Vol 45, No 2 (2011)

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Preganglionic injuries in perinatal brachial plexus palsies – results of surgical treatment

Jerzy Gosk1, Roman Rutowski12, Roman Wiącek1, Maciej Urban1, Piotr Mazurek1
DOI: 10.1016/S0028-3843(14)60025-6
Neurol Neurochir Pol 2011;45(2):140-147.

Abstract

Background and purpose

The authors report their experience in surgical treatment of preganglionic injuries in perinatal brachial plexus palsies.

Material and methods

Clinical material consisted of 16 children, of both sexes, aged from 2.5 to 33 months (mean 6.2 months), treated surgically between 1994 and 2006. The clinical view of the injury and location of preganglionic lesions was analysed and the description of the performed microsurgical techniques is provided. Control clinical examinations included a group of 14 children. The shortest postoperative observation period was 3 years. The currently accepted scales of evaluation of function of particular joints of the upper limb were used.

Results

The following outcome was noted after surgical treatment of perinatal brachial plexus palsies with signs of pre- and postganglionic injuries: good shoulder function in 6 cases, and average in 2 others; good elbow function in 4 cases, and average in 7 patients; functional position of the forearm in 9 cases, and good range of pronation and supination in 1 patient; useful function of wrist (flexion/extension) in 4 cases; good motor hand function in 3 cases, and fair in 6 patients.

Conclusions

In preganglionic perinatal brachial plexus injuries located in the upper-middle part, spinal nerve C7 roots avulsion is the most frequently observed, and in the lower part of the brachial plexus, spinal nerve C8 roots avulsion is the most frequently observed. In preganglionic injuries of the brachial plexus, the number of avulsed spinal nerves has an influence on technical possibilities of performing reconstruction procedures, and then the results of the surgical treatment.

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Neurologia i Neurochirurgia Polska