RESUMEN
PURPOSE: Peripheral nerve sheath tumors (PNSTs) are rare in pediatric patients, especially in the brachial plexus. Research on PNSTs is lacking. This article presents a retrospective cohort study of pediatric patients diagnosed and treated with PNSTs, specifically brachial plexus tumors. METHODS: All pediatric patients intervened in a single center between 2007 and 2023 with brachial plexus tumors were systemically analyzed. RESULTS: Eleven pediatric patients with 14 brachial plexus PNSTs were studied. The gender distribution was 64% female and 36% male, with an average age of 10.7 years. Ninety-one percent had a previous NF-1 diagnosis. Right brachial plexus presented a higher prevalence (64%). Pain, Tinel's sign, and stiffness masses were common during diagnosis. Motor deficits were noted in 43% of the patients. Surgery was indicated for symptoms, particularly pain and rapid growth, increasing malignancy risk. Due to suspected malignancy, an en bloc resection with safety margins was performed. Among the patients, 57% received a histopathological diagnosis of MPNST (malignant peripheral nerve sheath tumor). Treatment included radiotherapy and chemotherapy. Clinical follow-up was conducted for all cases, involving clinical and oncological evaluations for all MPNSTs. CONCLUSIONS: This article present a series of pediatric brachial plexus tumors, especially in NF-1, and emphasizes the importance of thorough evaluation for this group. Swift diagnosis is crucial in pediatrics, enabling successful surgery for small lesions with limited neurological symptoms, improving long-term outcomes. Prompt referral to specialized services is urged for suspected masses, irrespective of neurological symptoms. Benign tumor postsurgical progression shows better outcomes than MPNSTs, with complete resection as the primary goal. Needle-guided biopsy is not recommended.
Asunto(s)
Plexo Braquial , Neoplasias de la Vaina del Nervio , Humanos , Masculino , Femenino , Niño , Adolescente , Neoplasias de la Vaina del Nervio/cirugía , Estudios Retrospectivos , Plexo Braquial/cirugía , Plexo Braquial/patología , Preescolar , Neoplasias del Sistema Nervioso Periférico/cirugía , Neoplasias del Sistema Nervioso Periférico/patología , Estudios de Cohortes , Procedimientos Neuroquirúrgicos/métodosRESUMEN
INTRODUCTION: Traumatic spinal root injury caused by shoulder dislocation may involve the brachial plexus or, in some cases, a single nerve. The degree of severity of the injury depends on many patient-specific factors as well as the mechanism of injury. It is essential to suspect this type of lesion by means of a thorough physical examination in order to have better patient outcomes. CASE PRESENTATION: We presented the subtle magnetic resonance imaging (MRI) findings in a 35-yearold male with left shoulder trauma and dislocation after falling off a bicycle. He complained of decreased muscle strength and sensitivity in the C8 dermatome. Atrophy of the hypothenar region and flexion deformity of the 4th and 5th digits were noted. Magnetic resonance imaging findings were consistent with a partial preganglionic C8 motor root lesion. We found T2 increased signal intensity and thinning of the intradural segment of the C8 motor nerve root and low signal in the sequence of a multi- echo gradient recalled echo (GRE). CONCLUSION: MRI is a noninvasive tool that allows a detailed anatomical characterization of the nerves. In brachial plexus injuries, the use of the GRE sequence is useful to identify the lesions, even if they are subtle; however, some lesions may go unnoticed. It is important to note that these patients require an interdisciplinary group to reach a correct diagnosis, which is vital to establish the appropriate treatment and follow-up.
Asunto(s)
Plexo Braquial , Hombro , Humanos , Masculino , Adulto , Hombro/diagnóstico por imagen , Hombro/inervación , Plexo Braquial/diagnóstico por imagen , Plexo Braquial/lesiones , Plexo Braquial/patología , Imagen por Resonancia MagnéticaRESUMEN
BACKGROUND: Schwannoma is an extremely rare benign tumour of the peripheral nervous system; its association with breast cancer is sporadic, and its association with the brachial plexus is extremely rare. CASE DESCRIPTION: The authors report a case of a patient with breast cancer associated with nodulation in the left supraclavicular fossa, and due to the clinical and radiological features, it was considered metastatic lymph node disease. The patient underwent neoadjuvant chemotherapy, with partial response of the breast. Surgical treatment included resection of the supraclavicular nodule, which was found to be a supraclavicular fossa schwannoma. The correct diagnosis, influences the radiotherapeutic planning. The unusual presentation led to diagnostic confusion in the present case, a fact that changed the breast treatment. CONCLUSION: The best of our knowledge it is the third description of brachial plexus schwannoma associated with breast cancer and the first with a synchronous association. The knowledge of this pathology and its potential to alter treatment justify the reporting of the present case.
Asunto(s)
Plexo Braquial/patología , Neoplasias de la Mama/diagnóstico por imagen , Neurilemoma/diagnóstico por imagen , Adulto , Biopsia , Mama/patología , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Metástasis Linfática , Tomografía Computarizada por Rayos XRESUMEN
Resumen:Las lesiones del plexo braquial son más frecuentes de lo que se pueda pensar y las padecen generalmente personas jóvenes en edad reproductiva, lo que trae consigo importante afectación a la economía no solo familiar sino también a la de la nación. Esta entidad nosológica compromete de forma grave la función del miembro superior afectado produciendo parálisis sensitiva, motora y vegetativa, en muchos de los casos se ve acompañada además de dolor neuropático intenso, lo que no redunda en la incapacidad permanente de la persona afectada, con el agravante de que los recursos terapéuticos disponibles son limitados y el pronóstico sigue siendo muy variable, con un amplio espectro de posibilidades que van desde la completa hasta la nula recuperación.
Abstract:Brachial plexus injuries are more common than you might think and usually suffer from young people of reproductive age, which brings significant effect not only to the family economy but also to the nation. This disease entity severely compromises the function of the affected upper limb producing sensory, motor and vegetative paralysis, being that in many cases is accompanied besides intense neuropathic pain, which is not in permanent disability of the person concerned, with the aggravating circumstance that the therapeutic resources are limited and prognosis is still very variable, with a wide spectrum of possibilities ranging from full recovery to zero.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Parálisis , Plexo Braquial/patología , Extremidad Superior , Consecuencias de AccidentesRESUMEN
Brachial plexus neuropathies are common complaints among patients seen at orthopedic clinics. The causes range from traumatic to occupational factors and symptoms include paresthesia, paresis, and functional disability of the upper limb. Treatment can be surgical or conservative, but detailed knowledge of the brachial plexus is required in both cases to avoid iatrogenic injuries and to facilitate anesthetic block, preventing possible vascular punctures. Therefore, the objective of this study was to evaluate the topography of the infraclavicular brachial plexus fascicles in different upper limb positions adopted during some clinical procedures. A formalin-preserved, adult, male cadaver was used. The infraclavicular and axillary regions were dissected and the distance of the brachial plexus fascicles from adjacent bone structures was measured. No anatomical variation in the formation of the brachial plexus was observed. The metric relationships between the brachial plexus and adjacent bone prominences differed depending on the degree of shoulder abduction. Detailed knowledge of the infraclavicular topography of neurovascular structures helps with the diagnosis and especially with the choice of conservative or surgical treatment of brachial plexus neuropathies.
Las neuropatías del plexo braquial son quejas comunes entre los pacientes atendidos en las clínicas ortopédicas. Las causas van desde traumas a factores ocupacionales y los síntomas incluyen parestesias, paresia e incapacidad funcional del miembro superior. El tratamiento puede ser quirúrgico o conservador, pero se requiere un conocimiento detallado del plexo braquial en ambos casos para evitar lesiones iatrogénicas y para facilitar el bloqueo anestésico, evitando posibles lesiones vasculares. Por lo tanto, el objetivo de este estudio fue evaluar la topografía de los fascículos del plexo braquial infraclavicular en diferentes posiciones de los miembros superiores adoptadas durante algunos procedimientos clínicos. Se llevó a cabo la disección de las regiones infraclavicular y axilar de un cadáver adulto, de sexo masculino, conservado en formaldehído. Se midió la distancia de los fascículos del plexo braquial en relación a las estructuras óseas adyacentes. No se observó variación anatómica en la formación del plexo braquial. Las relaciones métricas entre el plexo braquial y las prominencias óseas adyacentes difieren en función del grado de abducción del hombro. El conocimiento detallado de la topografía infraclavicular de las estructuras neurovasculares ayuda con el diagnóstico y sobre todo con la elección del tratamiento conservador o quirúrgico de las neuropatías del plexo braquial.
Asunto(s)
Humanos , Masculino , Adulto , Plexo Braquial/lesiones , Traumatismos de los Nervios Periféricos/patología , Extremidad Superior/inervación , Plexo Braquial/patología , CadáverRESUMEN
OBJECTIVE: To examine birthweight and other predictors of brachial plexus injury (BPI) among births complicated by shoulder dystocia. STUDY DESIGN: A retrospective cohort study of term births complicated by shoulder dystocia in California between 1997 and 2006. Birthweight at time of delivery was stratified into 500-g intervals. Women were further stratified by diabetes status, parity, and race/ethnicity. The perinatal outcome of BPI was assessed. RESULTS: This study included 62,762 deliveries complicated by shoulder dystocia, of which 3168 (5 %) resulted in BPI. The association between birthweight and BPI remained significant regardless of confounders. Each increasing birthweight interval was associated with an increasing risk of BPI compared with 3000-3499-g birthweight. Race/ethnicity, diabetes, and parity were also independently associated with BPI. CONCLUSION: Increasing birthweight increases the risk of BPI among births with shoulder dystocia, independent of advanced maternal age, race, parity, gestational diabetes, or operative vaginal delivery.
Asunto(s)
Traumatismos del Nacimiento/etiología , Plexo Braquial/lesiones , Distocia/patología , Hombro/patología , Adulto , Plexo Braquial/patología , Neuropatías del Plexo Braquial/etiología , Estudios de Cohortes , Parto Obstétrico/efectos adversos , Femenino , Humanos , Embarazo , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Background: Primary neoplasms of peripheral nerves are uncommon in domestic animals and are mainly represented by nerve sheath tumors. They occur especially in the peripheral nerves of the brachial plexus, and may occasionally invade and compress the spinal cord. Initial clinical diagnosis is challenging, since the main clinical sign is a progressive claudication, whose origin, neurogenic or musculoskeletal, is not usually defined. The objective of this report is to describe clinical, ultrasonographic, tomographic and histopathological findings in a peripheral nerve sheath tumor in the brachial plexus of a dog, to assist clinicians making an early diagnosis, so patients can attain longer survival.Case: A 9-year-old, male, intact, Dachshund was presented to a veterinary neurologist with a history of lameness of the right forelimb onset five months ago. The condition progressed slowly to right hemiparesis and proprioceptive ataxia. Clinical and neurological findings included right hemiparesis, proprioceptive ataxia and proprioceptive deficits with decreased flexor reflex and marked atrophy of the right forelimb. Palpation of the right axilla allowed identification of a firm 1 x 3 cm mass, with intense hyperesthesia. Ultrasound examination of the right axilla revealed hypoechoic tubular mass of 1.5 x 3 cm (Figure 1). Once the animal presented signs of ataxia and paresis to the...
As neoplasias primárias dos nervos periféricos são infrequentes nos animais domésticos e são representadas, principalmente pelas neoplasias da bainha de mielina [1,2,13]. Podem originar-se nos nervos cranianos, espinhais e, principalmente, nos nervos periféricos ou raízes do plexo braquial, na qual, ocasionalmente, infiltram no canal medular e comprimem a medula espinhal [1,9]. O diagnóstico clínico inicial é desafiador, visto que o principal sinal clínico observado é uma claudicação progressiva, cuja origem, neurogê- nica ou músculo-esquelética, é difícil de ser esclarecida [3,6]. Com isso, na maioria das vezes, o diagnóstico é tardio, tornando, geralmente, o prognóstico desfavorá- vel. Exames complementares como ultrassonografia e tomografia computadorizada auxiliam no diagnóstico precoce [3,5,8-10]. O objetivo desse relato é descrever as alterações clínicas, ultrassonográficas, tomográficas e histopatológicas da neoplasia em bainha de mielina localizada no plexo braquial de um cão, visando auxiliar o clínico a realizar um diagnóstico precoce e possibilitar uma maior sobrevida aos pacientes...
Asunto(s)
Animales , Perros , Médula Ósea , Neurotecoma/patología , Neurotecoma/veterinaria , Plexo Braquial/patología , Nervios Periféricos/patologíaRESUMEN
Background: Primary neoplasms of peripheral nerves are uncommon in domestic animals and are mainly represented by nerve sheath tumors. They occur especially in the peripheral nerves of the brachial plexus, and may occasionally invade and compress the spinal cord. Initial clinical diagnosis is challenging, since the main clinical sign is a progressive claudication, whose origin, neurogenic or musculoskeletal, is not usually defined. The objective of this report is to describe clinical, ultrasonographic, tomographic and histopathological findings in a peripheral nerve sheath tumor in the brachial plexus of a dog, to assist clinicians making an early diagnosis, so patients can attain longer survival.Case: A 9-year-old, male, intact, Dachshund was presented to a veterinary neurologist with a history of lameness of the right forelimb onset five months ago. The condition progressed slowly to right hemiparesis and proprioceptive ataxia. Clinical and neurological findings included right hemiparesis, proprioceptive ataxia and proprioceptive deficits with decreased flexor reflex and marked atrophy of the right forelimb. Palpation of the right axilla allowed identification of a firm 1 x 3 cm mass, with intense hyperesthesia. Ultrasound examination of the right axilla revealed hypoechoic tubular mass of 1.5 x 3 cm (Figure 1). Once the animal presented signs of ataxia and paresis to the...(AU)
As neoplasias primárias dos nervos periféricos são infrequentes nos animais domésticos e são representadas, principalmente pelas neoplasias da bainha de mielina [1,2,13]. Podem originar-se nos nervos cranianos, espinhais e, principalmente, nos nervos periféricos ou raízes do plexo braquial, na qual, ocasionalmente, infiltram no canal medular e comprimem a medula espinhal [1,9]. O diagnóstico clínico inicial é desafiador, visto que o principal sinal clínico observado é uma claudicação progressiva, cuja origem, neurogê- nica ou músculo-esquelética, é difícil de ser esclarecida [3,6]. Com isso, na maioria das vezes, o diagnóstico é tardio, tornando, geralmente, o prognóstico desfavorá- vel. Exames complementares como ultrassonografia e tomografia computadorizada auxiliam no diagnóstico precoce [3,5,8-10]. O objetivo desse relato é descrever as alterações clínicas, ultrassonográficas, tomográficas e histopatológicas da neoplasia em bainha de mielina localizada no plexo braquial de um cão, visando auxiliar o clínico a realizar um diagnóstico precoce e possibilitar uma maior sobrevida aos pacientes...(AU)
Asunto(s)
Animales , Perros , Neurotecoma/patología , Neurotecoma/veterinaria , Plexo Braquial/patología , Médula Ósea , Nervios Periféricos/patologíaRESUMEN
Thoracic outlet syndrome (TOS) is a blanket term encapsulating many different clinical entities. Neurologic or neurogenic TOS (NTOS) is its main contributor, but it remains a complicated and sometimes controversial entity. NTOS incorporates numerous types, etiologies, clinical presentations, diagnostic findings, and therapeutic modalities. This article reviews the spectrum of disease within the thoracic outlet that affects the brachial plexus, with a special emphasis on the commonly afflicted sports medicine patient.
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Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/terapia , Medicina Deportiva/tendencias , Síndrome del Desfiladero Torácico/diagnóstico , Síndrome del Desfiladero Torácico/terapia , Traumatismos en Atletas/epidemiología , Plexo Braquial/patología , Humanos , Medicina Deportiva/métodos , Síndrome del Desfiladero Torácico/epidemiologíaRESUMEN
Introducción: El objetivo del estudio es evaluar los patrones morfológicos de lesión en parálisis obstétricas del plexo braquial en 27 casos. Materiales y métodos: Se evaluaron retrospectivamente los datos de las historias clínicas de 27 exploraciones microquirúrgicas realizadas durante el período 2009-2012. Se usó la clasificación clínica de Narakas. Se compararon los hallazgos operatorios con el patrón clínico de lesión. Resultados: Se observaron 18 patrones diferentes de lesión. Las parálisis totales mostraban el mayor tipo de diversidad de lesiones, en general, presentaban roturas de raíces altas con avulsiones de raíces bajas. El compromiso clínico de la raíz de C7 no siempre se correlacionó con los hallazgos quirúrgicos. Conclusión: Las parálisis obstétricas del plexo braquial muestran una gran diversidad de lesiones. La cirugía es altamente demandante, requiere el manejo de todas las estrategias de reconstrucción, según los hallazgos quirúrgicos. Nivel de Evidencia: IV
Asunto(s)
Humanos , Traumatismos del Nacimiento , Neuropatías del Plexo Braquial , Parálisis Obstétrica/cirugía , Plexo Braquial/lesiones , Plexo Braquial/patología , Microcirugia , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Introducción: El objetivo del estudio es evaluar los patrones morfológicos de lesión en parálisis obstétricas del plexo braquial en 27 casos. Materiales y métodos: Se evaluaron retrospectivamente los datos de las historias clínicas de 27 exploraciones microquirúrgicas realizadas durante el período 2009-2012. Se usó la clasificación clínica de Narakas. Se compararon los hallazgos operatorios con el patrón clínico de lesión. Resultados: Se observaron 18 patrones diferentes de lesión. Las parálisis totales mostraban el mayor tipo de diversidad de lesiones, en general, presentaban roturas de raíces altas con avulsiones de raíces bajas. El compromiso clínico de la raíz de C7 no siempre se correlacionó con los hallazgos quirúrgicos. Conclusión: Las parálisis obstétricas del plexo braquial muestran una gran diversidad de lesiones. La cirugía es altamente demandante, requiere el manejo de todas las estrategias de reconstrucción, según los hallazgos quirúrgicos. Nivel de Evidencia: IV (AU)
Asunto(s)
Humanos , Parálisis Obstétrica/cirugía , Plexo Braquial/patología , Plexo Braquial/lesiones , Traumatismos del Nacimiento , Neuropatías del Plexo Braquial , Estudios Retrospectivos , Microcirugia , Factores de RiesgoRESUMEN
Schwanomas originating from the brachial plexus, although rare, may be mistaken for another type of tumour. A 40 year-old woman, who had been treated years earlier for a breast adenocarcinoma, showed in the 5-year follow-up magnetic resonance examination a localized lesion in the right brachial plexus. The presumptive radiological diagnosis was a metastasis from the primary adenocarcinoma. Following surgical access via the right axilla, a well-circumscribed mass in the brachial plexus was detected. Under intraoperative electrophysiological guidance, the lesion was observed to depend on the ulnar nerve and its complete resection was possible without compromising nerve function. Histological findings indicated a schwannoma thus ruling out the presence of metastasis. The postoperative development was uneventful and six years after surgery, the patient is to date tumour-free. To the best of our knowledge, this is the first report of a brachial plexus schwannoma arising from the ulnar branch. Intraoperative electrophysiological monitoring is essential for a good surgical outcome.
Asunto(s)
Adenocarcinoma/patología , Neuropatías del Plexo Braquial/patología , Neoplasias de la Mama/patología , Neurilemoma/patología , Adenocarcinoma/secundario , Adulto , Plexo Braquial/patología , Diagnóstico Diferencial , Femenino , Humanos , Periodo Intraoperatorio , Imagen por Resonancia Magnética , Neurilemoma/cirugíaRESUMEN
Los neurinomas del plexo braquial son tumores infrecuentes que pueden confundirse con otras lesiones de índole tumoral. Se presenta el caso de una mujer de 40 años, tratada previamente de un adenocarcinoma de mama derecha en el pasado, que en el estudio de extensión realizado 5 años después se detectó una lesión localizada en el plexo braquial derecho. La paciente se encontraba asintomática. El diagnóstico radiológico de presunción fue metástasis de adenocarcinoma mamario. Se realizó un abordaje axilar derecho descubriendo una lesión bien delimitada en el plexo braquial. Con ayuda de la monitorización neurofisiológica intraoperatoria, se observó que la lesión dependía de la rama cubital y se pudo realizar una resección completa preservando la función de dicho nervio. El estudio anatomopatológico confirmó que se trataba de un neurinoma, descartando así la existencia de metástasis. La evolución postoperatoria fue satisfactoria. Seis años después de la intervención no existe recidiva tumoral. En nuestro conocimiento este es el primer caso publicado en la literatura de un neurinoma del plexo braquial dependiente de la rama cubital. La monitorización neurofisiológica intraoperatoria resulta fundamental para abordar este tipo de lesiones con baja morbilidad.
Schwa nomas originating from the brachial plexus, although rare, may be mistaken for another type of tumour. A 40 year-old woman, who had been treated years earlier for a breast adenocarcinoma, showed in the 5-year follow-up magnetic resonance examination a localized lesion in the right brachial plexus. The presumptive radiological diagnosis was a metastasis from the primary adenocarcinoma. Following surgical access via the right axilla, a well-circumscribed mass in the brachial plexus was detected. Under intraoperative electrophysiological guidance, the lesion was observed to depend on the ulnar nerve and its complete resection was possible without compromising nerve function. Histological findings indicated a schwannoma thus ruling out the presence of metastasis. The postoperative development was uneventful and six years after surgery, the patient is to date tumour-free. To the best of our knowledge, this is the first report of a brachial plexus schwannoma arising from the ulnar branch. Intraoperative electrophysiological monitoring is essential for a good surgical outcome.
Asunto(s)
Adulto , Femenino , Humanos , Adenocarcinoma/patología , Neuropatías del Plexo Braquial/patología , Neoplasias de la Mama/patología , Neurilemoma/patología , Adenocarcinoma/secundario , Plexo Braquial/patología , Diagnóstico Diferencial , Periodo Intraoperatorio , Imagen por Resonancia Magnética , Neurilemoma/cirugíaRESUMEN
BACKGROUND: Using grafts directed to distal targets in brachial plexus reconstruction has the advantage over proximal targets of avoiding axonal dispersion. A long graft (more than 10 cm) is needed to reach most distal targets. The objective of this article is to identify factors associated with good versus poor outcomes in a clinical series of long grafts used for distal brachial plexus reconstruction. METHODS: In 34 patients with a flail arm, 47 sural grafts >10 cm long were followed for ≥2 years postoperatively. Surgical technique included standard supraclavicular exposure of the proximal brachial plexus and its branches, the phrenic nerve and spinal accessory nerve. Distal target nerves were exposed via an incision starting at the axilla, following the gap between the biceps and triceps. Cases achieving a good result were statistically compared against those with a poor result as to the donor nerve/root, target nerve, patient age and weight, time from trauma to surgery, graft length and long-term rehabilitation quality. FINDINGS: A good outcome was observed with 23 grafts (48.9%), but 66.7% of the 30 long grafts done within 6 months of trauma yielded a good result. Only 1 of 15 patients with the lowest quality rehabilitation score experienced a good result (6.6%) versus all 12 patients with the highest rating (p < 0.001). Trauma-to-surgery time was roughly half as long in those with a good result (4.7 vs. 9.0 months, p < 0.001). No other inter-group differences were observed. CONCLUSIONS: The results of a series of distal brachial plexus target reinnervations with long grafts is presented and analyzed. According to them, time from trauma to surgery and an adequate postoperative rehabilitation are important predictors of outcome.
Asunto(s)
Neuropatías del Plexo Braquial/cirugía , Plexo Braquial/cirugía , Transferencia de Nervios/métodos , Procedimientos de Cirugía Plástica/métodos , Nervio Sural/trasplante , Trasplante Autólogo/métodos , Adolescente , Adulto , Plexo Braquial/lesiones , Plexo Braquial/patología , Neuropatías del Plexo Braquial/patología , Neuropatías del Plexo Braquial/rehabilitación , Humanos , Masculino , Estudios Retrospectivos , Nervio Sural/anatomía & histología , Nervio Sural/fisiología , Adulto JovenRESUMEN
OBJETIVO: Avaliar ganho de força e amplitude de movimento do cotovelo após cirurgia de Steindler Modificada em pacientes com lesão do tronco superior do plexo braquial. MÉTODO: Foram acompanhados de 1998 a 2007 onze pacientes com lesão traumática fechada do tronco superior do plexo braquial. Todos apresentavam evolução de pelo menos 1 ano da lesão e grau de força de flexão do cotovelo que variou de M1 a M3. Os pacientes foram submetidos à cirurgia de Steindler modificada e seguidos por período mínimo de 6 meses. Realizadas avaliações pré e pós-operatórias do ganho de força muscular, amplitude de movimento do cotovelo e pontuação conforme escala DASH. RESULTADOS: Dos onze pacientes analisados, nove (82 por cento) atingiram nível de força igual ou maior a M3 (MRC). Dois (18 por cento) chegaram ao nível de força M2(MRC). Observamos que os pacientes apresentaram ganho médio de amplitude de movimento do cotovelo pós-operatória de 43,45 graus. A média de flexão do cotovelo pós-operatória foi de 88 graus. Houve melhora da função do cotovelo demonstrada na Escala DASH em 81 por cento dos pacientes do estudo. CONCLUSÃO: A cirurgia de Steindler Modificada mostrou-se eficaz no tratamento dos pacientes com lesão de tronco superior de plexo braquial, com ganho estatisticamente significativo de amplitude de movimento. Em todos os casos algum grau de ganho de força e amplitude de flexão do cotovelo, sendo tanto maior quanto maior a força muscular inicial. Nível de Evidência: Nível II, ensaio clínico prospective.
OBJECTIVE: To evaluate the gain in strength and range of motion after modified Steindler surgery of the elbow in patients with lesions of the upper trunk of the brachial plexus. METHOD: From 1998 to 2007, eleven patients with traumatic closed upper trunk lesion of the brachial plexus were studied. All the patients had development of at least 1 year of injury and degree of strength of elbow flexion ranging from M1 to M3. The patients underwent Steindler surgery with at least 6 months of follow-up. Pre- and post-operative assessments were carried out to determine gain in muscle strength, range of motion of the elbow, and DASH scale score. RESULTS: Of the eleven patients studied, nine (82 percent) achieved a level of strength equal to or greater than M3 (MRC) with good functional recovery. Two (18 percent) reached strength level M2 (MRC). We observed that the patients had an average postoperative gain in range of motion of the elbow of 43.45 degrees. The average elbow flexion after surgery was 88 degrees. There was an improvement in elbow function, as demonstrated in the DASH Scale, in 81 percent of the patients studied. CONCLUSION: Modified Steindler surgery was effective in the treatment of patients with injuries of the upper trunk of the brachial plexus, with statistically significant gains in range of motion. In all the cases studied, there was some degree of gain in strength and range of elbow flexion, the gain being correlated with the initial muscle strength. Level of Evidence: Level II, prospective clinical trial.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Codo/inervación , Miembro Anterior , Plexo Braquial/lesiones , Plexo Braquial/patología , Procedimientos de Cirugía Plástica/rehabilitación , Codo/fisiopatología , Articulación del Codo , RehabilitaciónRESUMEN
BACKGROUND: Tumours of the brachial plexus region are rare and most publications are case reports or studies with a small series of patients. The aim of this study is to present our experience in managing these lesions. METHODS: We review 18 patients with tumours in the brachial plexus region submitted to surgical treatment in a 6 year period, including their clinical presentation, neuro-imaging data, surgical findings and outcome. FINDINGS: The tumours comprised a heterogeneous group of lesions, including schwannomas, neurofibromas, malignant peripheral nerve sheath tumour (MPNST), sarcomas, metastases, desmoids and an aneurysmal bone cyst. The most common presentation was an expanding lump (83.33%). Eleven tumours were benign and 7 were malignant. Neurofibromatosis was present in only 2 patients (11.11%). Gross total resection was achieved in 14 patients and sub-total resection in the others. Only 3 patients presented with new post-operative motor deficits. The incidence of complications was low (16.5 %). CONCLUSIONS: The majority of tumours were benign and most of them could be excised with a low incidence of additional deficits. Some of the malignant tumours could be controlled by surgery plus adjuvant therapy, but this category is still associated with high morbidity and mortality rates.
Asunto(s)
Neuropatías del Plexo Braquial/diagnóstico , Neuropatías del Plexo Braquial/cirugía , Plexo Braquial/patología , Plexo Braquial/cirugía , Neoplasias del Sistema Nervioso Periférico/diagnóstico , Neoplasias del Sistema Nervioso Periférico/cirugía , Adolescente , Adulto , Quistes Óseos Aneurismáticos/diagnóstico , Quistes Óseos Aneurismáticos/patología , Quistes Óseos Aneurismáticos/cirugía , Plexo Braquial/fisiopatología , Neuropatías del Plexo Braquial/fisiopatología , Niño , Femenino , Fibromatosis Agresiva/diagnóstico , Fibromatosis Agresiva/fisiopatología , Fibromatosis Agresiva/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia/diagnóstico , Metástasis de la Neoplasia/fisiopatología , Recurrencia Local de Neoplasia/epidemiología , Neoplasias de la Vaina del Nervio/diagnóstico , Neoplasias de la Vaina del Nervio/fisiopatología , Neoplasias de la Vaina del Nervio/cirugía , Neurilemoma/diagnóstico , Neurilemoma/fisiopatología , Neurilemoma/cirugía , Neurofibroma/diagnóstico , Neurofibroma/fisiopatología , Neurofibroma/cirugía , Procedimientos Neuroquirúrgicos , Dolor/etiología , Parestesia/etiología , Neoplasias del Sistema Nervioso Periférico/fisiopatología , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Sarcoma/diagnóstico , Sarcoma/fisiopatología , Sarcoma/cirugía , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto JovenRESUMEN
Solitary schwannomas of the head and neck are uncommon tumors arising from any cranial or autonomic nerve. Twenty-five percent to 45% of extracranial schwannomas occur in the head and neck. A total of 28 consecutive patients treated be tween January 2000 and August 2006 for solitary schwannomas in different major nerves of the head and neck were included in this study. Most affected trunks were cranial nerves in 14 patients (50%), cervical sympathetic chain in 7 (25%), and brachial plexus in 7 (25%). The most common sign was an isolated well-demarcated lesion placement at the lateral aspect of the neck for those tumors arising from vagus, lingual, and sympathetic nerves. Total resection with nerve conservation was the treatment of choice for these tumors. In 26 patients (94%), no functional sequels were detected; in 2 other patients (6%), Horner syndrome was a consequence of sympathetic chain resection. No relapse was detected in all 28 patients.
Asunto(s)
Neoplasias de Cabeza y Cuello/cirugía , Neurilemoma/cirugía , Adolescente , Adulto , Anciano , Enfermedades del Sistema Nervioso Autónomo/cirugía , Plexo Braquial/patología , Neoplasias de los Nervios Craneales/cirugía , Femenino , Ganglios Simpáticos/patología , Síndrome de Horner/etiología , Humanos , Enfermedades del Nervio Hipogloso/cirugía , Nervio Lingual/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neoplasias del Sistema Nervioso Periférico/cirugía , Tomografía Computarizada por Rayos X , Enfermedades del Nervio Vago/cirugía , Adulto JovenRESUMEN
In this case of a male adult Caucasian cadaver, variations were noted involving the location of the C5 ventral ramus descending anterior and superolateral to the anterior scalene muscle. An unusual communicating branch was discovered that originated from C5 at the midpoint of the anterior scalene muscle, two centimeters proximal to Erb's point, to communicate with C6 and another communicating branch originating from C6 to C7. Awareness of the possibility of this variation is of great importance during certain surgical procedures. Comparison of this case with the literature is discussed.
En este caso de un cadáver adulto varón caucásico, se observaron variaciones que involucraban la localización de la rama ventral del quinto nervio cervical (C5) anterior descendente y superior lateral en relación con el músculo escaleno anterior. Se descubrió una rama comunicante inusual que se originaba a partir del C5 en el punto medio del músculo escaleno anterior, dos centímetros próximo al punto de Erb, para comunicarse con el C6 y otra rama comunicante son su punto de origen en C6 hasta C7. Conocer la posibilidad de esta variación es de gran importancia durante la realización de ciertos procedimientos quirúrgicos. Se discute la comparación de este caso con la literatura.