The biannual conference for brachial plexus injuries was staged this week in Barcelona. The usual topics of obstetric plexus injury and adult plexus injuries were represented, though of the sessions it was the one relating to basic science that I found the most interesting. Of particular note was the presentation on MR neurography (or tractography) that caught my attention. I had not seen first hand the level of anatomic detail that can be provided using this technique and was very impressed at what could be visualised – avulsions and ruptures of the nerve roots can be clearly seen, as can the intralesional structure of nerve sheath tumours. This is definitely something that I will have to try to introduce into my imaging protocols for patients with nerve injury.
Another exceedingly interesting talk was given by one of my colleagues Tom Quick who presented on diffusion MRI imaging of regenerating nerves – demonstrating how it is now possible to assess the progress of individual axon regeneration. Although this is still very much an experimental technique it offers tremendous potential for monitoring post surgical recovery (and prognosis) in the future – allowing real time assessment of nerve regrowth. Professor Thomas Carlstedt gave an excellent paper on the potential use of a retinoic acid beta receptor agonist (a novel molecule that he has been involved in the development of) that experimentally demonstrates improved nerve regeneration rates post injury – this will be going to initial phase clinical trials soon and if the experimental data translates into similar improvements in humans it could dramatically change outcomes for patients after nerve injury.
Other highlights included Oskar Aszmann’s paper ‘quantitative analysis of the sensory and motor fibres of the brachial plexus in man’ which for the first time provided us with the true motor and sensory axonal counts in the nerves of he upper limb – I am looking forward to reading his full publication on this in the near future.