Outcome of Surgically Treated Birth-Related Brachial Plexus Injuries in Twenty Cases

Abstract

Birth-related brachial plexus injury occurs in 0.19–2.5 per 1,000 live births, of which 70–92% improve with conservative management. With the advent of microsurgical techniques, patients who fail expectant treatment may benefit from brachial plexus exploration and reconstruction. From 1991 to 1996, 87 patients were referred to the multidisciplinary brachial plexus clinic at St. Louis Children’s Hospital. Twenty patients were selected for surgical management. The average age at surgery was 10.5 months (range 3–35, median = 8), with an average follow-up of 23.9 months (range 7–45, median = 24). Two patients were lost to follow-up. Surgical procedures included neurolysis (n = 8), neurotization (n = 2), nerve grafting (n = 5), and a combination (n = 3) of the above. Two patients underwent exploration without repair. Intercostal nerves, pectoral nerves, and C4 roots were used for neurotizations, and the sural nerve was used for nerve grafting. Results from 18 patients were available for follow-up review. Fifteen patients (83% demonstrated clinical improvement postoperatively. Of the 3 patients without improvement, 2 underwent exploration without repair, and one underwent neurolysis of the axillary nerve. Of patients undergoing reconstruction, 93% had improved strength postoperatively. No subjects had worsening neurologic status, and there were no complications. These results suggest that surgery for birth-related brachial plexus injury may show favorable outcomes if patients are selected appropriately. Patients undergoing neurolysis and nerve grafting had more favorable outcomes than those undergoing neurotization.

A Systematic Review of Brachial Plexus Surgery for Birth-Related Brachial Plexus Injury

“…The natural history of birth-related brachial plexus injury was the subject of 11 of these papers [1, 2, 3, 4, 5, 7, 17, 18, 19, 20, 21](table 1). An additional 12 papers examined surgical intervention in the management of these patients [8, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32](table 2). …”

Avaliação eletroneurográfica comparativa precoce de pacientes com plexopatia braquial obstétrica

“…Muitos autores englobam esta apresentação clínica sob a denominação de forma de Erb-Duchenne (LAURENT e LEE, 1994;SHERBURN et al, 1997;GROSSMAN, 2000;DODDS e WOLFE, 2000), o que é historicamente incorreto. A diferenciação entre as lesões C 5 -C 6 e C 5 -C 7 tem importância clínica e prognóstica (GILBERT, 1993;NEHME et al, 2002).…”

“…A maioria dos autores acredita que a PBO é produzida por um estiramento do plexo braquial durante o parto (SERVER, 1925;PAINTER e BERGMAN, 1982;GILBERT et al, 1988;LAURENT e LEE, 1994;SHERBURN et al, 1997;DONNELLY et al, 2002). Os achados cirúrgicos são compatíveis com essa teoria (GILBERT e WHITAKER, 1991 .…”

“…Embora alguns autores defendam a eletroneuromiografia como importante ferramenta na avaliação de pacientes com PBO (FLEITES et al, 1990;ENG et al, 1996;GOPINATH et al, 2002), resultados desanimadores foram relatados por vários pesquisadores (GILBERT et al, 1988;HUNT, 1998;HENZ e MEYER, 1991;LAURENT e LEE, 1994;CLARKE e CURTIS, 1995;SHERBURN et al, 1997;SHENAQ et al, 1998 inervaria parte dos miótomos C 5 e C 6 (VREDEVELD et al, 2000); a reinervação aberrante decorrente do direcionamento errôneo dos brotos axoniais (ROTH, 1983) e a apraxia resultante da falta de estimulação sensitivo-motora do membro afetado (BROWN et al, 2000).…”

“…O ressurgimento da cirurgia de reconstrução do plexo braquial em bebês (GILBERT et al, 1988) trouxe grandes expectativas: muitos autores defendem a cirurgia como alternativa para melhorar o prognóstico dos pacientes com lesões graves (KAWABATA et al, 1987;HUNT, 1988;BOOME e KEYE, 1988;HENZ e MEYER, 1991;LAURENT et al, 1993;CLARKE e CURTIS, 1995;GROSSMAN, 1996;SHERBURN et al, 1997;SHENAQ et al, 1998;KAY, 1999).…”