Surgery for lesions of the brachial plexus

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Trauma Surgery

Background:

• Brachial plexus injuries encompass a range of conditions including stretch injuries, gunshot wounds, lacerations, iatrogenic damage, tumors, and thoracic outlet syndromes.
• Effective management requires a thorough understanding of diagnostic modalities and surgical interventions.

Purpose of the Study:

• To review current diagnostic workup and surgical management strategies for various brachial plexus injuries.
• To summarize radiologic and electrodiagnostic studies pertinent to patient evaluation.
• To discuss controversial aspects of management, including surgical indications and techniques.

Main Methods:

• Review of current literature on brachial plexus injuries.
• Summary of diagnostic imaging (radiologic) and electrophysiological (electrodiagnostic) studies.
• Analysis of surgical outcomes and techniques, including magnification and intraoperative recording.

Main Results:

• Surgery can benefit well-selected patients with stretch injuries.
• Many patients with gunshot wounds to the brachial plexus require surgical intervention despite potential for spontaneous recovery.
• Early, aggressive tumor removal is crucial; magnification and intraoperative recording aid in neurofibroma resection.
• Specific considerations for lacerations, iatrogenic injuries, thoracic outlet syndrome, and plexus neuropathy are discussed.

Conclusions:

• Individualized assessment of nerve element deficits is critical for treatment planning.
• Advancements in intraoperative stimulation, recording, magnification, and grafting techniques enhance the management of brachial plexus injuries.
• These developments have renewed interest in optimizing surgical outcomes for complex brachial plexus lesions.