Diagnosis of root avulsions in traumatic brachial plexus injuries: value of computerized tomography myelography and magnetic resonance imaging

1997 ◽  
Vol 86 (1) ◽  
pp. 69-76 ◽  
Author(s):  
Gustavo Adolpho Carvalho ◽  
Guido Nikkhah ◽  
Cordula Matthies ◽  
Götz Penkert ◽  
Madjid Samii
Keyword(s):  
Mr Imaging ◽  
Brachial Plexus ◽  
Computerized Tomography ◽  
Root Avulsion ◽  
Imaging Studies ◽  
Ct Myelography ◽  
Content Type ◽  
Brachial Plexus Surgery ◽  
Cervical Root ◽  
Fine Print

✓ Surgical management and prognosis of traction injuries of the brachial plexus depend on the accurate diagnosis of root avulsion from the spinal cord. Myelography, computerized tomography (CT) myelography, and recently magnetic resonance (MR) imaging have become the main radiological methods for preoperative diagnosis of cervical root avulsions. Most of the previous studies on the accuracy of CT myelography and MR imaging studies have correlated the radiological findings with the extraspinal surgical findings at brachial plexus surgery. Surgical experience shows that in many cases extraspinal findings diverge from intradural determinations. Consequently, only correlation with the intradural surgical findings will allow assessment of the factual accuracy of CT myelography and MR imaging studies. In a prospective study, 135 cervical roots (C5–8) were evaluated by CT myelography and/or MR imaging and further explored intradurally via a hemilaminectomy. The accuracy of the preoperative CT myelography—based diagnosis in relation to the intraoperative findings was 85%. On the other hand, MR imaging demonstrated an accuracy of only 52%. The most common reasons for false-positive or false-negative findings were: 1) partial rootlet avulsion; 2) intradural fibrosis; and 3) dural cystic lesions. Computerized tomography myelography scans using 1- to 3-mm axial slices prove to be the most reliable method to evaluate preoperatively the presence of complete or partial root avulsion in traumatic brachial plexus injuries. Because extradural judgment of cervical root avulsion can be unreliable, accurate assessment of intraspinal root avulsion enormously simplifies the decision concerning the choice of donor nerves for transplantation and/or neurotization during brachial plexus surgery.

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.

Fast spin—echo magnetic resonance imaging for radiological assessment of neonatal brachial plexus injury

1995 ◽  
Vol 83 (3) ◽  
pp. 461-466 ◽  
Author(s):  
Paul C. Francel ◽  
Myles Koby ◽  
T. S. Park ◽  
Benjamin C. P. Lee ◽  
Michael J. Noetzel ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Brachial Plexus ◽  
General Anesthesia ◽  
Spin Echo ◽  
Fast Spin Echo ◽  
Ct Myelography ◽  
Content Type ◽  
Fast Spin ◽  
Fine Print

✓ Neurosurgical management of birth-related brachial plexus palsy involves observing the patient for a period of several months. Operative intervention is usually undertaken at 3 to 6 months of age or more in infants who have shown little or no improvement in affected muscle groups. Ancillary tests such as electromyography and nerve conduction studies are occasionally useful. No radiological study has been consistently helpful in operative planning, except for contrast computerized tomography (CT) myelography, which requires general anesthesia in infants. This is because the infant's small size exceeds the functional resolution of the imaging modalities. This report describes the use of a special sequence of magnetic resonance (MR) imaging entitled “fast spin echo” (FSE-MR). Unlike CT myelography, this technique provides high-speed noninvasive imaging that allows clinicians to evaluate preganglionic nerve root injuries without the use of general anesthesia and lumbar puncture. The utility of this technique is illustrated in three cases, two involving either infraclavicular exploration or a combination of infraclavicular and supraclavicular exposure based on FSE-MR findings. The FSE-MR imaging offers an excellent alternative to contrast CT myelography in evaluation of infants with birth-related brachial plexus injuries.

Focal cerebral hyperemia after focal head injury in humans: a benign phenomenon?

1995 ◽  
Vol 83 (2) ◽  
pp. 277-284 ◽  
Author(s):  
Damianos E. Sakas ◽  
M. Ross Bullock ◽  
James Patterson ◽  
Donald Hadley ◽  
David J. Wyper ◽  
...  
Keyword(s):  
Head Injury ◽  
Mr Imaging ◽  
Computerized Tomography ◽  
Injury Severity ◽  
Single Photon ◽  
Wide Spectrum ◽  
Photon Emission ◽  
Normal Brain ◽  
Content Type ◽  
Fine Print

✓ To assess the relationship between posttraumatic cerebral hyperemia and focal cerebral damage, the authors performed cerebral blood flow mapping studies by single-photon emission computerized tomography (SPECT) in 53 patients within 3 weeks of brain injury. Focal zones of hyperemia were present in 38% of patients. Hyperemia was correlated with clinical features and early computerized tomography (CT) and magnetic resonance (MR) imaging performed within 48 hours of the SPECT study and late CT and MR studies at 3 months. The hyperemia was observed primarily in structurally normal brain tissue (both gray and white matter), as revealed by CT and MR imaging, immediately adjacent to intraparenchymal or extracerebral focal lesions; it persisted for up to 10 days, but was never seen within the edematous pericontusional zones. The percentage of patients in the hyperemic group having brief (< 30 minutes) or no loss of consciousness was significantly higher than in the nonhyperemic group (twice as high, p < 0.05). Other clinical parameters were not significantly more common in the hyperemic group. The mortality of patients with focal hyperemia was lower than that of individuals without it, and the outcome of survivors with hyperemia was slightly better than patients without hyperemia. These results differ from the literature, which suggests that global posttraumatic hyperemia is primarily an acute, malignant phenomenon associated with increased intracranial pressure, profound unconsciousness, and poor outcome. The current results agree with more recent studies which show that posttraumatic hyperemia may occur across a wide spectrum of head injury severity and may be associated with favorable outcome.

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.

Surgical treatment of superior sulcus tumors with spinal and brachial plexus involvement

2002 ◽  
Vol 97 (3) ◽  
pp. 301-309 ◽  
Author(s):  
Mark H. Bilsky ◽  
Todd W. Vitaz ◽  
Patrick J. Boland ◽  
Manjit S. Bains ◽  
Viswanathan Rajaraman ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Brachial Plexus ◽  
Tumor Resection ◽  
Incomplete Resection ◽  
Content Type ◽  
Superior Sulcus Tumors ◽  
Epidural Compression ◽  
Superior Sulcus ◽  
Complete Tumor ◽  
Fine Print

Object. Non—small cell lung carcinomas with spinal and brachial plexus involvement have traditionally been considered to be Stage IIIb lesions and therefore unresectable. Advances in spinal surgery, the application of magnetic resonance (MR) imaging, and improvements in neoadjuvant therapy require a reassessment of the potential for complete resection. Methods. The authors conducted a retrospective review of all procedures involving the resection of superior sulcus tumors with spinal or brachial plexus involvement performed between 1985 and 1999. Assessment or resectability and operative planning were based on an MR imaging classification scheme in which the extent of spinal involvement was considered. Class A tumors involved the periosteum of the vertebral body (VB) (16 patients); Class B, distal neural foramen without epidural compression (eight patients); Class C, proximal neural foramen with epidural compression (four patients); and Class D, bone involvement (VB or posterior elements) with or without epidural involvement (14 patients). Brachial plexus involvement was present in 21 patients, including 17 with T-1 nerve root only and four with C-8 or lower-trunk infiltration. Complete tumor resection was achieved in 27 patients and incomplete resection in 15. Complications occurred in 14 patients, two of which were related to instrumentation failures. The overall median survival was 1.44 years. The median survival for the complete and incomplete resection groups were 2.84 and 0.79 years, respectively (p = 0.0001). There was no statistical difference in survival among classification groups. Conclusions. Complete tumor resection of superior sulcus tumors is possible in selected patients in whom involvement of the spinal column and/or brachial plexus is present. Preoperative MR imaging is essential for evaluation of the spine and surgical planning. Survival and cure are dependent on complete resection, regardless of the extent of spinal involvement.

Convective distribution of macromolecules in the primate brain demonstrated using computerized tomography and magnetic resonance imaging

2003 ◽  
Vol 98 (3) ◽  
pp. 584-590 ◽  
Author(s):  
Tung T. Nguyen ◽  
Yashdip S. Pannu ◽  
Cynthia Sung ◽  
Robert L. Dedrick ◽  
Stuart Walbridge ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Computerized Tomography ◽  
Ct Scanning ◽  
Therapeutic Agents ◽  
Content Type ◽  
Drug Concentrations ◽  
The Brain ◽  
Fine Print

Object. Convection-enhanced delivery (CED), the delivery and distribution of drugs by the slow bulk movement of fluid in the extracellular space, allows delivery of therapeutic agents to large volumes of the brain at relatively uniform concentrations. This mode of drug delivery offers great potential for the treatment of many neurological disorders, including brain tumors, neurodegenerative diseases, and seizure disorders. An analysis of the treatment efficacy and toxicity of this approach requires confirmation that the infusion is distributed to the targeted region and that the drug concentrations are in the therapeutic range. Methods. To confirm accurate delivery of therapeutic agents during CED and to monitor the extent of infusion in real time, albumin-linked surrogate tracers that are visible on images obtained using noninvasive techniques (iopanoic acid [IPA] for computerized tomography [CT] and Gd—diethylenetriamine pentaacetic acid for magnetic resonance [MR] imaging) were developed and investigated for their usefulness as surrogate tracers during convective distribution of a macromolecule. The authors infused albumin-linked tracers into the cerebral hemispheres of monkeys and measured the volumes of distribution by using CT and MR imaging. The distribution volumes measured by imaging were compared with tissue volumes measured using quantitative autoradiography with [14C]bovine serum albumin coinfused with the surrogate tracer. For in vivo determination of tracer concentration, the authors examined the correlation between the concentration of the tracer in brain homogenate standards and CT Hounsfield units. They also investigated the long-term effects of the surrogate tracer for CT scanning, IPA-albumin, on animal behavior, the histological characteristics of the tissue, and parenchymal toxicity after cerebral infusion. Conclusions. Distribution of a macromolecule to clinically significant volumes in the brain is possible using convection. The spatial dimensions of the tissue distribution can be accurately defined in vivo during infusion by using surrogate tracers and conventional imaging techniques, and it is expected that it will be possible to determine local concentrations of surrogate tracers in voxels of tissue in vivo by using CT scanning. Use of imaging surrogate tracers is a practical, safe, and essential tool for establishing treatment volumes during high-flow interstitial microinfusion of the central nervous system.

Mineralization of the falx cerebri simulating interhemispheric vascular anomalies on MR imaging

1990 ◽  
Vol 72 (6) ◽  
pp. 971-974 ◽  
Author(s):  
John R. Ruge ◽  
Eric J. Russell ◽  
Robert M. Levy
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Computerized Tomography ◽  
Vascular Anomalies ◽  
Vascular Lesions ◽  
Falx Cerebri ◽  
Content Type ◽  
Fine Print

✓ Three cases of ossification of the falx cerebri initially mistaken for vascular lesions based on their magnetic resonance (MR) appearance are reviewed. The MR imaging and computerized tomography characteristics of mineralization of the falx cerebri and their differentiation from interhemispheric vascular lesions are discussed.

Magnetic resonance imaging studies of age-dependent responses to scaled focal brain injury in the piglet

2003 ◽  
Vol 99 (3) ◽  
pp. 542-548 ◽  
Author(s):  
Ann-Christine Duhaime ◽  
Jill V. Hunter ◽  
Loretta L. Grate ◽  
Anje Kim ◽  
Jeffrey Golden ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Mechanical Trauma ◽  
Lesion Volume ◽  
Imaging Studies ◽  
Content Type ◽  
Age Dependent ◽  
The Brain ◽  
Over Time ◽  
Fine Print

Object. Whether the brain differs in its response to traumatic injury as a function of age remains unclear. To further investigate the age-dependent response of the brain to mechanical trauma, a cortical contusion model scaled for brain growth during maturation was used to study the evolution of injury over time as demonstrated on serial magnetic resonance (MR) imaging studies in piglets of different ages.Methods. Sixteen Yorkshire piglets received scaled cortical contusions. Animals were either 5 days (six animals), 1 month (five animals), or 4 months (five animals) of age at injury. These ages correspond developmentally to human infants, toddlers, and early adolescents, respectively. Serial MR imaging examinations, including fluid-attenuated inversion-recovery and T1-, T2-, and diffusion-weighted sequences were performed at 24 hours, 1 week, and 1 month after injury. Lesions were quantified and expressed as a ratio of the lesion volume divided by the volume of the uninjured hemisphere for each animal and each MR sequencing. Differences in relative lesion volume among the varied ages at a single time point and in lesion volume over time at each age were compared. In addition, the relationship between age and evolution of injury were analyzed using a two-compartment mathematical model. Histological features were examined at 1 month postinjury. Despite comparable injury inputs, the youngest animals had lesions whose volumes peaked earlier and resolved more quickly than those in older animals. The intermediate-age piglets (toddler) had the most pronounced swelling of any age group, and the oldest piglets (adolescent) had the latest peak in lesion volume.Conclusions. Scaled cortical contusions in piglets demonstrated age-dependent differences in injury response, both in magnitude and time course. These observations may shed light on development-related trauma response in the gyrencephalic brain.

Evaluation of intercostal to musculocutaneous nerve transfer in reconstructive brachial plexus surgery

1998 ◽  
Vol 88 (2) ◽  
pp. 266-271 ◽  
Author(s):  
Martijn J. A. Malessy ◽  
Ralph T. W. M. Thomeer
Keyword(s):  
Brachial Plexus ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Musculocutaneous Nerve ◽  
Accessory Nerve ◽  
Reconstructive Procedure ◽  
Content Type ◽  
Intercostal Nerves ◽  
Brachial Plexus Surgery ◽  
Fine Print

Object. Direct coaptation of intercostal nerves (ICNs) to the musculocutaneous (MC) nerve was performed to restore elbow flexion in 25 patients with brachial plexus root avulsions. Methods. Seventy-five ICNs were transected as close as possible to the sternum to obtain sufficient length and then tunneled to the axilla and coapted to the MC nerve. Direct coaptation was achieved in 95% of ICNs, and functional elbow flexion was regained in 64% of the patients. The results were compared with several reported transfer techniques in which either an ICN or other donor nerves were used. Conclusions. Direct coaptation was equally effective and more straightforward than transfers involving interposition of grafts. The use of alternative donors such as the accessory nerve carries inherent disadvantages compared with the use of ICNs, and the results are not substantially better. Direct ICN—MC nerve transfer is a valuable reconstructive procedure.

Magnetic resonance image—directed stereotactic neurosurgery: use of image fusion with computerized tomography to enhance spatial accuracy

1995 ◽  
Vol 83 (2) ◽  
pp. 271-276 ◽  
Author(s):  
Eben Alexander ◽  
Hanne M. Kooy ◽  
Marcel van Herk ◽  
Marc Schwartz ◽  
Patrick D. Barnes ◽  
...  
Keyword(s):  
Magnetic Field ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Image Fusion ◽  
Computerized Tomography ◽  
Target Volume ◽  
Stereotactic Neurosurgery ◽  
Content Type ◽  
Geometric Precision ◽  
Fine Print

✓ Distortions of the magnetic field, such as those caused by susceptibility artifacts and peripheral magnetic field warping, can limit geometric precision in the use of magnetic resonance (MR) imaging in stereotactic procedures. The authors have routinely found systematic error in MR stereotactic coordinates with a median of 4 mm compared to computerized tomography (CT) coordinates. This error may place critical neural structures in jeopardy in some procedures. A description is given of an image fusion technique that uses a chamfer matching algorithm; the advantages of MR imaging in anatomical definition are combined with the geometric precision of CT, while eliminating most of the anatomical spatial distortion of stereotactic MR imaging. A stereotactic radiosurgical case is presented in which the use of MR localization alone would have led to both irradiation of vital neural structures outside the desired target volume and underdose of the intended target volume. The image fusion approach allows for the use of MR imaging, combined with stereotactic CT, as a reliable localizing technique for stereotactic neurosurgery and radiosurgery.

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