title: Invasive neural interfaces: the perspective of the surgeon.
abstract: BACKGROUND
  By implanting electrodes inside peripheral nerves, amputee's intentions are picked up and exploited to control novel dexterous sensorized hand prostheses. Under the pretext of presenting surgical technique and clinical outcomes of the implant of invasive peripheral neural interfaces in a human amputee, this article critically comments, from the point of view of the surgeon, strengths and weaknesses of the procedure.
  
  
  METHODS
  Four multielectrodes were implanted in the medial and ulnar nerves of a young volunteer, which, following a car-crash, had a left transradial amputation. Both nerves were approached with a single incision in the medial aspect of the upper arm. Four weeks later, the electrodes were removed.
  
  
  RESULTS
  Even if the trauma and the postamputation plastic processes altered the anatomy, electrodes were proficiently implanted with an overall success of 66%. Looking at the procedure from the surgeon's viewpoint unveils few still open issues. Electrodes weaknesses were related to the absence of stabilizing structures, the cable transit through the skin, the implant angle, and the unproven magnetic resonance imaging compatibility. Future investigations are needed to definitely address the better anesthesia, number and sites of incisions, the nerves to implant, and the convenience of performing epineural microdissection.
  
  
  CONCLUSIONS
  Invasive neural interfaces developmental process almost completely relies on the efforts of bioengineers and neurophysiologists; however, the surgeon is responsible for intra and perioperative factors. Therefore, he deserves to play a major role also at the stage of specifying the requirements, to satisfy the requisites of a safe, stable, and long-lasting implant.
authors.affiliation: Institute of Neurology, Campus Bio-Medico University, Rome, Italy; Fondazione Alberto Sordi - Research Institute for Ageing, Rome, Italy; Laboratory of Biomedical Robotics and Biomicrosystems, CIR, Campus Bio-Medico University, Rome, Italy. Electronic address: g.dipino@unicampus.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Pino
authors.affiliation: Department of Neurosurgery, Padua University Hospital, Padova, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Denaro
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy. Electronic address: g.vadala@unicampus.it.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Vadalà
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Marinozzi
authors.affiliation: Institute of Neurology, Campus Bio-Medico University, Rome, Italy; Fondazione Alberto Sordi - Research Institute for Ageing, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Tombini
authors.affiliation: Institute of Neurology, Campus Bio-Medico University, Rome, Italy; Fondazione Alberto Sordi - Research Institute for Ageing, Rome, Italy.
authors.forename: Florinda
authors.initials: F
authors.lastname: Ferreri
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Papalia
authors.affiliation: Laboratory of Biomedical Robotics and Biomicrosystems, CIR, Campus Bio-Medico University, Rome, Italy.
authors.forename: Dino
authors.initials: D
authors.lastname: Accoto
authors.affiliation: Laboratory of Biomedical Robotics and Biomicrosystems, CIR, Campus Bio-Medico University, Rome, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Guglielmelli
authors.affiliation: Institute of Neurology, Campus Bio-Medico University, Rome, Italy; Fondazione Alberto Sordi - Research Institute for Ageing, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Di Lazzaro
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Denaro
mesh_terms: D000328:Adult; D001186:Artificial Limbs; D020878:Device Removal; D004567:Electrodes, Implanted; D006225:Hand / Q000294:innervation; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000601:surgery*; D009493:Neurosurgery; D019635:Neurosurgical Procedures; D019919:Prosthesis Implantation; D014459:Ulnar Nerve / Q000601:surgery*
keywords: Amputees; Hand prostheses; Invasive neural interface; Peripheral nerves; Upper limb surgery