rats were separated into two groups. In Group A (20 rats), the segment with the highest amplitude during TMS was selected as the motor neurotizer and transferred to the musculocutaneous nerve. In Group B (20 rats), only the medial one-third segment was selected and transferred without using TMS. The results were compared using grooming tests, nerve electrophysiological studies, muscle tetanus contraction force measurements, muscle weight, and axon counts at 16 weeks.

Results The grooming test showed that Group A performed significantly better than Group B at 12 and 16 weeks postoperatively. Tetanic muscle contraction force measurements also revealed that Group A had significantly better outcomes than Group B. However, electrophysiological testing, muscle weight, and axon counts showed no significant differences between the two groups.

Conclusion This study suggests that TMS can be used to distinguish motor fascicles from sensory fascicles in a mixed nerve. It is desirable to apply this technique intraoperatively to differentiate motor and sensory fascicles for appropriate nerve matching and to select the motor fascicles as a motor neurotizer for functioning free muscle innervation in human mixed nerve injury.

Keywords

transcranial magnetic stimulation - mixed nerve injury - motor fascicle identification

Ethical Approval

Ethical approval for this study was obtained from the Chang Gung Memorial Hospital Institutional Review Board.




Publikationsverlauf

Eingereicht: 17. Juli 2024

Angenommen: 10. November 2024

Artikel online veröffentlicht:
07. Januar 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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