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This thesis comprises of three studies investigating the repair of brachial plexus avulsion injury from three different perspectives. The first aim of this thesis was to investigate the long-term effects of reimplantation surgery in patients with complete brachial plexus avulsion injury using standardized assessments. Patients are assessed with clinical examination, neurophysiological studies and patient-reported outcome questionnaires. It is shown that patients who have undergone brachial plexus re-implantation surgery demonstrate small, yet significant, improved function in motor and sensory recovery compared with patients who have not had this surgical intervention. These results are encouraging, but functional improvements are limited. One strategy aimed at further improving the effects of re-implantationis the transplantation of OECs during the surgical repair. The second study presented in this thesis comprises of a prospective observational study of human biopsies of nasal mucosa by endonasal dissection of the mucosa of the nasal septum during the approach for routine sinus surgery. Samples are cultured in the laboratory, and the yield of olfactory ensheathing cells is compared as to the location, size, and weight of the biopsies and patient characteristics including age, smoking, nasal disease severity. OEC yield is associated with mucosal disease and patients age. The third aim of this thesis is to develop novel MRI techniques that can be used in human trials of cell mediated repair of the brachial plexus to assess patients’ spinal cord regeneration after OEC transplantation and provide a more robust outcome measure for comparing different strategies of brachial plexus repair. We focus on magnetic resonance spectroscopy and demonstrate that this technique is sensitive to pathological changes that occur in the spinal cord above the injury. Myo-Inositol to creatine ratio is correlated with disability and is negatively correlated to time from injury. The implications of the above findings are discussed. |
