• Journal of Chest Surgery
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• v.27 no.4
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• pp.328-330
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• 1994

Brachial plexus injury developing after axillary thoracotomy is an uncommon complication. But if it occurs, it may cause annoying events. We recently experienced 2 patients who developed brachial plexus injury after wedge resection by axillary thoracotomy . The first patient was a 22 year-old man with right spontaneous pneumothorax . After wedge resection of the right upper lung by axillary thoracotomy, he complained total paralysis of the right arm. An electromyogram was obtained at 7 days after operation, with the confirmation of brachial plexus injury. He was discharged at 22days after operation and brachial plexus injury was completely recovered 4 months after discharge. The second patient was a 17 year-old man with recurrent right pneumothorax. He underwent wedge resection of the right upper lung by axillary thoracotomy. Electromyogram confirmed the diagnosis of brachial plexus injury in the immediate postoperative period. He was discharged at 15 days after operation and brachial plexus injury was recovered 2months after discharge.Brachial plexus injury after axillary thoracotomy is caused by stretching around the clavicle and tendon of pectoralis minor by fixation of the abducted arm to the frame. Thus, when we perform wedge resection by axillary thoracotomy, we must avoid over-stretching of the brachial plexus in positioning. If brachial plexus injury develops, immediate attention and management with close rapport are important to avoid possible medicolegal problems.

• The Korean Journal of Pain
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• v.33 no.2
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• pp.144-152
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• 2020

Background: Hemidiaphragmatic paralysis, a frequent complication of the brachial plexus block performed above the clavicle, is rarely associated with an infraclavicular approach. The costoclavicular brachial plexus block is emerging as a promising infraclavicular approach. However, it may increase the risk of hemidiaphragmatic paralysis because the proximity to the phrenic nerve is greater than in the classical infraclavicular approach. Methods: This retrospective analysis compared the incidence of hemidiaphragmatic paralysis in patients undergoing costoclavicular and supraclavicular brachial plexus blocks. Of 315 patients who underwent brachial plexus block performed by a single anesthesiologist, 118 underwent costoclavicular, and 197 underwent supraclavicular brachial plexus block. Propensity score matching selected 118 pairs of patients. The primary outcome was the incidence of hemidiaphragmatic paralysis, defined as a postoperative elevation of the hemidiaphragm > 20 mm. Factors affecting the incidence of hemidiaphragmatic paralysis were also evaluated. Results: Hemidiaphragmatic paralysis was observed in three patients (2.5%) who underwent costoclavicular and 47 (39.8%) who underwent supraclavicular brachial plexus blocks (P < 0.001; odds ratio, 0.04; 95% confidence interval, 0.01-0.13). Both the brachial plexus block approach and the injected volume of local anesthetic were significantly associated with hemidiaphragmatic paralysis. Conclusions: The incidence of hemidiaphragmatic paralysis is significantly lower with costoclavicular than with supraclavicular brachial plexus block.

• Journal of Korean Neurosurgical Society
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• v.39 no.5
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• pp.396-399
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• 2006

Brachial plexus schwannoma is rare. A case of a 28-year old woman who complained of a palpable mass in the right axilla is presented. She had previous incisional biopsy on the axillary mass. Brachial plexus magnetic resonance imaging revealed a well circumscribed contrast enhancing mass on the right distal cord of the brachial plexus. EMG revealed normal. Tumor resection was performed with the transaxillary approach. Though dense granulation tissue obscured normal brachial plexus nerve anatomy, using the surgical microscope and nerve stimulator, grossly total tumor resection was performed. She is free of any neurologic symptom at three months postoperatively.

• Journal of Chest Surgery
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• v.25 no.11
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• pp.1278-1281
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• 1992

We have experienced two cases of traumatic subclavian artery rupture at the department of thoracic and cardiovascular surgery, Youngdong Severance hospital, Yonsei University college of medicine. One was combined with brachial plexus injury and the other was combined with brachial plexus injury and subclavian vein rupture. They were treated with graft interposition after segmental resection of ruptured subclavian artery and neurorrhaphy for brachial plexus injury. Post operative courses were not eventful.

• Investigative Magnetic Resonance Imaging
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• v.11 no.2
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• pp.119-126
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• 2007

MR (magnetic resonance) imaging of the brachial plexus is challenging because of the complex and tangled anatomy of the brachial plexus and the multifariouness of pathologies that can put on it. Improvements in imaging techniques, including the availability of high resolution MR image systems and high channels multidetector computed tomography (CT), have led to more accurate diagnoses and improved serve for treatment planning. For the purpose of imaging and treatment of the brachioplexopathy, it is considerate to divide traumatic and nontraumatic diseases affecting the brachial plexus. MRI is the current gold standard imaging modality for nontraumatic brachial plexopathy. CT myelography is the preferred for the diagnosis of nerve root avulsions affecting the brachial plexus. Other modalities, such as CT, ultrasonography and positron emission tomography, have a limited role in the evaluation of brachial plexus pathology. High-quality, high-resolution MRI remains the main tool for imaging the brachial plexopathy.

• Journal of Korean Neurosurgical Society
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• v.52 no.2
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• pp.138-143
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• 2012

Objective : This is a retrospective review of 22 surgically treated benign and malignant tumors of brachial plexus region to describe clinical presentation, the characteristics of brachial plexus tumor and clinical outcomes with a literature review. Methods : Twenty-one patients with consecutive 22 surgeries for primary brachial plexus tumors were enrolled between February 2002 and November 2011 were included in this study. The medical records of all patients were reviewed. Results : Eleven male and 10 female patients were enrolled. Mean age was 39 years. Three patients had brachial plexus tumor associated with neurofibromatosis (13.6%). Presenting signs and symptoms included parenthesis and numbness (54.5%), radiating pain (22.7%), direct tenderness and pain (27.2%), palpable mass (77.3%). Twelve patients presented preoperative sensory deficit (54.5%) and 9 patients presented preoperative motor deficit (40.9%). Twenty tumors (90.9%) were benign and 2 tumors (9.1%) were malignant. Benign tumors included 15 schwannomas (68.2%), 4 neurofibromas (18.2%) and 1 granular cell tumor (4.5%). There were 1 malignant peripheral nerve sheath tumor (MPNST) and 1 malignant granular cell tumor. Gross total resection was achieved in 16 patients (72.7%), including all schwannomas, 1 neurofibroma. Subtotal resection was performed in 6 tumors (27.3%), including 3 neurofibromatosis associated with brachial plexus neurofibromas, 1 MPNST and 2 granular cell tumor in one patient. Conclusion : Resection of tumor is the choice of tumor in the most of benign and malignant brachial plexus tumors. Postoperative outcomes are related to grade of resection at surgery and pathological features of tumor.

• Journal of Korean Neurosurgical Society
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• v.61 no.5
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• pp.625-632
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• 2018

Objective : Because the anatomical structure of the brachial plexus is very complex, surgical treatment of tumors in this region is challenging. Therefore, a lot of clinical and surgical experience is required for successful treatment; however, many neurosurgeons have difficulty accumulating this experience owing to the rarity of brachial plexus tumors. The purpose of this report is to share our surgical experience with brachial plexus tumor with other neurosurgeons. Methods : The records of 18 consecutive patients with brachial plexus tumors who underwent surgical treatment between January 2010 and December 2017 in a single institution were retrospectively reviewed. The surgical approach was determined according to the tumor location and size, and intraoperative neurophysiological monitoring (IONM) was used in most of cases to prevent iatrogenic nerve injury during surgery. In addition, to evaluate the differences in tumor characteristics according to pathologic diagnosis, the tumors were divided twice into two groups, based on two separate classifications, and statistical analysis was performed. Results : The 18 brachial plexus tumors comprised 15 (83.3%) benign peripheral nerve sheath tumors including schwannoma and neurofibroma, one (5.6%) malignant peripheral nerve sheath tumor, one (5.6%) benign tumor of non-neural sheath origin (neurogenic cyst), and one (5.6%) metastatic tumor (papillary carcinoma). The authors analyzed relationship between tumor size/location and tumor characteristic parameters such as age, size, right-left, and pathology. There were no statistically significant differences except a tendency of bigger tumor size in young age. Conclusion : For a successful surgical outcome, an appropriate surgical approach is essential, and the appropriate surgical approach is determined by the location and size of the tumor. Furthermore, applying IONM may prevent postoperative complications and it is favorable option for brachial plexus tumors surgery.

• The Journal of Pediatrics of Korean Medicine
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• v.28 no.1
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• pp.14-23
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• 2014

Objectives The objective of this study is to report the effects of acupuncture on neonatal brachial plexus palsy (neonatal brachial plexopathy). Methods We treated the patient with acupuncture for 4 months. Acupuncture was performed on the infant with flaccid paresis of a lower extremity. The effects of neonatal brachial plexus injury were measured by the active movement scale and the electromyographic test. Results 1. In electromyographic test, conduction velocity in left median nerve was elevated. 2. Active movement scale score was increased from 6 to 27 during the 4 months of treatment. 3. Grasping power of the patient's left hand was 60% stronger than the first medical examination. Conclusions This study showed that acupuncture was effective in treating the symptoms of brachial plexopathy. The further studies might be also needed.

• The Korean Journal of Pain
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• v.21 no.3
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• pp.244-247
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• 2008

After a traumatic brachial plexus injury, 80% of patients develop severe pain in the deafferentated arm. This type of pain is considered very resistant to many forms of therapy. When we plan treatments for the patient who suffer from a pain from traumatic brachial plexus injury, clarifying the location of injured nerve is very important. EMG (electromyography), NCV (nerve conduction study), MRI (magnetic resonance imaging) and CT (computed tomography) myelography are recommended diagnostic method for this purpose. Here, we presented a patient who was suspected to have both preganglionic and postganglionic brachial plexus lesion by EMG and NCV study, he showed favorable response after spinal cord stimulation.

• Journal of Chest Surgery
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• v.37 no.1
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• pp.84-87
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• 2004

Neurogenic tumors of brachial plexus are rare lesions. Recently 1 experienced a case of Schwannoma arising from the brachial plexus. Thirtyfour-year-old man presented with a slow-growing mass on the left supraclavicular area. Magnetic resonance imaging revealed a well demarcated solid mass on posterosuperior aspect of the left subclavian artery. During operation, a well-encapsulated mass was seen beneath the brachial plexus. 1 performed intracapsular enucleation of the tumor from the none in an effort to avoid damaging none fibers as much as possible. Post-operative neurological deficit was not found.