Brachial Plexus Surgery - Present Limits and Perspectives

Abstract

Surgery of the brachial plexus is demanding field of surgery. The most common condition in this section of neurosurgical expertise that requires surgical treatment is brachial plexus injury. Timing of the surgical treatment is of the outmost importance. Most experts recommend conservative treatment for patients who have showed spontaneous recovery within the first few week after the trauma. Surgical treatment is indicated for patients who have an associated vascular lesion and for sharp wounds, in which a nerve lesion can be expected, exploration and repair of the divided neural elements should be undertaken as soon as the patient’s condition permits. The patient with a root avulsion injury should undergo surgery within the first few months after the injury. A closed injury without evidence of root avulsion should be treated by surgery, if there is no sign of recovery within 6 months. In cases of brachial plexus traction injuries only possibility is nerve transfer. Surgical treatment consists of neurolysis, nerve grafting, nerve transfer and combination of these procedures. Goal of the treatment is achieving good shoulder and elbow control, than elbow, wrist and finger extension, and finally sensibility of the hand and the forearm. Combined use of donor nerves in reinnervation of the musculocutaneus or axillary nerves results with high rate and better quality of recovery when compared with the other modalities of nerve transfer. The use of intraplexal and contralateral plexal neurotization along with a better understanding of central-peripheral function integration may provide improved results and purposeful hand function for our patients in the future. The other, much rarer pathology are tumors of brachial plexus. Radical to complete excision of the tumor with preservation of neurological function of the involved nerve is an ideal surgical treatment option with brachial plexus tumor surgery.