Neurosurgical correction of upper brachial plexus birth injuries

1993 ◽  
Vol 79 (2) ◽  
pp. 197-203 ◽  
Author(s):  
John P. Laurent ◽  
Rita Lee ◽  
Saleh Shenaq ◽  
Julie T. Parke ◽  
Itzel S. Solis ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Surgical Reconstruction ◽  
Content Type ◽  
Birth Injuries ◽  
Neurological Improvement ◽  
Children First ◽  
Fine Print

✓ The authors review the cases of 116 infants treated consecutively for birth-related brachial plexus injuries. Twenty-eight infants with upper brachial plexus lesions who showed no neurological improvement by 4 months of age were selected for early surgical reconstruction (at a mean age of 5 months). Neurological improvement of the affected arm was observed in more than 90% (p < 0.05) of the children examined longer than 9 months after brachial plexus reconstruction. A conservatively managed control subgroup of 44 children, first examined at less than 3 months of age, demonstrated neurological improvement by 4 months of age and continued to show improvement at 1 year of age. Early surgical reconstruction is recommended for infants with birth-related upper brachial plexus injury who show no neurological improvement by the age of 4 months.

Superficial siderosis of the central nervous system after brachial plexus injury

1994 ◽  
Vol 80 (5) ◽  
pp. 931-934 ◽  
Author(s):  
Virginio Bonito ◽  
Cristina Agostinis ◽  
Stefano Ferraresi ◽  
Carlo Alberto Defanti
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Hearing Loss ◽  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Superficial Siderosis ◽  
Content Type ◽  
Initial Symptoms ◽  
The Central Nervous System ◽  
Fine Print

✓ Superficial siderosis is a rare condition characterized by deposition of hemosiderin in the leptomeninges and in the subpial layers of the brain and spinal cord. It is associated with cerebrospinal fluid abnormalities consistent with recurrent bleeding into the subarachnoid space. The usual symptoms are hearing loss, ataxia, spastic paraparesis, sensory and sphincter deficits, and mental deterioration. A case is presented of severe superficial siderosis of the central nervous system in a 51-year-old man who had suffered a brachial plexus injury at the age of 20 years. The diagnosis was made by means of magnetic resonance imaging 16 years after the initial symptoms, which comprised bilateral hearing loss and anosmia. Subarachnoid bleeding was due to traumatic pseudomeningocele of the brachial plexus, a very unusual cause of superficial siderosis. This case is interesting insofar as the surgical treatment prevented further bleeding and possibly progression of the disease.

Surgical reconstruction of the musculocutaneous nerve in traumatic brachial plexus injuries

1997 ◽  
Vol 87 (6) ◽  
pp. 881-886 ◽  
Author(s):  
Madjid Samii ◽  
Gustavo A. Carvalho ◽  
Guido Nikkhah ◽  
Götz Penkert
Keyword(s):  
Brachial Plexus ◽  
Postoperative Outcome ◽  
Musculocutaneous Nerve ◽  
Surgical Reconstruction ◽  
Time Interval ◽  
Neurosurgical Department ◽  
Content Type ◽  
Additional Information ◽  
Brachial Plexus Surgery ◽  
Fine Print

✓ Over the last 16 years, 345 surgical reconstructions of the brachial plexus were performed using nerve grafting or neurotization techniques in the Neurosurgical Department at the Nordstadt Hospital, Hannover, Germany. Sixty-five patients underwent graft placement between the C-5 and C-6 root and the musculocutaneous nerve to restore the flexion of the arm. A retrospective study was conducted, including statistical evaluation of the following pre- and intraoperative parameters in 54 patients: 1) time interval between injury and surgery; 2) choice of the donor nerve (C-5 or C-6 root); and 3) length of the grafts used for repairs between the C-5 or C-6 root and the musculocutaneous nerve. The postoperative follow-up interval ranged from 9 months to 14.6 years, with a mean ± standard deviation of 4.4 ± 3 years. Reinnervation of the biceps muscle was found in 61% of the patients. Comparison of the different preoperative time intervals (1–6 months, 7–12 months, and > 12 months) showed a significantly better outcome in those patients with a preoperative delay of less than 7 months (p < 0.05). Reinnervation of the musculocutaneous nerve was demonstrated in 76% of the patients who underwent surgery within the first 6 months postinjury, in 60% of the patients with a delay of between 6 and 12 months, and in only 25% of the patients who underwent surgery after 12 months. Comparison of the final outcome according to the root (C-5 or C-6) that was used for grafting the musculocutaneous nerve showed no statistical difference. Furthermore, statistical analysis (regression test) of the length of the grafts between the donor (C-5 or C-6 root) nerve and the musculocutaneous nerve displayed an inverse relationship between the graft length and the postoperative outcome. Together, these results provide additional information to enhance the functional outcome of brachial plexus surgery.

Brachial plexus injury: factors affecting functional outcome in spinal accessory nerve transfer for the restoration of elbow flexion

2003 ◽  
Vol 98 (2) ◽  
pp. 307-312 ◽  
Author(s):  
Amir Samii ◽  
Gustavo Adolpho Carvalho ◽  
Madjid Samii
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Elbow Flexion ◽  
Nerve Graft ◽  
Musculocutaneous Nerve ◽  
Accessory Nerve ◽  
Time Interval ◽  
Content Type ◽  
The Impact ◽  
Fine Print

Object. Between 1994 and 1998, 44 nerve transfers were performed using a graft between a branch of the accessory nerve and musculocutaneous nerve to restore the flexion of the arm in patients with traumatic brachial plexus injuries. A retrospective study was conducted, including statistical evaluation of the following pre- and intraoperative parameters in 39 patients: 1) time interval between injury and surgery; and 2) length of the nerve graft used to connect the accessory and musculocutaneous nerves. Methods. The postoperative follow-up interval ranged from 23 to 84 months, with a mean ± standard deviation of 36 ± 13 months. Reinnervation of the biceps muscle was achieved in 72% of the patients. Reinnervation of the musculocutaneous nerve was demonstrated in 86% of the patients who had undergone surgery within the first 6 months after injury, in 65% of the patients who had undergone surgery between 7 and 12 months after injury, and in only 50% of the patients who had undergone surgery 12 months after injury. A statistical comparison of the different preoperative time intervals (0–6 months compared with 7–12 months) showed a significantly better outcome in patients treated with early surgery (p < 0.05). An analysis of the impact of the length of the interposed nerve grafts revealed a statistically significant better outcome in patients with grafts 12 cm or shorter compared with that in patients with grafts longer than 12 cm (p < 0.005). Conclusions. Together, these results demonstrated that outcome in patients who undergo accessory to musculocutaneous nerve neurotization for restoration of elbow flexion following brachial plexus injury is greatly dependent on the time interval between trauma and surgery and on the length of the nerve graft used.

Spinal nerve root repair and reimplantation of avulsed ventral roots into the spinal cord after brachial plexus injury

2000 ◽  
Vol 93 (2) ◽  
pp. 237-247 ◽  
Author(s):  
Thomas Carlstedt ◽  
Praveen Anand ◽  
Rolf Hallin ◽  
Peter Vigay Misra ◽  
Georg Norén ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Time Lag ◽  
Sensory Function ◽  
Successful Outcome ◽  
Nerve Roots ◽  
Content Type ◽  
Root Repair ◽  
Fine Print

Object. The authors review the first series of 10 cases in which injured intraspinal brachial plexus were surgically repaired. They describe the technique of spinal cord implantation or repair of ruptured nerve roots, as well as patient outcome. Methods. Spinal root repair/implantation was performed from 10 days to 9 months postinjury. There were nine male patients and one female patient. Postoperatively in most cases, regeneration of motor neurons from the spinal cord to denervated muscles could be demonstrated. The first signs of regeneration were noted approximately 9 to 12 months postoperatively. Useful function with muscle power of at least Medical Research Council Grade 3 occurred in three of 10 cases. Magnetic brain stimulation studies revealed a normal amplitude and latency from the cortex to reinnervated muscles on surgically treated and control sides. A certain degree of cocontraction between antagonistic muscles (for example, biceps—triceps) compromised function. With time there was a reduction of cocontractions, probably due to spinal cord plasticity. In these cases there was also, surprisingly, a return of sensory function, although the mechanism by which this occurred is uncertain. Sensory stimulation (thermal and mechanical) within the avulsed dermatomes was perceived abnormally and/or experienced at remote sites. There was some return of patients' sense of joint position. Conclusions. A short time lag between the accident and the surgery was recognized as a significant factor for a successful outcome. Reimplantation of avulsed nerve roots may be combined with other procedures such as nerve transfers in severe cases of brachial plexus injury.

Cervical nerve root avulsion in brachial plexus injuries: magnetic resonance imaging classification and comparison with myelography and computerized tomography myelography

2002 ◽  
Vol 96 (3) ◽  
pp. 277-284 ◽  
Author(s):  
Kazuteru Doi ◽  
Ken Otsuka ◽  
Yukinori Okamoto ◽  
Hiroshi Fujii ◽  
Yasunori Hattori ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Brachial Plexus ◽  
Nerve Root ◽  
Brachial Plexus Injury ◽  
Root Avulsion ◽  
Cervical Nerve ◽  
Ct Myelography ◽  
Content Type ◽  
Nerve Root Avulsion ◽  
Fine Print

Object. The authors describe a new magnetic resonance (MR) imaging technique to demonstrate the status of the cervical nerve roots involved in brachial plexus injury. They discuss the accuracy and reproducibility of a MR imaging—derived classification for diagnosis of nerve root avulsion compared with those of myelography combined with computerized tomography (CT) myelography. Methods. The overlapping coronal—oblique slice MR imaging procedure was performed in 35 patients with traumatic brachial plexus injury and 10 healthy individuals. The results were retrospectively evaluated and classified into four major categories (normal rootlet, rootlet injuries, avulsion, and meningocele) after confirming the diagnosis by surgical exploration with or without spinal evoked potential (EP) measurements and by referring to myelography and CT myelography findings. The reliability and reproducibility of the MR imaging—based classification was prospectively assessed by eight independent observers, and its diagnostic accuracy was compared with that of traditional myelography/CT myelography classification, correlated with surgical and spinal EP findings in another 50 cervical roots in 10 patients with traumatic brachial plexus injury. Conclusions. In the retrospective study in which MR imaging and myelography/CT myelography findings involving 175 cervical roots in 35 patients were compared, the sensitivity of detection of the cervical nerve root avulsion was the same (92.9%) with both modalities. In the prospective study, interobserver reliability and intraobserver reproducibility showed that there was no statistically significant difference between MR imaging and myelography/CT myelography and that their accuracy for detecting cervical root avulsion was the same as that in the retrospective study. The overlapping coronal—oblique slice MR imaging technique is a reliable and reproducible method for detecting nerve root avulsion. The information provided by this modality enabled the authors to assess the roots of the brachial plexus and provided valuable data for helping to decide whether to proceed with exploration, nerve repair, primary reconstruction, or other imaging modalities.

Brachial plexus injury following axillary arteriography

1980 ◽  
Vol 53 (6) ◽  
pp. 853-857 ◽  
Author(s):  
Dennis M. O'Keefe
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Clinical Findings ◽  
Surgical Decompression ◽  
Motor Dysfunction ◽  
Arterial Puncture ◽  
Review Of The Literature ◽  
Puncture Site ◽  
Content Type ◽  
Fine Print

✓ A case of brachial plexus injury following axillary arteriography is reported. Electrodiagnostic studies localized the lesion to the region of the puncture site. Review of the literature indicates that neural injury is due to a localized hematoma or pseudoaneurysm at the site of arterial puncture. Surgical decompression of the brachial plexus within 24 hours of the onset of motor dysfunction results in a much improved prognosis. Clinical findings that help to differentiate between postoperative traction injury and brachial plexus injury following axillary arteriography are discussed.

Contralateral motor rootlets and ipsilateral nerve transfers in brachial plexus reconstruction

2004 ◽  
Vol 101 (5) ◽  
pp. 770-778 ◽  
Author(s):  
Jayme Augusto Bertelli ◽  
Marcos Flávio Ghizoni
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Phrenic Nerve ◽  
Cranial Nerve ◽  
External Rotation ◽  
Elbow Flexion ◽  
Content Type ◽  
Nerve Transfers ◽  
Contralateral Motor ◽  
Fine Print

Object. The goal of this study was to evaluate outcomes in patients with brachial plexus avulsion injuries who underwent contralateral motor rootlet and ipsilateral nerve transfers to reconstruct shoulder abduction/external rotation and elbow flexion. Methods. Within 6 months after the injury, 24 patients with a mean age of 21 years underwent surgery in which the contralateral C-7 motor rootlet was transferred to the suprascapular nerve by using sural nerve grafts. The biceps motor branch or the musculocutaneous nerve was repaired either by an ulnar nerve fascicular transfer or by transfer of the 11th cranial nerve or the phrenic nerve. The mean recovery in abduction was 90° and 92° in external rotation. In cases of total palsy, only two patients recovered external rotation and in those cases mean external rotation was 70°. Elbow flexion was achieved in all cases. In cases of ulnar nerve transfer, the muscle scores were M5 in one patient, M4 in six patients, and M3+ in five patients. Elbow flexion repair involving the use of the 11th cranial nerve resulted in a score of M3+ in five patients and M4 in two patients. After surgery involving the phrenic nerve, two patients received a score of M3+ and two a score of M4. Results were clearly better in patients with partial lesions and in those who were shorter than 170 cm (p < 0.01). The length of the graft used in motor rootlet transfers affected only the recovery of external rotation. There was no permanent injury at the donor sites. Conclusions. Motor rootlet transfer represents a reliable and potent neurotizer that allows the reconstruction of abduction and external rotation in partial injuries.

Surgical Reconstruction of Isolated Upper Trunk Brachial Plexus Birth Injuries in the Presence of an Avulsed C5 or C6 Nerve Root

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Kristen M. Davidge ◽  
Emily S. Ho ◽  
Christine G. Curtis ◽  
Howard M. Clarke
Keyword(s):  
Brachial Plexus ◽  
Nerve Root ◽  
Surgical Reconstruction ◽  
Birth Injuries

Tethered cord syndrome in children with anorectal malformations

2000 ◽  
Vol 92 (4) ◽  
pp. 626-630 ◽  
Author(s):  
Natarajan Muthukumar ◽  
Bhuvaneswari Subramaniam ◽  
Thangaraj Gnanaseelan ◽  
Ramesh Rathinam ◽  
Appaswamy Thiruthavadoss
Keyword(s):  
Tethered Cord ◽  
Anorectal Malformations ◽  
Neurological Deficits ◽  
Radiographic Evidence ◽  
Content Type ◽  
X Ray ◽  
Neurological Improvement ◽  
Intraspinal Anomalies ◽  
Bone Abnormalities ◽  
Fine Print

Object. Anorectal malformations are known to be associated with neurological deficits, which may contribute to the disability suffered by patients with these malformations. This study was undertaken to determine the incidence and pattern of sacral abnormalities in children with anorectal malformations, the incidence and nature of the neurological deficits, and the incidence and nature of operable intraspinal abnormalities in patients with this condition.Methods. Neurological evaluation was performed in 81 children with anorectal malformations. Plain x-ray films were obtained to identify the presence of sacral abnormalities. The patients with neurological deficits were evaluated for the presence of operable intraspinal anomalies, and when such anomalies were identified, correction of the same was undertaken. In 21% of these children radiographic evidence of sacral abnormalities was shown. Fifteen percent of patients harbored neurological deficits, and 10% harbored operable intraspinal anomalies. In addition, one patient had split notochord syndrome. Patients with operable intraspinal anomalies underwent surgical correction, with resultant neurological improvement.Conclusions. Bone abnormalities of the sacrum, neurological deficits, and operable intraspinal lesions are not uncommon in children with anorectal malformations. Because the neurological deficits can contribute to the disability suffered by these individuals, we recommend routine screening of patients with anorectal malformations and neurological deficits and/or sacral abnormalities for the early identification and treatment of potentially correctable intraspinal lesions.

Brachial plexus dorsal rhizotomy in the treatment of upper-limb spasticity

2000 ◽  
Vol 93 (1) ◽  
pp. 26-32 ◽  
Author(s):  
Jayme Augusto Bertelli ◽  
Marcos Flavio Ghizoni ◽  
Adalberto Michels
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Dorsal Root ◽  
Functional Improvement ◽  
Content Type ◽  
Root Section ◽  
Dorsal Rhizotomy ◽  
Movement Ability ◽  
Limb Spasticity ◽  
Fine Print

Object. This study was conducted to evaluate the effects of dorsal rhizotomy on upper-limb spasticity, functional improvement, coordination, and hand sensibility.Methods. Fifteen spastic upper limbs in 13 patients were selected and prospectively studied. Brachial plexus dorsal rhizotomy was performed in which two, three, or four dorsal roots were completely sectioned. Patients were followed up for at least 12 months after surgery; the mean follow-up period was 15.6 months and the maximum period was 30 months. A remarkable relief of spasticity was observed in all cases. Recurrence was observed in only one patient and was caused by insufficient dorsal root section. Functional improvement was observed in all cases, and functional improvement in the hand was found to be related to the presence of active finger extension in the preoperative period. Even when extended dorsal root section was performed, no hand anesthesia, either total or partial, was observed. No patient lost movement ability in the postoperative period, and no ataxic limbs were observed.Conclusions. Brachial plexus dorsal rhizotomy is very effective as a treatment for upper-limb spasticity and results in functional improvement without loss of sensation in the hand.

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