The importance of the preoperative clinical parameters and the intraoperative electrophysiological monitoring in brachial plexus surgery

Abstract

Objective:The study aims to demonstrate the impact of some preoperative clinical parameters on the functional outcome of patients sustaining brachial plexus injuries, and to trace some commentaries about the use of intraoperative monitoring techniques. Method: A retrospective study one hundred cases of brachial plexus surgery. The analysis regarding postoperative outcomes was performed by comparing the average of the final result of the surgery for each studied cohort. Results: Direct electrical stimulation was used in all patients, EMG in 59%, SEPs in 37% and evoked NAPs in 19% of the cases. Patients in whom the motor function of the hand was totally or partially preserved before surgery, and those in whom surgery was delayed less than 6 months demonstrated significant (p<0.05) better outcomes. Conclusion: The preoperative parameters associated to favorable outcomes in reconstruction of the brachial plexus are a good post-traumatic status of the hand and a short interval between injury and surgery. Key words: brachial plexus, palsy, nerve surgery.A importância dos parâmetros clínicos pré-operatórios e da monitoração eletrofisiológica intra-operatória para a cirurgia do plexo braquial RESUMO Objetivo: Apresentar o impacto de alguns parâmetros clínicos pré-operatórios sobre o prognóstico de pacientes com lesões traumáticas do plexo braquial e tecer comentários a respeito da monitorização eletrofisiológica intraoperatória. Método: Estudo retrospectivo de cem cirurgias de plexo braquial, incluindo apenas os casos que atingiram um tempo de seguimento em que poderia se assumir que o resultado final da cirurgia foi obtido. Resultados: Pacientes apresentando função motora da mão normal ou parcialmente preservada após o trauma, além daqueles nos quais o intervalo entre trauma e cirurgia foi menor do que de seis meses, apresentaram os melhores resultados (p<0,05). Conclusão: Os parâmetros clínicos mais fortemente associados à obtenção de melhores resultados cirúrgicos são o estado neurológico pré-operatório da mão e um curto intervalo entre o trauma e a cirurgia. A estimulação elétrica simples é um método útil em casos de lesões associadas à tração; EMG e NAP são úteis para lesões infraclaviculares de nervos longos. Palavras-chave: plexo braquial, paralisia, cirurgia de nervos periféricos.

Functional Outcomes after Treatment of Traumatic Brachial Plexus Injuries: Clinical Study

“…Compatible with the literature, [2,6,[25][26][27] the results of this study demonstrated that patients who underwent surgery for BPI within the first six months of injury have better functional outcomes compared with patient who waited longer. In the current series, patients operated in the first six months of trauma scored significantly better results in SF36, DASH and PSS assessments.…”

“…[27] For the current study this was not the case. The preoperative strength of each muscle group were analyzed according to the scores the patients reported and there was not a significant difference in any muscle group for PSS/DASH/SF-36 assessments.…”

“…Flores stated that they improved this problem by means of workshops and discussions related to the necessity of early investigation of the cases among other physicians. [27] Some authors, like Magalon et al, [31] advocate for very early surgery for TBPI patients, as they believe regardless of associated vascular or bone injuries, brachial plexus lesions should be repaired within the first 7 days after injury. They stated that it is easier to operate early because relatively shorter grafts can be used.…”

Infraclavicular Topography of the Brachial Plexus Fascicles in Different Upper Limb Positions

“…However, studies involving a larger and more diverse sample of cadavers and considering sex, race, age, biotype and cadaveric rigidity are needed to standardize the variations that can occur in the formation and topographic arrangement of the brachial plexus. These data would have a direct impact on the conservative and surgical approach to the treatment of upper limb neuropathies (Gusmão et al;Butler;Flores, 2006;Flores, 2011 ).…”

What has changed in brachial plexus surgery?

“…It is now possible to conduct studies on the condition of the brachial plexus nerves in greater detail during the surgery (18). With the aid of electrical studies conducted during the operation, it should be possible to achieve greater sureness with regard to making decisions such as whether to preserve an injured neural segment.…”