J Reconstr Microsurg 1999; 15(1): 3-8
DOI: 10.1055/s-2007-1000063
ORIGINAL ARTICLE

© 1999 by Thieme Medical Publishers, Inc.

Diagnosis and Surgery of Brachial Plexus Injuries

Goetz Penkert, Gustavo Adolpho Carvalho, Guido Nikkhah, Marcos Tatagiba, Cordula Matthies, Madjid Samii
  • Department of Neurosurgery, Nordstadt Hospital, Hannover, Germany
Further Information

Publication History

Accepted for Publication 1998

Publication Date:
08 March 2008 (online)

ABSTRACT

The surgical outcome of traumatic injuries of the brachial plexus (BP) depends on the following parameters: 1) accurate preoperative diagnosis of cervical root avulsion; 2) time interval between injury and surgery; 3) delicate handling of the nerve tissue; and 4) postoperative physiologic training. This report is based on a 15-year experience in brachial plexus surgery and is supported on the grounds of two major studies. In a prospective study, the authors controlled for the reliability of preoperative radiologic diagnosis by myelo-CT and MRI scans for 40 patients, to evaluate the integrity of the intraspinal cervical roots after brachial plexus injury. Surgical inspection via a cervical hemilaminectomy proved the accuracy of 85 percent and 52 percent of CT myelography and MRI, respectively. Retrospective statistical analyses were carried out of the long-term surgical results of 54 patients with traumatic injuries of the BP who received a grafting procedure between cervical roots C5 or C6 and the musculocutaneous nerve. Patients operated on up to 6 months after trauma showed a better result than patients operated on later than 12 months after trauma (p<0.05). In contrast, grafting between cervical root C5 or C6 and the use of different sural-graft sizes to reconstruct the musculocutaneous nerve demonstrated no statistically significant difference in the final outcome.