Outcomes of surgery in 1019 brachial plexus lesions treated at Louisiana State University Health Sciences Center.
OBJECTIVE
Outcomes of 1019 brachial plexus lesions in patients who underwent surgery at Louisiana State University Health Sciences Center during a 30-year period are reviewed in this paper to provide management guidelines.


METHODS
Causes of brachial plexus lesions included 509 stretches/contusions (50%), 161 plexus tumors (16%), 160 thoracic outlet syndromes (TOSs, 16%), 118 gunshot wounds (12%), and 71 lacerations (7%). Many features of clinical presentation, including prior treatment, patient's neurological status, results of electrophysiological studies, intraoperative findings, and postoperative level of function, were studied. The minimum follow-up period was 18 months and the mean follow-up period was 42 months. Repairs were best for injuries located at the C-5, C-6, and C-7 levels, the upper and middle trunk, the lateral cord to the musculocutaneous nerve, and the median and posterior cords to the axillary and radial nerves. Conversely, results were poor for injuries at the C-8 and T-1 levels, and for lower trunk and medial cord lesions, with the exception of injuries of the medial cord to the median nerve. Outcomes were most favorable when patients were carefully evaluated and selected for surgery, although variables such as lesion type, location, and severity, as well as time since injury also affected outcome. This was true also of TOSs and tumors arising from the plexus, especially if they had not been surgically treated previously.


CONCLUSIONS
Surgical exploration and repair of brachial plexus lesions is technically feasible and favorable outcomes can be achieved if patients are thoroughly evaluated and appropriately selected.
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California 94305-5327, USA. neurokim@stanford.edu
Daniel H
DH
Kim
Yong-Jun
YJ
Cho
Robert L
RL
Tiel
David G
DG
Kline
D000200:Action Potentials / Q000502:physiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D001917:Brachial Plexus / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D020516:Brachial Plexus Neuropathies / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D019091:Critical Pathways; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009416:Nerve Regeneration / Q000502:physiology; D018317:Nerve Sheath Neoplasms / Q000503:physiopathology / Q000601:surgery*; D010525:Peripheral Nerves / Q000637:transplantation; D010524:Peripheral Nervous System Neoplasms / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D012189:Retrospective Studies; D013901:Thoracic Outlet Syndrome / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome