Video-assisted thoracoscopic dissection of the brachial plexus: cadaveric study and illustrative case.
OBJECTIVE
Standard surgical approaches to the brachial plexus require an open operative technique with extensive soft tissue dissection. A transthoracic endoscopic approach using video-assisted thoracoscopic surgery (VATS) was studied as an alternative direct operative corridor to the proximal inferior brachial plexus.


METHODS
VATS was used in cadaveric dissections to study the anatomic details of the brachial plexus at the thoracic apex. After placement of standard thoracoscopic ports, the thoracic apex was systematically dissected. The limitations of the VATS approach were defined before and after removal of the first rib. The technique was applied in a 22-year-old man with neurofibromatosis who presented with a large neurofibroma of the left T1 nerve root.


RESULTS
The cadaveric study demonstrated that VATS allowed for a direct cephalad approach to the inferior brachial plexus. The C8 and T1 nerve roots as well as the lower trunk of the brachial plexus were safely identified and dissected. Removal of the first rib provided exposure of the entire lower trunk and proximal divisions. After the fundamental steps to the dissection were identified, the patient underwent a successful gross total resection of a left T1 neurofibroma with VATS.


CONCLUSIONS
VATS provided an alternative surgical corridor to the proximal inferior brachial plexus and obviated the need for the extensive soft tissue dissection associated with the anterior supraclavicular and posterior subscapular approaches.
Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Chad J
CJ
Morgan
Jefferson
J
Lyons
Benjamin C
BC
Ling
P Colby
PC
Maher
Robert J
RJ
Bohinski
Jeffrey T
JT
Keller
John A
JA
Howington
Charles
C
Kuntz
D000328:Adult; D001917:Brachial Plexus / Q000033:anatomy & histology* / Q000601:surgery*; D002102:Cadaver; D006801:Humans; D008297:Male; D009423:Nervous System Neoplasms / Q000601:surgery*; D009455:Neurofibroma / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*