Obstetric brachial plexus lesions and their neurosurgical treatment

The present series of 655 brachial plexus lesions includes 240 obstetric palsies. The results of neurophysiological and radiological examinations in these cases are often disappointing in regard to the evaluation of the severity of the lesion. Timing for surgery was according to the criterium of Gilbert: lack of clinical signs of recovery of the biceps at the end of the third month. Intra- and/or extraplexal neurotizations were performed in 94 children. Although only 28 children operated upon have been followed up for at least 2 years, some tentative conclusions may be drawn. A good to very good result was achieved in 10 children with an upper plexus lesion, born in cephalic presentation. In breech presentation cases, often associated with root avulsion, and in (sub)total lesions, the final result was much less.