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Allan J. Belzberg and James N. Campbell

graftings and end-to-side neurorrhaphies connecting the phrenic nerve to the brachial plexus. Plast Reconstr Surg 96 : 494 – 495 , 1995 (Letter) Viterbo F, Franciosi LF, Palhares A: Nerve graftings and end-to-side neurorrhaphies connecting the phrenic nerve to the brachial plexus. Plast Reconstr Surg 96: 494–495, 1995 (Letter) 8. Viterbo F , Trindade JC , Hoshino K , et al : Two end-to-side neurorrhaphies and nerve graft with removal of the epineural sheath: experimental study in rats. Br J Plast Surg 47

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A brachial plexopathy due to myositis ossificans

Case report and review of the literature

John F. Reavey-Cantwell, Ira Garonzik, Michael P. Viglione, Edward F. M. McCarthy and Allan J. Belzberg

restricting range of motion. Ultimately, the mass ceases to grow over a period of 1 or 2 months, and after a year may gradually become smaller or even regress completely. 10, 18 There are few reported cases in the literature of MO causing peripheral neuropathy and these involved the radial, median, sciatic, and sural nerves. 5, 7, 8, 13, 19 We present the clinical, radiographic, and histopathological features of a patient in whom a brachial plexus neuropathy developed secondary to an MO lesion arising in the neck. Case Report This 30-year-old woman without a

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Allan J. Belzberg, Michael J. Dorsi, Phillip B. Storm and John L. Moriarity

Background

Brachial plexus injuries (BPIs) are often devastating events that lead to upper-extremity paralysis, rendering it a painful extraneous appendage. Fortunately, there are several nerve repair techniques that provide restoration of some function. Although there is general agreement in the medical community concerning which patients may benefit from surgical intervention, the actual repair technique for a given lesion is less clear.

Object

The authors sought to identify and better define areas of agreement and disagreement among experienced peripheral nerve surgeons regarding the management of BPIs.

Methods

The authors developed a detailed survey in two parts: one part addressing general issues related to BPI and the other presenting four clinical cases. The survey was mailed to 126 experienced peripheral nerve physicians of whom 49 (39%) participated in the study. The respondents represented 22 countries and multiple surgical subspecialties. They performed a mean of 34 brachial plexus reconstructions annually. Areas of significant disagreement included the timing and indications for surgical intervention in birth-related palsy, management of neuroma-in-continuity, the best transfers to achieve elbow flexion and shoulder abduction, the use of intra- or extraplexal donors for motor neurotization, and the use of distal compared with proximal coaptation during nerve transfer.

Conclusions

Experienced peripheral nerve surgeons disagreed in important respects as to the management of BPI. The decisions made by the various treating physicians underscored the many areas of disagreement regarding the treatment of BPI including the diagnostic approach to defining the injury, timing of and indications for surgical intervention in birth-related palsy, management of neuroma-in-continuity, choice of nerve transfers to achieve elbow flexion and shoulder abduction, use of intra- or extraplexal donors for neurotization, and the use of distal or proximal coaptation during nerve transfer.

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David G. Kline

As is the case in much of medicine as well as in life, “the devil is in the details.” Too often in talks and even in some publications concerning nerve injuries operative indications, surgical procedures, and outcomes are painted in broad strokes because details in individual cases can vary widely. Belzberg, et al., are to be applauded for attempting to focus the reader's attention on a specific, albeit frequent type of injury to the brachial plexus, the closed stretch—contusion. Questionnaires were sent to brachial plexus surgeons in different disciplines in

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Allan J. Belzberg, Michael J. Dorsi, Phillip B. Storm and John L. Moriarity

clearly defined. The present study was designed to define variability among experienced peripheral nerve surgeons on how best to treat a particular brachial plexus lesion. Our hypothesis is that when peripheral nerve surgeons are provided with the clinical details of a patient with a BPI, significant treatmentrelated disagreement will be observed. Additionally, it is hoped that the results of this survey will provide the less experienced practitioner with an overview of various brachial plexus lesions and the management approaches most often used by more experienced

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10.3171/jns.2005.102.2.0403 Neurosurgical Forum: Letters to the Editor To The Editor Marcos Tatagiba , M.D., Ph.D. Andrei Koerbel , M.D. University of Tuebingen Tuebingen, Germany 403 404 Abstract Object. Brachial plexus injuries (BPIs) are often devastating events that lead to upper-extremity paralysis, rendering the limb a painful extraneous appendage. Fortunately, there are several nerve repair techniques that provide restoration of some function. Although there is general agreement in

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William S. Anderson, Herman Christopher Lawson, Allan J. Belzberg and Frederick A. Lenz

anterior rami of the C6–8 (posterior scalene), C3–8 (MS), and C5–6 spinal roots (anterior scalene). 20 , 36 The MS extends the most superiorly of these 3 and is the first muscle encountered anterior to the LS. Fortunately, it also represents the last substantial muscular layer of protection between the surgeon and the underlying neurovascular structures. The brachial plexus is classically described as passing between the anterior scalene and MS as it descends inferiorly; however, this is true in ~ 60% of specimens, 36 with the most significant variations involving

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Michael J. Dorsi, Wesley Hsu and Allan J. Belzberg

T raumatic brachial plexus injuries can occur in young adults and result in significant neurological impairment. Although BPIs afflict slightly more than 1% of adult multitrauma victims, 23 their occurrence in children, excluding perinatal palsy, is considered very rare. Note, however, that their actual prevalence and characteristics in the pediatric population are unknown, and few publications describe the features and management of BPI in children. 10 , 11 , 14 Thus, we undertook this study to determine the prevalence and evaluate the characteristics of

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of those structures can be safe if appropriate technique is adopted. Full investigation of the anatomical position of the vessels might be required before surgery is performed. Neurosurg Focus Neurosurgical Focus FOC 1092-0684 American Association of Neurological Surgeons 2014.3.FOC-DSPNABSTRACTS Abstract Mayfield Clinical Science 233. Utility of Delayed Surgical Repair of Neonatal Brachial Plexus Palsy Zarina S Ali , MD , Dara Bakar , Yun Li , Alex Judd , Hiren C. Patel , MBBS, PhD

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Courtney Pendleton, Allan J. Belzberg, Robert J. Spinner and Alfredo Quinones-Hinojosa

T horacic outlet syndrome (TOS) remains a challenging entrapment syndrome to diagnose and treat, despite description of its symptoms dating back centuries. Neurogenic TOS, caused by compression of the lower trunk of the brachial plexus, is known to physicians and surgeons interested in the peripheral nervous system. Although descriptions of cervical ribs and their contributions to brachial plexus compression and TOS have been described since Vesalius, 12 with whom Dr. Harvey Cushing (1869–1939) was most certainly familiar, cervical rib resection for treatment