Magnetic Resonance Myelography in Brachial Plexus Injury

Nakamura, Toshiyasu; Yabe, Yutaka; Homma, Yukio; Takayama, Shojiro

doi:10.1302/0301-620x.79b5.0790764

Cited by 40 publications

(28 citation statements)

References 21 publications

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“…Although CT-myelography is still considered to be the "gold standard" for studying root lesions, recent advances in magnetic resonance imaging (MRI) are producing images of much higher resolution, such that MRI can now match the diagnostic accuracy of CT-myelography 35,36 . Because of continuous development of MRI techniques, this imaging examination will soon become the most important method for evaluating brachial plexus injuries.…”

Section: Electrophysiological and Imaging Evaluationsmentioning

confidence: 99%

Surgical treatment of adult traumatic brachial plexus injuries: an overview

Siqueira

Martins

2011

Arq. Neuro-Psiquiatr.

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Traumatic injuries to the brachial plexus in adults are severely debilitating. They generally affect young individuals. A thorough understanding of the anatomy, clinical evaluation, imaging and electrodiagnostic assessments, treatment options and proper timing of surgical interventions will enable nerve surgeons to offer optimal care to patients. Advances in microsurgical technique have improved the outcome for many of these patients. The treatment options offer patients with brachial plexus injuries the possibility of achieving elbow flexion, shoulder stability with limited abduction and the hope of limited but potentially useful hand function. Key words: brachial plexus injury, surgical treatment, nerve repair.Tratamento cirúrgico das lesões traumáticas do plexo braquial em adultos: uma visão geral RESUMO As lesões traumáticas do plexo braquial em adultos são severamente debilitantes e, em geral, afetam indivíduos jovens. Uma ampla compreensão da anatomia, da avaliação clínica, dos estudos eletrodiagnósticos e por imagem, das opções de tratamento e do momento apropriado para o tratamento cirúrgico irá permitir que o cirurgião de nervos ofereça o tratamento ideal ao paciente. Os avanços na técnica microcirúrgica melhoraram os resultados para muitos desses pacientes. As opções de tratamento oferecem aos pacientes com lesões do plexo braquial a possibilidade de obter flexão do cotovelo, estabilidade do ombro com abdução limitada e a esperança de função limitada mas potencialmente útil da mão. Palavras-chave: lesão do plexo braquial, tratamento cirúrgico, reparo de nervos. Traumatic brachial plexus lesions in adults are devastating injuries. The typical patient is a young man who was injured in a motorcycle accident. These lesions are of great social significance since most of the patients have to face severe residual morbidity after their injuries. The exact number of lesions occurring each year is difficult to ascertain, but it is certainly growing, in parallel with the increasing number of high-speed motor vehicle accidents, especially involving motorcycles.Based on experience with 1,068 patients with brachial plexus injuries, Narakas 1 developed a rule of "seven seventies" that gives an approximate idea of the statistics involved in brachial plexus lesions: approximately 70% of traumatic brachial plexus injuries are secondary to motor vehicle accidents; of these, approximately 70% involve motorcycles or bicycles. Of the cycle riders, approximately 70% have multiple injuries. Overall, 70% have supraclavicular lesions; of these, 70% have at least one root avulsion. At least 70% of patients with a root avulsion also have avulsions of the lower roots (C7, C8 or T1). Finally, of patients with lower root avulsion, nearly 70% will experience persistent pain.

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Section: Electrophysiological and Imaging Evaluationsmentioning

confidence: 99%

Surgical treatment of adult traumatic brachial plexus injuries: an overview

Siqueira

Martins

2011

Arq. Neuro-Psiquiatr.

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“…In fact, MR imaging is claimed to be the technique of choice for most brachial plexus pathologic conditions by several authors ( 5,(18)(19)(20). However, few MR studies in OBPLs and adult brachial traumatic plexopathies have actually reported observation of the roots from the spinal cord by using three-dimensional T2-weighted sequences (21)(22)(23). Most of these reports focused only on the presence of pseudocysts ( 11,(24)(25)(26)(27).…”

Section: Neuroradiology: Ct Myelography In Obstetric Brachial Plexus mentioning

confidence: 99%

Obstetric Brachial Plexus Lesions: CT Myelography

Steens¹,

Pondaag²,

Malessy³

et al. 2011

Radiology

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Purpose:To evaluate the value of computed tomographic (CT) myelography in the detection of root damage and differentiation of root avulsions from neurotmesis in a large cohort of patients with an obstetric brachial plexus lesion (OBPL). Materials and Methods:Institutional review board approval was obtained. Informed consent was waived by the medical ethics committee. One hundred eighteen patients with OBPL born in the cephalic position and six patients born in the breech position were selected for surgery by two neurosurgeons in a multidisciplinary team. Functional loss of the C5 through T1 innervated muscles was noted. All patients underwent preoperative CT myelography at an average age of 19 weeks. CT myelographic examination results were reviewed by two radiologists, who were blinded to the clinical fi ndings, for the presence of root avulsions and pseudocysts. Interobserver agreement was assessed by calculating k values. Results:CT myelographic results showed root avulsions in at least one level in 66 (56%) of 118 patients born in the cephalic position and in six (100%) of six patients born in the breech position. Levels C7 and C8 showed the most root avulsions, even if not expected from clinical examination results. A large number of root avulsions showed pseudocysts (73 [68%] of 107 levels in patients born in the cephalic position and 11 [73%] of 15 levels in patients born in the breech position). Conclusion:CT myelographic results showed root avulsions in more than half of patients with OBPL. Root avulsions were even detected at levels that were not expected at clinical examination. Because root avulsions require specifi c reconstructive techniques, CT myelography is recommended for every preoperative patient with OBPL.

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“…MRI has improved over the past several years and can be helpful in evaluating the patient with a suspected nerve root avulsion [24][25][26]. It has some advantages over CT/myelogram because it is noninvasive and can visualize much of the brachial plexus, whereas CT/myelography shows only nerve root injury.…”

Section: Radiographic Evaluationmentioning

confidence: 99%