Predictive value of computed tomographic myelography in obstetrical brachial plexus palsy

Area of Science:

• Pediatric Surgery
• Neurosurgery
• Radiology

Background:

• Birth trauma can cause brachial plexus injuries, specifically root avulsions.
• Accurate preoperative diagnosis of these avulsions is crucial for effective surgical reconstruction.
• Radiologic studies are employed to aid in surgical planning for these complex injuries.

Purpose of the Study:

• To determine the predictive value of computed tomographic (CT) myelography in detecting brachial plexus nerve root avulsions.
• To compare CT myelography findings with surgical outcomes in patients with obstetrical brachial plexus palsy.

Main Methods:

• Sixty-three patients with obstetrical brachial plexus palsy underwent preoperative CT myelography and reconstructive surgery.
• A single neuroradiologist analyzed CT myelograms for pseudomeningoceles and the presence/absence of rootlets, blinded to surgical results.
• A single surgeon reviewed surgical findings of extraforaminal root avulsions, blinded to radiographic results.
• Radiographic and surgical findings were compared at each root level.

Main Results:

• A total of 281 roots were analyzed.
• The presence of pseudom বিনিয়োগoceles alone was not a sensitive indicator of root avulsions (sensitivity 0.63, specificity 0.85).
• The absence of identifiable rootlets within a pseudomeningocele showed higher predictive value (sensitivity 0.37, specificity 0.98, positive predictive value 0.74, likelihood ratio 18.5).

Conclusions:

• CT myelography is a valuable tool for assessing brachial plexus injuries.
• The absence of nerve rootlets within a pseudomeningocele on CT myelography is a highly specific indicator of extraforaminal root avulsion.
• This finding can significantly aid in preoperative surgical planning for brachial plexus reconstruction.