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Robert J. Spinner, Kimberly K. Amrami, Michel Kliot, Shawn P. Johnston and Joaquim Casañas

infraspinatus more than the supraspinatus muscle. Treatment. At surgery, an anterior supraclavicular approach allowed access to the SSN. The upper trunk of the brachial plexus, its divisions, and the SSN were mobilized. An intraneural ganglion was apparent in the lateral-most aspect of the distal portion of the upper trunk. A multilobulated cyst was noted to involve the SSN as it was traced distally toward the suprascapular notch ( Fig. 1 ). Intraoperatively, with stimulation of the SSN, no compound muscle action potential was recorded and no visible contraction was

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Robert J. Spinner, Bernd W. Scheithauer, Arie Perry, Kimberly K. Amrami, Ryan Emnett and David H. Gutmann

T he clinical and histological spectrum of nerve sheath tumors continues to expand. We present a patient without stigmata of NF1, NF2, or schwannomatosis, 5 , 6 who was found to have contiguous, albeit discrete nerve sheath tumors affecting the infraclavicular brachial plexus. The two separate lesions, a large cellular schwannoma and an adjacent plexiform neurofibroma, both arose from the same location, namely the radial nerve and posterior cord of the infraclavicular brachial plexus, respectively. We report this case to discuss the distinct

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Huan Wang, Robert Q. Terrill, Shota Tanaka, Kimberly K. Amrami and Robert J. Spinner

than other theories on the subject, especially the degenerative one. 87 Path of Least Resistance Intraneural propagation within the epineurium occurs following the path of least resistance. 22 Just as in the lower extremity where extensive longitudinal dissection of cyst may occur (for example, buttock level extension of a peroneal nerve 30 , 95 ) we identified a similar situation where an ulnar nerve cyst propagated from the cubital tunnel to the infraclavicular brachial plexus. 17 A suprascapular intraneural ganglia arising from the glenohumeral joint

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Robert J. Spinner, Bernd W. Scheithauer, Kimberly K. Amrami, Doris E. Wenger and Marie-Noëlle Hébert-Blouin

Arthrosc 19 : 823 – 824 , 2011 63 Phalen GS , Kendrick JI , Rodriguez JM : Lipomas of the upper extremity. A series of fifteen tumors in the hand and wrist and six tumors causing nerve compression . Am J Surg 121 : 298 – 306 , 1971 64 Price AJ , Compson JP , Calonje E : Fibrolipomatous hamartoma of nerve arising in the brachial plexus . J Hand Surg Br 20 : 16 – 18 , 1995 65 Rau CS , Hsieh CH , Liu YW , Wang LY , Cheng MH : Meralgia paresthetica secondary to lipoma. Case report . J Neurosurg Spine 12 : 103 – 105 , 2010

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Marie-Noëlle Hébert-Blouin, Bernd W. Scheithauer, Kimberly K. Amrami, Susan R. Durham and Robert J. Spinner

nerves such as the sciatic nerve or the brachial plexus. Patients with these lesions typically present in early childhood with a mass and/or neurological symptoms. Although these lesions are described as nonneoplastic, knowledge of their natural history is limited because of their rarity and the short follow-up. Recently, our 1 previously reported patient 29 presented with aggressive fibromatosis (desmoid tumor) fully 8 years after his original diagnosis of NMC. The occurrence of this complication in this patient and in 2 other previously reported cases 5 , 33

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Nikhil K. Prasad, Robert J. Spinner, Jay Smith, Benjamin M. Howe, Kimberly K. Amrami, Joseph P. Iannotti and Diane L. Dahm

and suprascapular notches, toward the upper trunk of the brachial plexus. The supraspinatus and infraspinatus muscles exhibited early signs of denervation with intramuscular edema but no atrophy. All other C5- and C6-innervated muscles within the radiological field of view appeared normal. Shoulder MR arthrography demonstrated intraarticular contrast extending from the labral tear as a narrow neck into the intraneural cyst ( Fig. 1 right). Preoperative ultrasound confirmed these findings and provided a baseline for comparison with subsequent assessments. FIG. 1

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Stepan Capek, Kimberly K. Amrami, P. James B. Dyck and Robert J. Spinner

transfers in brachial plexus palsies . Chir Main 28 : 1 – 9 , 2009 19 Oh SJ : Diagnostic usefulness and limitations of the sural nerve biopsy . Yonsei Med J 31 : 1 – 26 , 1990 20 Rajshekhar V : Current status of stereotactic biopsy . Stereotact Funct Neurosurg 76 : 137 – 139 , 2001 21 Ruth A , Schulmeyer FJ , Roesch M , Woertgen C , Brawanski A : Diagnostic and therapeutic value due to suspected diagnosis, long-term complications, and indication for sural nerve biopsy . Clin Neurol Neurosurg 107 : 214 – 217 , 2005 22 Spinner

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Nikhil K. Prasad, Mark A. Mahan, Benjamin M. Howe, Kimberly K. Amrami and Robert J. Spinner

neurological examination were normal. There was no percussion tenderness over the brachial plexus, and thoracic outlet maneuvers were negative. Imaging High-resolution 3-T MRI ( Fig. 1B ) showed that the lipomatous mass had regrown and was now associated with striking bony overgrowth ( Fig. 2B ). There was a circumferential proliferation of fatty tissue around the left-sided spinal nerves (C-7 to T-2) with extradural extension through the intervertebral foramen as far proximally as the spinal cord; distally it extended into the axillary sheath surrounding the brachial

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Pierre Laumonerie, Stepan Capek, Kimberly K. Amrami, P. James B. Dyck and Robert J. Spinner

previously reported the experience of 112 targeted fascicular biopsies of the sciatic nerve in proximal lower-extremity neuropathies and lumbosacral plexopathies, showing this biopsy technique to be safe and efficacious in obtaining a histological diagnosis. 5 In this report, we describe the results of our technique of fascicular biopsy applied to patients with brachial plexopathies and proximal neuropathies of the upper limb. As described above, a biopsy of the brachial plexus involves one to mixed motor/sensory nerve(s), with the distinct possibility of causing

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Jonathan J. Stone, Nikhil K. Prasad, Pierre Laumonerie, B. Matthew Howe, Kimberly K. Amrami, Jodi M. Carter, Mark E. Jentoft and Robert J. Spinner

.1007/s00256-012-1546-7 23184268 23 Özger H , Özkunt O , Akgül T , Sağlam Y : Preventing neurovascular invasion in desmoid tumors . Acta Orthop Traumatol Turc 47 : 286 – 290 , 2013 10.3944/AOTT.2013.2690 23999518 24 Polveche G , Langeron P , Saout J : [Extra-abdominal desmoid tumors. Apropos of a case in the calf.] J Chir (Paris) 123 : 255 – 260 , 1986 ( Fr ) 3745311 25 Press JM , Rayner SL , Philip M , Monga TN , Katz RT : Intraoperative monitoring of an unusual brachial plexus tumor . Arch Phys Med Rehabil 73 : 297