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Brachial plexus injury following axillary arteriography

Case report and review of the literature

Dennis M. O'Keefe

W ith the rapid development of vascular surgery over the past 25 years, angiography with catheter techniques has become commonplace in most hospitals. Most studies are performed by retrograde femoral catheterization. In certain clinical situations involving evaluation for severe aortoiliac disease, abdominal aortic aneurysm, or coarctation of the aorta, the femoral route is impossible or contraindicated. The axillary artery may then be used as an alternative route. Injury to the brachial plexus and its branches as a complication of axillary arteriography has

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Paul M. Arnold, John B. Oldershaw, Larry W. McDonald, and Bradley G. Langer

mass is sometimes palpable. 1–5, 7, 9, 11, 18, 19, 21 We report a case of a myxomatous cyst associated with the brachial plexus. Case Report This 42-year-old black woman reported a 1-year history of worsening right-sided neck, shoulder, and arm pain. She also noted some weakness and a tingling numbness in her right hand. She denied having trouble with any of her other extremities. There was no history of trauma, cancer, or previous radiation therapy. Examination Physical examination was remarkable for 4/5 strength in all muscle groups of the right upper

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Annie S. Dubuisson, David G. Kline, and Steven S. Weinshel

the brachial plexus was developed when one of the authors (D.G.K.) was approached by a thoracic surgeon who requested help with a patient suffering TOS-like symptoms complicated by neurological impairment. It was decided that a posterior approach might provide exposure for both first-rib resection and for visualization of the proximal brachial plexus. In 1978, 12 examples of brachial plexus lesions explored through the posterior subscapular approach were presented and preliminary indications for the procedure were discussed. 9 Since then, 105 posterior subscapular

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David G. Kline and Donald J. Judice

S ome disagreement persists concerning the value of operative intervention for brachial plexus lesions. Thus, a few clinical investigators believe that most gunshot wounds (GSW) to the plexus recover without surgery; some view with some justifiable skepticism operations for stretch palsies of the plexus; others consider that some tumors intrinsic to the plexus are not resectable without serious loss of function, and that perhaps the rewards from repair even of sharply transected plexus elements are small due to their proximal location and the distance that

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John P. Laurent, Rita Lee, Saleh Shenaq, Julie T. Parke, Itzel S. Solis, and Lisa Kowalik

T he incidence of brachial plexus birth injuries varies from one to two in every 1000 live births. 13 The majority of infants will recover prior to consultation with a referral physician. This report considers the neurosurgical approach to birth injuries of the upper brachial plexus that have not shown improvement with conventional conservative therapy by the time the infant has reached the age of 4 months. Clinical Material and Methods Patient Population Of the 127 children consecutively evaluated for brachial plexus injury at The Texas Children

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David G. Kline

T he British experience with gunshot wounds (GSW's) to the brachial plexus in World War II indicated that some upper trunk and posterior cord lesions recovered spontaneously. Resection and suture led to functional improvement only in lesions of the upper trunk or C-5 and C-6 spinal nerve roots; although neurolysis of other elements did help pain, it seldom improved outcome. 3, 14 The experience in the United States, although larger and analyzed in a more detailed fashion, revealed similar limitations to operations on the plexus. 4, 13 In the interim, several

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Lee M. Burkholder, David A. Houlden, Rajiv Midha, Erin Weiss, and Marco Vennettilli

I t is imperative to evaluate accurately the type and level of lesions involved in brachial plexus injury, because management and prognosis of such an injury is determined by the distinction between proximal (preganglionic) and distal (postganglionic) lesion sites. 1 For example, in cases of postganglionic lesions in which the nerve rootlets are continuous with the spinal cord, direct nerve repair with or without grafts to promote regeneration of degenerated nerve fibers is possible. In the case of preganglionic lesions, however, in which the nerve roots are

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Sunit Das, Aruna Ganju, Robert L. Tiel, and David G. Kline

✓Tumors of the brachial plexus are relatively rare and present a clinical challenge for the neurosurgeon. The management of these tumors therefore requires not only an understanding of the complex anatomy of the brachial plexus but also an appreciation of the appropriate surgical approach to the various tumors that may be encountered. Over a 30-year period (1969–1999), 226 patients with brachial plexus tumors were evaluated and surgically treated by the senior authors (R.L.T., D.G.K.). In the present paper they review the most common benign and malignant brachial plexus tumors and discuss management and surgical principles established through their experience at the Louisiana State University Health Sciences Center.

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Deepak Awasthi, David G. Kline, and Edwin N. Beckman

forearm as well as shortness of breath during exercise. These symptoms persisted for the 3 months prior to admission. She denied any noticeable weakness in her left upper extremity. The patient was referred to our clinic after magnetic resonance imaging had revealed a large mass in the left brachial plexus area. In 1954, the patient had undergone a partial resection of a left supraclavicular mass at the age of 7 months. During the initial surgery the mass was noted to involve intimately the brachial plexus and the subclavian artery. It was considered that the tumor

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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