NEUROSURGERY Report

Daily news and updates provided by the NEUROSURGERY® Editorial Office

Posts Tagged ‘brachial plexus

Free Editor Choice with CME: Single or Double Nerve Transfer

A_Prospective_Study_Comparing_Single_and_DoubleBackground: The recovery of elbow flexion in upper brachial plexus injury can be achieved by the reinnervation of the biceps muscle (single reinnervation), but concomitant restoration of brachialis and biceps function (double reinnervation) has been recommended to improve elbow flexion strength.

Objective: To prospectively compare morbidity and outcomes of single or double muscle reinnervation in restoring elbow flexion following incomplete injury to the brachial plexus.

Methods: Forty consecutive patients were prospectively submitted to single or double muscle reinnervation. Elbow flexion strength was evaluated with a push-and-pull dynamometer 12 months after surgery. Hand morbidity related to the procedures was evaluated by the Semmes-Weinstein monofilaments test, quantification of static 2-point discrimination, and measurements of handgrip and lateral pinch strength in serial evaluations up to the final follow-up.

Read the rest of this entry »

Written by NEUROSURGERY® Editorial Office

April 22, 2013 at 2:00 PM

Ahead of Print: Reconstruction of Hand Sensation

Background: In complete brachial plexus palsy, we have hypothesized that grafting to the musculocutaneous nerve should restore some hand sensation, because the musculocutaneous nerve can drive hand sensation directly or via communication with the radial and median nerves.

Objective: To investigate sensory recovery in the hand and forearm following C5 root grafting to the musculocutaneous nerve in patients with a total brachial plexus injury.

Methods: Eleven patients who had recovered elbow flexion following musculocutaneous nerve grafting from a preserved C5 root, and who had been followed-up for a minimum of three years were screened for sensory recovery in the hand and forearm. Six matched patients who had not undergone surgery served as controls. Methods of assessment included testing for pain sensation using Adson forceps, cutaneous pressure threshold measurements using Semmes-Weinstein monofilaments, and the static two-point discrimination test. Deep sensation was evaluated by squeezing the first web space, and thermal sensation was assessed using warm and cold water.

Read the rest of this entry »

Written by NEUROSURGERY® Editorial Office

July 2, 2012 at 8:14 AM

Ahead of Print: Spinal Nerve Origins of Radial Nerve Muscular Branches

Background: In injuries of the lower brachial plexus, finger flexion can be restored by nerve or tendon transfer. However, there is no technique that can guarantee good recovery of finger and thumb extension.

Objective: To determine the spinal nerve origins of the muscular branches of the radial nerve and identify potential intraplexus donor nerves for neurotization of the posterior interosseous nerve in patients with lower brachial plexus injuries.

Methods: An intraoperative electrophysiological study was carried out during 16 contralateral C7 nerve transfers. The CMAP (compound muscle action potential) of each muscle innervated by the radial nerve was recorded while the C5-T1 nerves were individually stimulated.

Read the rest of this entry »

Written by NEUROSURGERY® Editorial Office

April 10, 2012 at 8:01 AM

Ahead of Print: Synovial Sarcoma of the Brachial Plexus

Background and Importance: Synovial sarcoma (SS) is a malignant soft tissue tumor that rarely involves brachial plexus. The authors report a case of brachial plexus SS and review the relevant literature.

Clinical presentation: A middle aged female presented with gradually enlarging right subclavicular mass over five years associated with sharp aching pain radiating down toward radial three fingers. On exam, she had corresponding firm mass in the supraclavicular region with positive Tinel’s sign. There was no objective neurological deficit. She underwent partial excision of this mass without any further adjuvant radiation or chemotherapy. Pathology was consistent with SS.

Read the rest of this entry »

Written by NEUROSURGERY® Editorial Office

March 1, 2012 at 2:00 PM

Ahead of Print: Synovial Sarcoma of the Brachial Plexus

Background and Importance: Synovial sarcoma (SS) is a malignant soft tissue tumor that rarely involves brachial plexus. The authors report a case of brachial plexus SS and review the relevant literature.

Clinical presentation: A middle aged female presented with gradually enlarging right subclavicular mass over five years associated with sharp aching pain radiating down toward radial three fingers. On exam, she had corresponding firm mass in the supraclavicular region with positive Tinel’s sign. There was no objective neurological deficit. She underwent partial excision of this mass without any further adjuvant radiation or chemotherapy. Pathology was consistent with SS.

Read the rest of this entry »

Written by NEUROSURGERY® Editorial Office

February 8, 2012 at 7:49 AM

Ahead of Print: Cortical Reorganisation Following Neurotization

BACKGROUND: Following successful intercosto-musculocutaneous (ICN-MCN) neurotization for brachial plexus injuries (BPI), patients initially show a synkinetic movement of elbow flexion during inspiration. Later they are able to flex the elbow, independent of respiratory activity.

OBJECTIVE: To demonstrate cortical reorganization following ICN-MCN co-aptation in BPI through functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI).

METHODS: 30 adults and 14 age and gender matched controls underwent ICN-MCN co-aptation for BPI. All patients had Sunderland 3 or 4 degree of injury. Patients underwent fMRI and DTI (pre and postoperatively) with EMG of the biceps. Maps of neural activity within the motor cortex were generated in the paralyzed and control arms and center of maximum activity was calculated. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were generated from fMRI over the motor cortex and comparison was made between the paralyzed and control arms.

Read the rest of this entry »

Written by NEUROSURGERY® Editorial Office

November 25, 2011 at 8:00 AM

Ahead of Print: Partial Ipsilateral C7 Transfer

BACKGROUND: Ipsilateral whole C7 root transfer has been reported in treating C5-C6 avulsion. To minimize donor deficits, partial ipsilateral C7 (PIC7) transfer was developed.

OBJECTIVE: To investigate the long-term results of PIC7 transfer to the upper trunk in treating C5-C6 avulsion of the brachial plexus.

METHODS: We prospectively studied eight young adults with C5-C6 avulsion. Five patients (Group A) who also had spinal accessory nerve (SAN) injury underwent PIC7 transfer to the upper trunk. The other three patients (Group B) without SAN injury underwent a combination of PIC7 to the upper trunk and the SAN to the suprascapular nerve (SSN). Postsurgical evaluations including donor deficits, functional recovery and co-contraction of the muscles were performed one week later and then at intervals of 3 months.

Read the rest of this entry »

Written by NEUROSURGERY® Editorial Office

November 24, 2011 at 2:00 PM

Follow

Get every new post delivered to your Inbox.

Join 13,691 other followers