Brachial plexus variations during the fetal period

Abstract

The brachial plexus is an important nervous system structure. It can be injured during the perinatal period and by postnatal damage. The goal of this study was to assess human fetal brachial plexus variability. A total of 220 brachial plexuses were surgically prepared from 110 human fetuses aged 14-32weeks of fetal life (50 females and 60 males) ranging in CRL from 80 to 233mm. The study incorporated the following methods: dissectional and anthropological, digital image acquisition, digital image processing using Image J and GIMP software, and statistical methods (Statistica 9.0). Symmetry and sexual dimorphism were examined. Anomalies of the brachial plexuses were observed in 117 (53.18%) cases. No sexual dimorphism was found. It was observed that cord variations occurred more often on the left side. Division variants (33.64%) occurred most often, but also cords (18.18%) as well as root nerves and terminal ramifications (15.90%) were found. Trunk anomalies were rare and occurred in only 5.45% of plexuses. Three height types of median nerve roots in combination with the nerve were distinguished. In one-third of cases, median nerve root connections were found below the axillary fossa and even half in the proximal part of the humerus. In conclusion, the brachial plexus was characterized for anatomical structural variability. Most often division and cord variations were observed. Anomalies occurred regardless of sex or body side except for cord variants. Brachial plexus variation recognition is significant from the neurosurgical and traumatological point of view.