Article ; Online: Differences in the surgical treatment of adult and pediatric brachial plexus injuries among peripheral nerve surgeons.
Clinical neurology and neurosurgery
2023 Volume 228, Page(s) 107686
Abstract: Objectives: Peripheral nerve surgeons disagree on the optimal timing and treatment of brachial plexus injuries (BPI). This study aims to survey peripheral nerve surgeons on their management of BPI, including disagreement.: Methods: Surgeons responded ...
| Abstract | Objectives: Peripheral nerve surgeons disagree on the optimal timing and treatment of brachial plexus injuries (BPI). This study aims to survey peripheral nerve surgeons on their management of BPI, including disagreement. Methods: Surgeons responded to a case-based survey involving traumatic and birth injuries leading to BPI involving the upper and lower trunks, and pre- and post-ganglionic injuries. Results: Out of 255 invited surgeons, 154 participated, with specialties of Neurosurgery (33.7%), Plastic surgery (32.5%), and Orthopedics (32.5%). For the adult C5-6 avulsion injury, 97.4% agreed they would operate. There was 46.2% disagreement regarding the pediatric upper trunk neuroma-in-continuity case, and similar disagreement (50.0%) was recorded on exploring the brachial plexus for a pediatric lower trunk injury case. High percentages of surgeons were more likely to explore the plexus, such as at upper BPI. Also, most participants reported nerve transfer for the upper and lower trunk avulsion injuries, but there was 55.6% disagreement regarding nerve transfer for the infant with the upper trunk neuroma-in-continuity. Among those elected to perform nerve transfer, most (70.0%-84.5%) would perform an accessory-to-suprascapular nerve transfer for upper BPI, while brachialis-to-anterior interosseous and supinator branch of the radial nerve-to-posterior interosseous were preferred for lower BPI (30.0%-55.9%). Conclusions: Substantial disagreement exists among peripheral nerve surgeons in managing adult and pediatric BPI. In adult BPI, most prefer to operate at the time of the presentation and perform extensive nerve transfers. The accessory-suprascapular transfer was recommended for upper BPI, while brachialis and radial nerves were preferred for lower BPI. The most significant disagreements exist in operation and nerve transfer for pediatric upper BPI and brachial plexus explorations. Geography, specialty, and operative volume contribute to the differences seen. |
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| MeSH term(s) | Infant ; Humans ; Adult ; Child ; Brachial Plexus/surgery ; Brachial Plexus/injuries ; Peripheral Nerves ; Neurosurgical Procedures ; Neuroma/surgery ; Surgeons ; Peripheral Nerve Injuries/surgery |
| Language | English |
| Publishing date | 2023-03-21 |
| Publishing country | Netherlands |
| Document type | Journal Article |
| ZDB-ID | 193107-6 |
| ISSN | 1872-6968 ; 0303-8467 |
| ISSN (online) | 1872-6968 |
| ISSN | 0303-8467 |
| DOI | 10.1016/j.clineuro.2023.107686 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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