RESUMEN
BACKGROUND AND PURPOSE: MR imaging is the most comprehensive noninvasive means to assess structural changes in injured central nervous system (CNS) tissue in humans over time. The few published in vivo MR imaging studies of spinal cord injury in rodent models by using field strengths < or = 7T suffer from low spatial resolution, flow, and motion artifacts. The aim of this study was to assess the capacity of a 17.6T imaging system to detect pathologic changes occurring in a rat spinal cord contusion injury model ex vivo and in vivo. METHODS: Seven adult female Fischer 344 rats received contusion injuries at thoracic level T10, which caused severe and reproducible lesions of the injured spinal cord parenchyma. Two to 58 days postinjury, high-resolution MR imaging was performed ex vivo (2) or in vivo in anesthetized rats (5 spinal cord injured + one intact control animal) by using 2D multisection spin- and gradient-echo imaging sequences, respectively, combined with electrocardiogram triggering and respiratory gating. RESULTS: The acquired images provided excellent resolution and gray/white matter differentiation without significant artifacts. Signal intensity changes, which were detected with ex vivo and in vivo MR imaging following spinal cord injury, could be correlated with histologically defined structural changes such as edema, fibroglial scar, and hemorrhage. CONCLUSIONS: These results demonstrate that MR imaging at 17.6T allows high-resolution structural analysis of spinal cord pathology after injury.
Asunto(s)
Imagen por Resonancia Magnética/métodos , Traumatismos de la Médula Espinal/patología , Animales , Femenino , Ratas , Ratas Endogámicas F344RESUMEN
OBJECTIVE: This article reviews novel restorative therapies for cavernous nerves that may be used to replace resected cavernous nerves at the time of pelvic surgery. METHODS: A literature-based presentation (Medline search) on current nerve replacement strategies was conducted with emphasis on neurobiological factors contributing to the restoration of erectile function after cavernous nerve injuries. RESULTS: A promising alternative to autologous nerve grafts for extending the length of successful nerve regeneration are artificial nerve guides. The addition of neurotrophic factors, extracellular matrix components and Schwann cells has been shown to promote cavernous nerve regeneration. Neurotrophic factors can be incorporated in the scaffold or can be supplied by cells seeded into the stroma. The regenerative capacity of these cells can be further enhanced by genetic modification with neurotrophic factor encoding genes. CONCLUSIONS: Artificial nerve guides, especially biodegradable ones containing growth-promoting factors or cells, are a promising option for the repair of cavernous nerve lesions.
Asunto(s)
Disfunción Eréctil/cirugía , Regeneración Tisular Dirigida/métodos , Regeneración Nerviosa/fisiología , Erección Peniana/fisiología , Pene/inervación , Células de Schwann/trasplante , Disfunción Eréctil/etiología , Humanos , Masculino , Recuperación de la FunciónRESUMEN
Iatrogenic cavernous nerve lesions occurring during radical pelvic surgery often lead to irreversible erectile dysfunction. The nerve defects after excision of the neurovascular bundles must be reconstructed by interposition grafting to supply a permissive scaffold for oriented axonal regrowth. The use of autologous nerve grafts for the repair of human cavernous nerves during radical prostatectomy has been controversial regarding the limited success achieved with bilateral nerve grafting. Artificial nerve guides consisting of natural or synthetic materials have been successfully used for bridging peripheral nerve defects. The combination with Schwann cells, neurotrophic factors and extracellular matrix components has been shown to promote cavernous nerve regeneration.
Asunto(s)
Disfunción Eréctil/cirugía , Regeneración Tisular Dirigida/métodos , Regeneración Nerviosa , Procedimientos Neuroquirúrgicos/métodos , Pene/inervación , Células de Schwann/trasplante , Procedimientos Quirúrgicos Urológicos Masculinos/efectos adversos , Disfunción Eréctil/etiología , Humanos , Masculino , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina , Recuperación de la Función , Resultado del TratamientoRESUMEN
The objective was to demonstrate the feasibility and to evaluate the performance of high-resolution in vivo magnetic resonance (MR) imaging of the rat spinal cord in a 17.6-T vertical wide-bore magnet. A probehead consisting of a surface coil that offers enlarged sample volume suitable for rats up to a weight of 220 g was designed. ECG triggered and respiratory-gated gradient echo experiments were performed on a Bruker Avance 750 wide-bore spectrometer for high-resolution imaging. With T*2 values between 5 and 20 ms, good image contrast could be obtained using short echo times, which also minimizes motion artifacts. Anatomy of healthy spinal cords and pathomorphological changes in traumatically injured rat spinal cord in vivo could be visualized with microscopic detail. It was demonstrated that imaging of the rat spinal cord in vivo using a vertical wide-bore high-magnetic-field system is feasible. The potential to obtain high-resolution images in short scan times renders high-field imaging a powerful diagnostic tool.
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Aumento de la Imagen/instrumentación , Imagen por Resonancia Magnética/instrumentación , Traumatismos de la Médula Espinal/patología , Médula Espinal/patología , Animales , Diseño de Equipo , Análisis de Falla de Equipo , Estudios de Factibilidad , Femenino , Aumento de la Imagen/métodos , Imagen por Resonancia Magnética/métodos , Magnetismo , Ratas , Ratas Endogámicas F344 , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Vértebras Torácicas/patologíaRESUMEN
Dissection of the cavernous nerves eliminates spontaneous erections and may lead to irreversible erectile dysfunction due to degeneration of cavernous tissue. Novel procedures to reconstruct penile innervation include cavernous nerve interposition grafting and neurotrophic treatments to revitalize penile neural input, evaluated thus far in various preclinical models of cavernous nerve injury. Schwann cells crucially contribute to successful axonal regeneration by mechanical and paracrine mechanisms in the injured nerve, and Schwann cells seeded into guidance channels have been successfully employed to support regeneration in animal models of cavernous nerve injury. Gene therapy, tissue engineering, and reconstructive techniques have been combined to deliver neurotrophic factors and recover erectile function.
Asunto(s)
Disfunción Eréctil/cirugía , Regeneración Nerviosa/fisiología , Pene/inervación , Pene/cirugía , Enfermedades del Sistema Nervioso Periférico/cirugía , Células de Schwann/trasplante , Ingeniería de Tejidos/métodos , Implantes Absorbibles , Animales , Disfunción Eréctil/diagnóstico , Disfunción Eréctil/etiología , Disfunción Eréctil/terapia , Terapia Genética/métodos , Humanos , Masculino , Factores de Crecimiento Nervioso/genética , Factores de Crecimiento Nervioso/uso terapéutico , Enfermedades del Sistema Nervioso Periférico/complicaciones , Enfermedades del Sistema Nervioso Periférico/terapia , Resultado del TratamientoRESUMEN
PURPOSE: Dissection of the cavernous nerves eliminates spontaneous erections. We evaluated the ability of Schwann cell seeded nerve guidance tubes to restore erections after bilateral cavernous nerve resection in rats. MATERIALS AND METHODS: Sections (5 mm) of the cavernous nerve were excised bilaterally, followed by immediate bilateral microsurgical reconstruction. In 10 animals per group (20 study nerves) reconstruction was performed by genitofemoral nerve interposition, interposition of silicone tubes or interposition of silicone tubes seeded with homologous Schwann cells. As the control 10 animals (20 study nerves) underwent sham operation (positive control) and bilateral nerve ablation (without reconstruction) was performed in a further 10 (negative control). Erectile function was evaluated 3 months postoperatively by relaparotomy, electrical nerve stimulation and intracavernous pressure recording. RESULTS: After 3 months neurostimulation resulted in an intact erectile response in 90% (18 of 20) of Schwann cell grafts, while treatment with autologous nerves (30% or 6 of 20) or tubes only (50% or 10 of 20) was less successful (p <0.01). Whereas untreated ablated rats showed no inducible erections (0% or 0 of 20), all sham operated animals had an intact erectile response (100% or 20 of 20). Maximum intracavernous pressure upon electrostimulation was significantly elevated using Schwann cell grafts compared to results in the other treatment groups (p <0.001). Morphological evaluation revealed advanced regeneration within Schwann cell grafts. CONCLUSIONS: Schwann cell seeded guidance tubes restore erectile function after the ablation of cavernous nerves in rats and they are superior to autologous nerve grafts.