Outcomes of surgery in 1019 brachial plexus lesions treated at Louisiana State University Health Sciences Center

Kim, Daniel H.; Cho, Yong Jun; Tiel, Robert L.; Kline, David G.

doi:10.3171/jns.2003.98.5.1005

Cited by 210 publications

(162 citation statements)

References 44 publications

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“…20 Patients with peripheral nerve tumors usually present with pain and paresthesias or with a palpable mass. 11,20,25,29 In our series, the most common presenting symptoms were palpable mass, numbness/paresthesias, pain, and weakness, symptomatology in agreement with that in the LSUHSC series. 20,29 Most often, early in the course, minimal neurological deficit will be present or there will be none at all.…”

Section: Epidemiology and Presenting Symptomssupporting

confidence: 71%

Primary brachial plexus tumors: imaging, surgical, and pathological findings in 25 patients

Binder¹,

Smith²,

Barbaro³

2004

FOC

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Object The authors report on the treatment of primary brachial plexus tumors in 25 patients at the University of California, San Francisco. They compare their findings with those obtained in similar series. Methods The authors reviewed the electronic and medical records, radiological images, operative reports, and pathological findings in 25 consecutive cases of primary brachial plexus tumors. Cases of metastatic lesions or adjacent neoplasms extending into and involving the brachial plexus were excluded. At presentation patients ranged in age from 19 to 71 years (mean 47 ±15 years), and neurofibromatosis was present in eight patients (32%). Presenting signs and symptoms included palpable mass (60%), numbness/paresthesias (44%), radiating pain (44%), local pain (16%), and weakness (12%). Duration of symptoms ranged from 2 months to 10 years. Neuroimaging revealed lesions ranging widely in size (volume ~1 to >100 ml). Pathological diagnoses included schwannoma (15 [60%]), neurofibroma (five [20%]), malignant peripheral nerve sheath tumor (four [16%]), and desmoid tumor (one [4%]). Conclusions Primary tumors arising in the brachial plexus are rare. Careful workup, surgical technique, and attention to pathological diagnosis optimize management.

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Section: Epidemiology and Presenting Symptomssupporting

confidence: 71%

Primary brachial plexus tumors: imaging, surgical, and pathological findings in 25 patients

Binder¹,

Smith²,

Barbaro³

2004

FOC

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“…Reconstruction using nerve grafts was performed for cases of extra-foraminal rupture, and nerve transfers were employed for cases nerve root avulsion. The strategy of surgery for open sharp injuries and gunshot wounds objected to restore the continuity of the injured nerve; for closed injuries associated to traction, the strategy included restoration of the following functions, in order of priority: [1] elbow flexion; [2] shoulder abduction; [3] elbow extension; [4] finger flexion; [5] protective sensory recovery on the fingers.…”

Section: Methodsmentioning

confidence: 99%

“…However, the types of lesion associated to trauma of the brachial plexus encompass a number of different clinical aspects, sustaining different degrees of severity 3,4 . To date, there is no standardized surgical protocol determining the best treatment to be offered to patients sustaining brachial plexus injuries, and the operative strategy is mainly based on the surgeon's own experience 5 .…”

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confidence: 99%

Brachial plexus surgery: the role of the surgical technique for improvement of the functional outcome

Flores¹

2011

Arq. Neuro-Psiquiatr.

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Objective:The study aims to demonstrate the techniques employed in surgery of the brachial plexus that are associated to evidence-based improvement of the functional outcome of these patients. Method: A retrospective study of one hundred cases of traumatic brachial plexus injuries. Comparison between the postoperative outcomes associated to some different surgical techniques was demonstrated. Results: The technique of proximal nerve roots grafting was associated to good results in about 70% of the cases. Significantly better outcomes were associated to the Oberlin's procedure and the Sansak's procedure, while the improvement of outcomes associated to phrenic to musculocutaneous nerve and the accessory to suprascapular nerve transfer did not reach statistical significance. Reinnervation of the hand was observed in less than 30% of the cases. Conclusion: Brachial plexus surgery renders satisfactory results for reinnervation of the proximal musculature of the upper limb, however the same good outcomes are not usually associated to the reinnervation of the hand. Key words: brachial plexus surgery, nerve grafting, nerve transfer, palsy.Cirurgia do plexo braquial: o papel da técnica cirúrgica para a obtenção de melhores resultados funcionais RESUMO Objetivo: Análise de resultados das técnicas que comprovadamente melhoraram o prognóstico funcional de pacientes com lesões traumáticas do plexo braquial. Método: Estudo retrospectivo de cem casos de lesões traumáticas do plexo braquial. Foi realizada comparação dos resultados pós-operatórios obtidos com as diferentes técnicas utilizadas. Resultados: A técnica de enxertia a partir de raízes proximais resultou em bons graus de reinervação em 70% dos casos. Bons resultados (p<0,05) também foram relacionados à técnica de Oberlin e de Sansak, enquanto que a transferência frênico-musculocutâneo e acessório-suprascapular não resultaram em melhora que atingisse significância estatística. Reinervação motora da mão foi observada em menos de 30% dos casos. Conclusão: A cirurgia de reinervação do plexo braquial em geral resulta em boa recuperação da função proximal do membro, porém esses mesmos bons resultados não são observados em termos de reinervação da mão. Palavras-chave: cirurgia de plexo braquial, enxertos nervosos, transferência de nervos, paralisia.

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“…Many outcome studies of nerve-injured patients present motor and sensory functional outcomes but do not report information regarding the absence or presence of pain [1,7,16,17,30,35,36,38,41,44]. In the surgical literature, many studies that report pain in nerve-injured patients generally use unidimensional measures (verbal ratings or visual analog scales of pain intensity) and do not include assessment of the psychosocial factors that may be associated with pain [5,8,28,32,34,40,42].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Pain Measurement Practices and Opinions of Peripheral Nerve Surgeons

Novak

Anastakis

Beaton

et al. 2009

Hand (New York, N,Y.)

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The purpose of this study was to evaluate the opinions and practices of peripheral nerve surgeons regarding assessment and treatment of pain in patients following nerve injury. Surgeons with expertise in upper extremity peripheral nerve injuries and members of an international peripheral nerve society were sent an introductory letter and electronic survey by email (n=133). Seventy members responded to the survey (49%) and 59 surgeons completed the survey (44%). For patients referred for motor or sensory dysfunction, 31 surgeons (52%) indicated that they always formally assess pain. In patients referred for pain, 44 surgeons (75%) quantitatively assess pain using a verbal scale (n=24) or verbal numeric scale (n=36). The most frequent factors considered very important in the development of chronic neuropathic pain were psychosocial factors (64%), mechanism of injury (59%), workers' compensation or litigation (54%), and iatrogenic injury (48%). In patients more than 6 months following injury, surgeons frequently see: cold sensitivity (54%), decreased motor function (42%), paraesthesia or numbness (41%), fear of returning to work (22%), neuropathic pain (20%), and emotional or psychological distress (17%). Only 52% of surgeons who responded to the survey always evaluate pain in patients referred for motor or sensory dysfunction. Pain assessment most frequently includes verbal patient response, and assessment of psychosocial factors is rarely included. Predominately, patient-related factors were considered important in the development of chronic neuropathic pain.

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Outcomes of surgery in 1019 brachial plexus lesions treated at Louisiana State University Health Sciences Center

Abstract: Surgical exploration and repair of brachial plexus lesions is technically feasible and favorable outcomes can be achieved if patients are thoroughly evaluated and appropriately selected.

Cited by 210 publications

References 44 publications

Primary brachial plexus tumors: imaging, surgical, and pathological findings in 25 patients

Primary brachial plexus tumors: imaging, surgical, and pathological findings in 25 patients

Brachial plexus surgery: the role of the surgical technique for improvement of the functional outcome

Evaluation of Pain Measurement Practices and Opinions of Peripheral Nerve Surgeons

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