Faculty Collaboration Database

Outcome of surgically treated birth-related brachial plexus injuries in twenty cases. Pediatr Neurosurg 1997 Jul;27(1):19-27

Date

07/01/1997

Pubmed ID

9486832

DOI

10.1159/000121220

Scopus ID

2-s2.0-0031408289 (requires institutional sign-in at Scopus site)   46 Citations

Abstract

Birth-related brachial plexus injury occurs in 0.19-2.5 per 1,000 live births, of which 70-92% improve with conservative management. With the advent of microsurgical techniques, patients who fail expectant treatment may benefit from brachial plexus exploration and reconstruction. From 1991 to 1996, 87 patients were referred to the multidisciplinary brachial plexus clinic at St. Louis Children's Hospital. Twenty patients were selected for surgical management. The average age at surgery was 10.5 months (range 3-35, median = 8), with an average follow-up of 23.9 months (range 7-45, median = 24). Two patients were lost to follow-up. Surgical procedures included neurolysis (n = 8), neurotization (n = 2), nerve grafting (n = 5), and a combination (n = 3) of the above. Two patients underwent exploration without repair. Intercostal nerves, pectoral nerves, and C4 roots were used for neurotizations, and the sural nerve was used for nerve grafting. Results from 18 patients were available for follow-up review. Fifteen patients (83% demonstrated clinical improvement postoperatively. Of the 3 patients without improvement, 2 underwent exploration without repair, and one underwent neurolysis of the axillary nerve. Of patients undergoing reconstruction, 93% had improved strength postoperatively. No subjects had worsening neurologic status, and there were no complications. These results suggest that surgery for birth-related brachial plexus injury may show favorable outcomes if patients are selected appropriately. Patients undergoing neurolysis and nerve grafting had more favorable outcomes than those undergoing neurotization.

Author List

Sherburn EW, Kaplan SS, Kaufman BA, Noetzel MJ, Park TS

Author

Bruce A. Kaufman MD Adjunct Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Brachial Plexus
Child, Preschool
Delivery, Obstetric
Female
Humans
Infant
Male
Paralysis, Obstetric
Patient Selection
Prospective Studies
Treatment Outcome