Radiological Investigations and Intra-operative Evoked Potentials for the Diagnosis of Nerve Root Avulsion: Evaluation of Both Modalities by Intradural Root Inspection

Abstract

Fourteen patients with traumatic brachial plexus injuries underwent intradural inspection of cervical nerve roots to evaluate radiological and intra-operative electrophysiological findings concerning cervical nerve root avulsion from the spinal cord. Four neurosurgeons of our department assessed independently from each other both myelography and CT-myelography concerning intradural nerve root lesions. Each neurosurgeon assessed a total of 26 cervical nerve roots. Two investigators assessed 6/26 and 2 investigators 7/26 nerve roots falsely concerning ventral or/and dorsal root lesions compared with the findings on intradural inspection (23% and 27% false findings). There was a considerable variance concerning the assessibility and findings among the 4 neurosurgeons. Reconstructive surgery was performed after a mean interval of 6.5 months following trauma and 2 weeks following intradural inspection. After exposure of the brachial plexus and the cervical nerve roots in question via a ventral approach, 13 cervical nerve roots were stimulated electrically close to the neuroforamen and cortical evoked potentials (root-SEPs) were recorded from the contralateral postcentral region. All 5 roots with SEPs were intact (no root lesion) and all 8 roots without SEPs showed interrupted (ventral or/and dorsal) rootlets on intradural inspection. Our results demonstrate that false radiological findings concerning root lesions are possible. Intra-operative root-SEPs seem to be a useful aid for evaluation of cervical nerve root lesions. However, more electrophysiological data are necessary to ascertain, if this modality is able to replace intradural inspection in unclear radiological cases in the future.

Feasibility of Diffusion Tensor Tractography of Brachial Plexus Injuries at 1.5 T

“…36 However, it should be taken into account that intradural surgical exploration is rarely performed in the treatment of BP injuries and that CTM is an invasive technique that has a rate of preoperative misdiagnosis, ranging from 15% to 27%. 26,37 Another limitation of the study is that there are no measurements of the fractional anisotropy values that were performed along the roots of the BP, which could have been theoretically useful in providing a more accurate and quantitative assessment of the severity of the postganglionic injuries.…”

Obstetric Brachial Plexus Lesions: CT Myelography

“…errors were partial avulsions, intradural fi brosis, and dural cystic lesions. Oberle and coworkers ( 16 ) reported between 23% and 27% of false-positive fi ndings by using CT myelography; however, there was large intraobserver…”

Management bei geburtstraumatischen Läsionen des Plexus brachialis

“…In der Arbeit von Oberle und Mitarb. [26] wurden eine intensive krankengymnastische Behandlung und zu einem späteren Zeitpunkt Ersatzoperationen erfolgen. retrospektiv die myelo-computertomographischen Befunde (1mm-Schichten) von 26 Nervenwurzeln mit dem intraoperativen Befund (zervikale Hemilaminektomie und intradurale Revision) verglichen.…”

“…Die durch Artefakte nicht eindeutig beurteilbaren Wurzeln wurden vorher ausgeschlossen. In 27% waren die intraoperativ nachgewiesenen Wurzelläsionen in der Myelo-Computertomographie nicht erkannt worden [26].…”