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Thomas J. Wilson, Kate W. C. Chang, Suneet P. Chauhan and Lynda J. S. Yang

N eonatal brachial plexus palsy (NBPP) results from the stretching of the nerves of the brachial plexus before, during, or after delivery. This disorder occurs in approximately 0.42 to 2.9 per 1000 live births. 3 , 11 , 14 , 16 The resulting neurological deficit depends on the portion of the brachial plexus that was injured, with the most common pattern being injury to C-5 and C-6 nerve roots (and/or upper trunk), resulting in weakness of shoulder abduction, external rotation, and elbow flexion. 7 Previous studies in the literature suggest that some

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.3171/2017.3.FOC-DSPNabstracts 2017.3.FOC-DSPNABSTRACTS Kline Peripheral Nerve Award Presentation 103. Prediction Algorithm for Surgical Intervention in Neonatal Brachial Plexus Palsy Thomas J. Wilson , MD , Kate Chang , and Lynda Jun-San Yang , MD, PhD 3 2017 42 3 Peripheral Nerve A2 A2 Copyright held by the American Association of Neurological Surgeons. You may not sell, republish, or systematically distribute any published materials without written permission from JNSPG. 2017 Introduction: Neonatal

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Kate W. C. Chang, Thomas J. Wilson, Miriana Popadich, Susan H. Brown, Kevin C. Chung and Lynda J. S. Yang

E ach year, neonatal brachial plexus palsy (NBPP) affects approximately 1.5 per 1000 live births in the United States. 43 , 45 Stretching of the nerves comprising the brachial plexus during the perinatal period results in weakness or paralysis of the shoulder, elbow, wrist, and/or hand. Approximately 10%–40% of infants with NBPP will have persistent NBPP at 1 year of age. 11 , 43 , 56 Depending on the site and severity of the injury, timely diagnosis, early referral, and surgical intervention can potentially benefit infants with persistent NBPP to maximize

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Thomas J. Wilson, B. Matthew Howe, Shelby A. Stewart, Robert J. Spinner and Kimberly K. Amrami

antigen in normal perineurial cells and perineurioma . Am J Surg Pathol 12 : 678 – 683 , 1988 3046395 10.1097/00000478-198809000-00004 2 Boyanton BL Jr , Jones JK , Shenaq SM , Hicks MJ , Bhattacharjee MB : Intraneural perineurioma: a systematic review with illustrative cases . Arch Pathol Lab Med 131 : 1382 – 1392 , 2007 17824794 3 Chung JH , Jeong SH , Dhong ES , Han SK : Surgical removal of intraneural perineurioma arising in the brachial plexus using an interfascicular dissection technique . Arch Plast Surg 41 : 296 – 299

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Thomas J. Wilson, Andres A. Maldonado, Kimberly K. Amrami, Katrina N. Glazebrook, Michael R. Moynagh and Robert J. Spinner

traumatic peroneal nerve palsy: the Inselspital Bern experience . Neurosurgery 77 : 572 – 580 , 2015 10.1227/NEU.0000000000000897 26164725 10 Oberlin C , Béal D , Leechavengvongs S , Salon A , Dauge MC , Sarcy JJ : Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsion of the brachial plexus: anatomical study and report of four cases . J Hand Surg Am 19 : 232 – 237 , 1994 8201186 10.1016/0363-5023(94)90011-6 11 Ratanshi I , Clark TA , Giuffre JL : Immediate nerve transfer for the treatment of peroneal nerve palsy

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Thomas J. Wilson, Andres A. Maldonado, Kimberly K. Amrami, Katrina N. Glazebrook, Michael R. Moynagh and Robert J. Spinner

ulnar nerve for C5-C6 avulsion of the brachial plexus: anatomical study and report of four cases . J Hand Surg Am 19 : 232 – 237 , 1994 11 Ratanshi I , Clark TA , Giuffre JL : Immediate nerve transfer for the treatment of peroneal nerve palsy secondary to an intraneural ganglion: case report and review . Plast Surg (Oakv) 25 : 54 – 58 , 2017 12 Reddy CG , Amrami KK , Howe BM , Spinner RJ : Combined common peroneal and tibial nerve injury after knee dislocation: one injury or two? An MRI-clinical correlation . Neurosurg Focus 39 ( 3 ): E

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Jawad M. Khalifeh, Christopher F. Dibble, Anna Van Voorhis, Michelle Doering, Martin I. Boyer, Mark A. Mahan, Thomas J. Wilson, Rajiv Midha, Lynda J. S. Yang and Wilson Z. Ray

investigation of alternative strategies has remained a priority. Only recently have nerve transfers been considered a viable treatment option, used alone or in combination with tendon transfers. 14 , 22 Using the same principles successfully applied for high peripheral nerve and brachial plexus injuries, nerve transfers in SCI place regenerating axons that remain under volitional cortical control close to the target motor endplates. 37 Nerve transfers rely on redundant motor axons above the SCI to reinnervate targets below the SCI, while preserving the natural biomechanics

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Jawad M. Khalifeh, Christopher F. Dibble, Anna Van Voorhis, Michelle Doering, Martin I. Boyer, Mark A. Mahan, Thomas J. Wilson, Rajiv Midha, Lynda J. S. Yang and Wilson Z. Ray

investigation of alternative strategies has remained a priority. Only recently have nerve transfers been considered a viable treatment option, used alone or in combination with tendon transfers. 14 , 22 Using the same principles successfully applied for high peripheral nerve and brachial plexus injuries, nerve transfers in SCI place regenerating axons that remain under volitional cortical control close to the target motor endplates. 37 Nerve transfers rely on redundant motor axons above the SCI to reinnervate targets below the SCI, while preserving the natural biomechanics

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Jawad M. Khalifeh, Christopher F. Dibble, Anna Van Voorhis, Michelle Doering, Martin I. Boyer, Mark A. Mahan, Thomas J. Wilson, Rajiv Midha, Lynda J. S. Yang and Wilson Z. Ray

in functional or strength outcomes after injury are lacking. 2 , 26 Only recently have nerve transfers been considered a viable treatment option, used alone or in combination with muscle and tendon transfers, to restore upper-extremity function. 10 , 17 Using the same principles successfully applied for peripheral nerve and brachial plexus injuries, nerve transfers in SCI place regenerating axons that remain under volitional control close to the target motor endplates. 26 Nerve transfers use redundant motor axons above the SCI to reinnervate target muscle groups