Supraclavicular Brachial Plexus Approach for Excision of C8 Nerve Root Schwannoma: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (5) ◽  
pp. 634-635 ◽  
Author(s):  
Radek P Kindl ◽  
Krunal Patel ◽  
Rikin A Trivedi
Keyword(s):  
Brachial Plexus ◽  
Ring Finger ◽  
Venous Plexus ◽  
Neural Foramen ◽  
Scalene Muscle ◽  
3 Dimensional ◽  
Finger Flexion ◽  
Neck Lump ◽  
Anterior Scalene Muscle

Abstract Brachial plexus tumors are uncommon lesions in young adults. The majority of these are benign peripheral sheath tumors. In this 3-dimensional video, we present a case of a 19-yr-old female who presented to the neurosurgical outpatients with an anterior neck lump. It has been present for months, causing occasional numbness and paraesthesia in the distribution of the left ring finger. There was no objective weakness in finger flexion with normal long flexors reflexes. The cervical spine and supraclavicular brachial plexus were investigated with a magnetic resonance imaging (Gadolinium) scan (Figure 1). It demonstrated 30 × 20 × 20 mm lesion adjacent to the C8 nerve arising from the neural foramen, however, mostly occupying the space lateral to it. The patient was consented for resection of the tumor. This was done via the supraclavicular brachial plexus approach. The brachial plexus nerves were macroscopically demonstrated lateral to the anterior scalene muscle. The intraoperative electrophysiology was used to directly stimulate the nerves, which aided in accurate tracking during the dissection. The tumor was exposed after tracing the C8 nerve deep and medial to the anterior scalene muscle. It was resected down to the foramen, reaching the level of the epidural venous plexus, while C8 was spared. The patient recovered with no neurological deficit. The histopathology confirmed grade 1 schwannoma. Subsequently, there was no radiological follow-up performed. This case demonstrates the surgical dissection of supraclavicular brachial plexus in 3-dimensions while describing the unusual dissection medial to scalenus anterior muscle.

scholarly journals Bilateral anatomic variation in the relation of the upper trunk of the brachial plexus to the anterior scalene muscle

2015 ◽  
Author(s):  
Miroslav Radunovic ◽  
Batric Vukcevic ◽  
Marija Abramovic ◽  
Nemanja Vukcevic ◽  
Nemanja Radojevic ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Anatomic Variation ◽  
Scalene Muscle ◽  
Anterior Scalene Muscle

Variations of the Course of the Upper Trunk of the Brachial Plexus and their Clinical Significance for the Thoracic Outlet Syndrome: A Study on 93 Cadavers

2006 ◽  
Vol 72 (2) ◽  
pp. 188-192 ◽  
Author(s):  
Konstantinos Natsis ◽  
Trifon Totlis ◽  
Prokopios Tsikaras ◽  
Nikolaos Anastasopoulos ◽  
Panagiotis Skandalakis ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Clinical Significance ◽  
Surgical Approach ◽  
Thoracic Outlet Syndrome ◽  
Anatomical Variations ◽  
Predisposing Factors ◽  
Scalene Muscle ◽  
Anterior Scalene Muscle

The aim of this study is the recording of the variations of the course of the upper trunk (UT) of the brachial plexus (BP) and their clinical significance for the thoracic outlet syndrome (TOS) and the anesthetic blockade of the BP. Five different anatomical variations of the course of the UT of the BP, in relation to the anterior scalene muscle (ASM), were observed in 24 out of the 186 sides of the 93 cadavers we studied (12.9%). The C5 root was passing anteriorly to the ASM in six cases. The UT was located anteriorly to the ASM in four cases and was perforating the ASM's belly in 12 cases. In one cadaver, the ASM was double and the UT was passing between the two bellies of the double ASM. Finally, in another cadaver, the C5 root was found to be anterior to the anterior scalene muscle, while the C6 root was perforating the ASM's belly. These variations are predisposing factors for the TOS; they cause specific symptomatology and require a different surgical approach in comparison with other causes of the syndrome. Moreover, knowledge of these is important during the performance of the anesthetic blockade of the BP.

scholarly journals Gracilis free muscle transfer for restoration of function after complete brachial plexus avulsion

2004 ◽  
Vol 16 (5) ◽  
pp. 1-9 ◽  
Author(s):  
Kimberly A. Barrie ◽  
Scott P. Steinmann ◽  
Alexander Y. Shin ◽  
Robert J. Spinner ◽  
Allen T. Bishop
Keyword(s):  
Brachial Plexus ◽  
Upper Extremity ◽  
Elbow Flexion ◽  
Muscle Transfer ◽  
Muscle Flaps ◽  
Wrist Extension ◽  
Finger Flexion ◽  
Vascular Insufficiency ◽  
Flexion Strength

Object The authors report the functional outcomes after functioning free muscle transfer (FFMT) for restoration of the upper-extremity movement after brachial plexus injury (BPI). Methods The authors conducted a retrospective review of 36 gracilis FFMT procedures performed in 27 patients with BPI between 1990 and 2000. Eighteen patients underwent a single gracilis FFMT procedure for restoration of either elbow flexion (17 cases) or finger flexion (one case). Nine patients underwent a double free muscle transfer for simultaneous restoration of elbow flexion and wrist extension (first muscle) and finger flexion (second muscle), combined with direct triceps neurotization. The results obtained in 29 cases of FFMT in which the follow-up period was 1 year are reported. Neurotization of the donor muscle was performed using the musculocutaneous nerve (one case), spinal accessory nerve (12 cases), or multiple intercostal motor nerves (16 cases). Two second-stage muscle flaps failed secondary to vascular insufficiency. Mean electromyography-measured reinnervation time was 5 months. At a minimum follow-up period of 1 year, five muscles achieved less than or equal to Grade M2, eight Grade M3, four Grade M4, and 12 Grade M5. Transfer for combined elbow flexion and wrist extension compared with elbow flexion alone lowered the overall results for elbow flexion strength. Seventy-nine percent of the FFMTs for elbow flexion alone (single transfer) and 63% of similarly innervated muscles transferred for combined motion achieved at least Grade M4 elbow flexion strength. Conclusions Functioning free muscle transfer is a viable reconstructive option for restoration of upper-extremity function in the setting of severe BPI. It is possible to achieve good to excellent outcomes in terms of muscle grades with the simultaneous reconstruction of two functions by one FFMT, making restoration of basic hand function possible. More reliable results are obtained when a single FFMT is performed for a single function.

Clinical use of supinator motor branch transfer to the posterior interosseous nerve in C7–T1 brachial plexus palsies

2010 ◽  
Vol 113 (1) ◽  
pp. 113-117 ◽  
Author(s):  
Zhen Dong ◽  
Yu-Dong Gu ◽  
Cheng-Gang Zhang ◽  
Lei Zhang
Keyword(s):  
Brachial Plexus ◽  
Reliable Method ◽  
Nerve Transfer ◽  
Posterior Interosseous Nerve ◽  
Viable Option ◽  
Motor Branch ◽  
Finger Extension ◽  
Finger Flexion ◽  
Anterior Interosseous Nerve

Object In C7–T1 brachial plexus palsies, finger extension and flexion are absent. At the authors' institution, finger flexion has been successfully reconstructed by transferring the brachialis motor branch to the anterior interosseous nerve. However, there is no reliable method for restoring finger extension. In the present study, the authors examined the surgical results of transferring the supinator motor branch to the posterior interosseous nerve. Methods Since October 2007, the authors have performed a supinator motor branch transfer to the posterior interosseous nerve in 4 patients. The patients underwent follow-up every 3–4 months postoperatively. Results Finger extension appeared between 5 and 9 months in the first 3 cases and demonstrated promising improvement over time. One recent case remains under follow-up. Conclusions A supinator motor branch to posterior interosseous nerve transfer leads to reliable recovery of thumb and finger extension. Therefore, it is a viable option for C7–T1 brachial plexus palsies.

Neuroanatomical relationship between Jingbi and the brachial plexus

2020 ◽  
pp. 096452842093837
Author(s):  
Kwan Leung Chia ◽  
Jian Hung Teoh ◽  
Rainer Viktor Haberberger
Keyword(s):  
Brachial Plexus ◽  
Jugular Vein ◽  
Acupuncture Point ◽  
Needle Insertion ◽  
External Jugular Vein ◽  
Neural Pathways ◽  
Scalene Muscle ◽  
Acupuncture Stimulation ◽  
The Right ◽  
Anterior Scalene Muscle

Background: This study examined the stratified anatomy of the traditional acupuncture point Jingbi and the neuroanatomical relationship between Jingbi and the brachial plexus, and investigated neural pathways that could be affected by acupuncture stimulation at Jingbi. Methods: Twelve dissected specimens were used to study the pathway of an acupuncture needle inserted at Jingbi. The stratified anatomy and the neuroanatomical relationship between Jingbi and the brachial plexus were studied. Our samples were grouped by gender and cause of death for comparative analysis. Results: All needles ( n = 24, on both sides of a total of 12 cadavers) punctured the anterior scalene muscle medial to the brachial plexus and external jugular vein, lateral to the phrenic nerve and internal jugular vein, and superior to the clavicle and subclavian artery/vein. The depth of needle insertion at Jingbi on the right side of male samples was 28.0 (interquartile range (IQR), 22.5–30.8) mm, which was approximately 8 mm deeper than for female subjects ( p < 0.05). The needle was 3.0 (IQR, 2.0–5.0) mm and 7.0 (IQR, 5.5–8.0) mm medial to the brachial plexus on the left and right sides, respectively. Conclusion: Deep needle insertion at Jingbi can puncture the anterior scalene muscle. The mechanism of action of acupuncture stimulation at Jingbi might be related to its close relationship with the brachial plexus. Significant differences in needling depth were observed when our samples were grouped by gender. More studies are needed.

RELATO DE CASO: SÍNDROME DO DESFILADEIRO TORÁCICO

2018 ◽  
Vol 5 (3) ◽  
pp. 24-27
Author(s):  
Tatiane Silva Gonçalves ◽  
Raíssa Nunes Bezerra De Sá ◽  
Jéssica Neto Ferreira Pacheco ◽  
Alexis Alison Cardozo Leite ◽  
Pedro Manuel Gonzales Cuellar
Keyword(s):  
Brachial Plexus ◽  
Thoracic Outlet Syndrome ◽  
Vascular Complications ◽  
Contributing Factors ◽  
Scalene Muscle ◽  
Insidious Onset ◽  
Analgesic Medication ◽  
Bone Anomalies ◽  
Anterior Scalene Muscle ◽  
Cervical Ribs

RESUMO Introdução: A Síndrome do Desfiladeiro Torácico (SDT) é uma entidade clínica com sintomatologia diversa, decorrente de compressão anormal do plexo braquial, na região do desfiladeiro torácico. Esta compressão é exercida, na maioria das vezes, pelo músculo escaleno anterior, mas pode resultar também da existência de bandas musculofibróticas, alteração da morfologia da primeira costela, costelas cervicais e músculos anômalos. A SDT pode ser classificada nos tipos vascular e neurogênico. Descrição do caso: Paciente, sexo feminino, 27 anos, com quadro de dor e parestesia, há dois anos, de início insidioso, em 4º e 5º quirodáctilos e, posteriormente, com progressão para todo membro superior esquerdo (MSE). Procurou Unidade de Pronto Atendimento, sendo prescrito apenas medicação analgésica. Após três dias, apresentou intensificação da dor, associada a palidez e parestesia de MSE procurando atendimento no Hospital Geral de Palmas. Discussão: A SDT acomete mais mulheres entre 20-50 anos, com vários fatores contribuintes, chegando a limitar as atividades diárias e laborais. O tratamento clínico, frequentemente, é a conduta inicial, procurando aliviar os sintomas. Em geral, o tratamento cirúrgico tem indicação em 15 % dos casos, quando a síndrome é decorrente de anomalias ósseas sintomáticas e complicações vasculares.   Palavras-chave: Síndrome do Desfiladeiro Torácico; Costela Cervical; Plexo Braquial. ABSTRACT Introduction: Thoracic Outlet Syndrome (TOS) is a clinical entity with diverse symptomatology due to abnormal compression of brachial plexus in the thoracic outlet region. This compression is often carried out by the anterior scalene muscle, but it may be a result from the presence of musculofibrotic bands, alteration of the first rib morphology, cervical ribs and anomalous muscles. TOS can be classified into vascular and neurogenic types. Case description: Patient, female, 27 years old, with pain and paresthesia, since two years ago, insidious onset, in 4th and 5th fingers, and later with progression to all left upper limb (LUL). She looked for Emergency Care Unit, and only analgesic medication was prescribed. After three days, she presented pain intensification, associated with pallor and paresthesia of LUL, looking for care at the General Hospital of Palmas. Discussion: The TOS affects more women between 20-50 years old, with several contributing factors, limiting daily activities and work. The clinical treatment, often, is the initial conduct, seeking to relieve symptoms. In general, the surgical treatment is indicated in 15% of cases, when the syndrome is due to symptomatic bone anomalies and vascular complications. Keywords: Thoracic Outlet Syndrome; Cervical Rib; Brachial Plexus.

scholarly journals Throwing can Increase the Stiffness of the Scalene Muscle

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0040
Author(s):  
Tetsuya Takenaga ◽  
Satoshi Takeuchi ◽  
Hideki Murakami ◽  
Katsumasa Sugimoto ◽  
Masahito Yoshida
Keyword(s):  
Surgical Treatment ◽  
Brachial Plexus ◽  
Shear Wave ◽  
Shear Wave Elastography ◽  
Muscle Stiffness ◽  
Deep Part ◽  
Baseball Players ◽  
Scalene Muscle ◽  
Throwing Motion ◽  
Anterior Scalene Muscle

Objectives: Thoracic outlet syndrome (TOS) has been reported as a set of symptoms due to the compression of the brachial plexus and subclavian vessels in the region of the thoracic outlet1. As a type of TOS, scalenus anticus syndrome involves the compression of the brachial nerves as they pass through the interval surrounded by the anterior and middle scalene muscles, and the first rib bone or cervical rib2. Recently, exercise-induced TOS is becoming more common in athletes, especially for those who perform repetitive overhead and hyperabduction maneuvers with upper limbs, such as baseball players. However, the effect of throwing on the stiffness of the scalene muscles is unknown. Thus, the purpose of this study was to quantitatively measure the stiffness of the scalene muscles using real-time shear wave elastography (SWE). The stiffness of scalene muscles was hypothesized to increase for the throwing side of baseball players. Methods: Thirty college baseball players (age range 19 to 21 years) were included for this study. Ultrasonic SWE with a 2-10 MHz linear array probe transducer (Aixplorer; SuperSonic Imagine, Aix-en-Provence, France) was used to assess the stiffness of the anterior and middle scalene muscles. Each participant was sited. The measurements were performed in two arm positions; 1) adducted and neutral rotation of the shoulder 2)90 degree of abduction and external rotation of shoulder with elbow flexed to simulate a clinical examination known as Roos test3. In both of the arm positions, the transducer was positioned just superior to the clavicular bone, parallel to its axis. Transducer was moved superiorly and tilted to visualize the superior surfaces of the anterior and middle scalene muscles parallel to the surface of the fifth cervical nerve simultaneously (Figure 1A). In this position, shear wave elastography was performed to measure the elasticity of each scalene muscle as its stiffness. Each muscle was divided into superior and deep areas. In both areas of each muscle, three 3mm-diameter circles were set to measure the elasticities of the scalene muscles and its averaged data in each area was defined as each stiffness (Figure 1B). A repeated-measures analysis of variance (ANOVA) was used to compare the elasticity of superior and deep areas in anterior and middle scalene muscles in throwing and non-throwing side. Values of p<0.05 were considered statistically significant. Results: For the throwing side, higher stiffness was found in the deep part of the middle scalene muscle compared to the superior and deep parts of the anterior scalene muscle with an adducted and neutrally rotated shoulder (p=0.0433). Moreover, the muscle stiffness was significantly higher in the superior and deep part of the middle scalene muscle than in the superior and deep parts of anterior scalene muscle in an abducted and externally rotated position of shoulder (p =0.00187). Meanwhile, no significant difference was found in the anterior and middle scalene muscles for the non-throwing side in both arm positions. Conclusion: In professional athletes with TOS who experienced surgical treatment, moderate to severe hypertrophy of the anterior scalenus muscles has been reported to be found4. Meanwhile, although the stiffness of the scalene muscles can be also related to the compression on the brachial plexus and on subclavian vessels in the region of the thoracic outlet, its quantitative measurements in the scalene muscles has not been reported. In this study, at throwing side, the muscle stiffness significantly increased in the superior area of middle scalene muscle in throwing side. While no contribution was identified in the scalene muscles at non-throwing side. As a result, repeat throwing motion can increase the stiffness of the middle scalene muscle. As a result, the brachial plexus and/or the subclavian artery could be compressed at the interscalene triangle. Throwing athletes with TOS should be treated, considering the stiffness of the middle scalene muscle, even conservative or surgical treatment. Our study was the first study to evaluate the effects of throwing on the stiffness of the scalene muscles in throwing athletes. Repetitive throwing motion can affect the stiffness of middle scalene muscle. Reduction of the middle scalene muscle should be considered to treat throwing athlete who has TOS. [Figure: see text]

Analysis of human acellular nerve allograft combined with contralateral C7 nerve root transfer for restoration of shoulder abduction and elbow flexion in brachial plexus injury: a mean 4-year follow-up

2020 ◽  
Vol 132 (6) ◽  
pp. 1914-1924 ◽  
Author(s):  
Liang Li ◽  
Jiantao Yang ◽  
Bengang Qin ◽  
Honggang Wang ◽  
Yi Yang ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Nerve Root ◽  
Functional Outcomes ◽  
Elbow Flexion ◽  
Shoulder Abduction ◽  
Allograft Reconstruction ◽  
Acellular Nerve Allograft ◽  
The Mean ◽  
Monofilament Test

OBJECTIVEHuman acellular nerve allograft applications have increased in clinical practice, but no studies have quantified their influence on reconstruction outcomes for high-level, greater, and mixed nerves, especially the brachial plexus. The authors investigated the functional outcomes of human acellular nerve allograft reconstruction for nerve gaps in patients with brachial plexus injury (BPI) undergoing contralateral C7 (CC7) nerve root transfer to innervate the upper trunk, and they determined the independent predictors of recovery in shoulder abduction and elbow flexion.METHODSForty-five patients with partial or total BPI were eligible for this retrospective study after CC7 nerve root transfer to the upper trunk using human acellular nerve allografts. Deltoid and biceps muscle strength, degree of shoulder abduction and elbow flexion, Semmes-Weinstein monofilament test, and static two-point discrimination (S2PD) were examined according to the modified British Medical Research Council (mBMRC) scoring system, and disabilities of the arm, shoulder, and hand (DASH) were scored to establish the function of the affected upper limb. Meaningful recovery was defined as grades of M3–M5 or S3–S4 based on the scoring system. Subgroup analysis and univariate and multivariate logistic regression analyses were conducted to identify predictors of human acellular nerve allograft reconstruction.RESULTSThe mean follow-up duration and the mean human acellular nerve allograft length were 48.1 ± 10.1 months and 30.9 ± 5.9 mm, respectively. Deltoid and biceps muscle strength was grade M4 or M3 in 71.1% and 60.0% of patients. Patients in the following groups achieved a higher rate of meaningful recovery in deltoid and biceps strength, as well as lower DASH scores (p < 0.01): age < 20 years and age 20–29 years; allograft lengths ≤ 30 mm; and patients in whom the interval between injury and surgery was < 90 days. The meaningful sensory recovery rate was approximately 70% in the Semmes-Weinstein monofilament test and S2PD. According to univariate and multivariate logistic regression analyses, age, interval between injury and surgery, and allograft length significantly influenced functional outcomes.CONCLUSIONSHuman acellular nerve allografts offered safe reconstruction for 20- to 50-mm nerve gaps in procedures for CC7 nerve root transfer to repair the upper trunk after BPI. The group in which allograft lengths were ≤ 30 mm achieved better functional outcome than others, and the recommended length of allograft in this procedure was less than 30 mm. Age, interval between injury and surgery, and allograft length were independent predictors of functional outcomes after human acellular nerve allograft reconstruction.

Thoracic Outlet Compression Syndrome Caused by a Schwannoma of the C7 Nerve Root

1997 ◽  
Vol 22 (5) ◽  
pp. 662-663 ◽  
Author(s):  
E. ATASOY
Keyword(s):  
Nerve Root ◽  
Carpal Tunnel Release ◽  
Pathological Examination ◽  
Clinical Impression ◽  
Scalene Muscle ◽  
Left Hand ◽  
Compression Syndrome ◽  
Left Elbow ◽  
Nocturnal Pain ◽  
Anterior Scalene Muscle

This is the first report of a schwannoma originating from the C7 nerve root causing thoracic outlet compression syndrome. The patient was a 30-year-old woman with a 3-year history of numbness on the radial side of the left hand, left arm tiredness, nocturnal pain in the left forearm and pain in the left elbow, shoulder and neck. Conservative treatment and previous operations, including carpal tunnel release and first rib resection, provided no relief. A left scalenectomy was performed. During the removal of the anterior scalene muscle, a mass approximately 3 cm long and 1.5 cm in diameter was noted under the anterior scalene muscle involving the C7 nerve root. The tumour was encapsulated and covered with attenuated and stretched nerve fascicles. It was completely excised without disturbing the nerve fascicles. The clinical impression was schwannoma, which was confirmed on pathological examination.

scholarly journals First Study of the Prevalence and Characterization of Brachial Plexus Injuries in Guatemala

2021 ◽  
Vol 16 (01) ◽  
pp. e46-e50
Author(s):  
Carmen Joanna González Lemus ◽  
Fernando Xavier Romero Prieto
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Main Mode ◽  
Cross Sectional ◽  
Speed Up ◽  
Male Patients ◽  
Mode Of Transportation ◽  
Surgery Department

Abstract Objective This study aimed to estimate the prevalence of brachial plexus injuries and to characterize clinically and epidemiologically patients with brachial plexus injury. Materials and Methods In this cross-sectional descriptive study, 2,923 medical records of patients aged 1 to 64 years who presented at outpatient peripheral nerve unit of the Orthopedic Surgery Department of Hospital Roosevelt, Guatemala, from January 2017 to December 2017, were prospectively analyzed to identify the prevalence and factors associated with brachial plexus injuries. Results The prevalence rate of brachial plexus injuries in patients was 5.74%. This injury is more common in men (90.5%) aged 24 to 64 years. Brachial plexus injuries occurred secondary to motorcycle accident in 72% of the cases, with the majority affecting the dominant upper extremity. In addition, 64.28% of the patients took 1 to 6 months to seek consultation, whereas only 16.07% requested medical assistance <1 month from the onset of symptoms, and this result was associated with early diagnosis and adequate recovery during follow-up. Furthermore, 66.67% presented upper brachial plexus injury with no associated fractures or vascular injury, manifesting distress while performing daily activities that required hand, arm, and elbow movements. Conclusion The risk of suffering BPIs in Guatemala increases in economically active male patients that use motorcycles as main mode of transportation. Patients should consult immediately after injury onset to optimize management results. For this reason, hospitals must develop specialized clinical guidelines to speed up the identification and treatment of BPI injuries.

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