NYMC Faculty Publications
Rare Median and Musculocutaneous Nerve Fusion With Intraoperative electrical Confirmation: Illustrative Case
Author Type(s)
Student, Resident/Fellow, Faculty
Journal Title
Journal of Neurosurgery. Case Lessons
Document Type
Article
Publication Date
12-11-2023
Department
Neurosurgery
Second Department
Neurology
Abstract
BACKGROUND: Nerve transfer is a surgical technique in which a redundant or expendable fascicle is transferred or coapted to an injured nerve distal to the site of injury for the purpose of reinnervation. Successful nerve transfer is dependent on correct intraoperative identification of donor and recipient nerves. OBSERVATIONS: An 8-year-old male was recommended for ulnar nerve fascicle to biceps branch of musculocutaneous nerve transfer to restore elbow flexion weakness after a demyelinating spinal cord injury. The biceps branch was identified approximately midway along the upper arm. Proximal musculocutaneous nerve stimulation induced hand movement and electromyography activity in the median nerve muscles. Neurolysis of the thickened proximal structure revealed fusion of the musculocutaneous and median nerves. Because of the proximity of the median and musculocutaneous nerves, median rather than ulnar nerve fascicles were used as donors for transfer. LESSONS: The authors provide the first reported intraoperative finding of an anatomical variant in which the musculocutaneous nerve and median nerve were fused in the upper arm, confirmed through intraoperative electrical stimulation. Surgeons should be aware of this rare anatomical variant to ensure correct nerve identification when performing nerve transfers in the proximal upper extremity.
Recommended Citation
Huang, A., Vazquez, S., Dominguez, J., Mohan, A., Li, J., & Pisapia, J. M. (2023). Rare Median and Musculocutaneous Nerve Fusion With Intraoperative electrical Confirmation: Illustrative Case. Journal of Neurosurgery. Case Lessons, 6 (24). https://doi.org/https://doi.org/10.3171/CASE23469
