• Archives of Reconstructive Microsurgery
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• v.19 no.1
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• pp.1-6
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• 2010

Schwannoma of the brachial plexus region is very rare. There has not been general agreement in terms of surgical outcome from limited number of studies. We analyzed surgical outcomes from 11 cases of schwannomas which occurred in the brachial plexus. From February 2000 to August 2009, 11 patients with schwannomas of the brachial plexus region were surgically treated by a single surgeon. We retrospectively reviewed the medical records and MRI of our cases, and evaluated the neurologic deficit and the recurrence of tumors after surgery. All the cases were proven histologically as schwannomas. The mean age of the patients was 52.6(36~67) years old, 4 of them were male and 7 were female. The tumor was located in the left side in 9 patients, and right in 2. The mean postoperative follow-up was 24.7(6~78) months. Initial presentation was usually painless, palpable mass. The mass was located in various level of the brachial plexus such as root, trunk, cord, or terminal branch level. The size of mass was from $1.5{\times}1.5{\times}0.5$ cm to $11.0{\times}10.0{\times}6.0$ cm. Eight of 11 patients showed no neurologic deficit. Three patients showed postoperative neurologic deficit; two of them had transient sensory deficit, and one of them had weakness of flexor pollicis longus and 2nd flexor digitorum profundus. There were no recurrences. The schwannoma of the brachial plexus region should be considered as a curable lesion with an acceptable surgical risk of injury to neurovascular structures. With precise surgical techniques, these tumors can be removed to improve patient's symptoms with minimal morbidity.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.137-146
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• 1996

There has been no general agreement about optimal time for nerve surgery in the closed brachial plexus injury(BPI). From our early experiences, we knew by chance that spontaneous recovery in BPI patients may begin even later than 8 months after injury. Authors' strategy, which was based on our early experiences, for the treatment of closed fresh injury was 'wait and see' unlit 8 months after injury. From 1985 to 1994, we observed 103 patients with BPI. All of them did not have any operation until 8 months after injury. There were 95 men and 8 women with a mean age of 29 years. Motorcycle injury(31%) and vehicle accident(28%) were main causes of injury. Whole plexus types were observed in 56 patients(54%), upper plexus types in 29(28%), lower plexus types in 3(3%), and infraclavicular types in 15(15%). Electromyography was performed in all patients. This was repeated every three months to detect the recovery. Results were evaluated by authors' criteria, in which AMA system of brachial plexus impairment was modified. Duration of follow up was average 25 months. 47 patients(46%) showed spontaneous improvement, which was initially detected at average 7.8 months(range,3 months-16 months) after trauma by electromyography. The average score of these 47 patients improved from 14.8 points to 39.8 points.31 patients(30%) had nerve surgery such as nerve graft, neurotization or neurolysis. Average duration from injury to nerve surgery, was 10 months. Among 31 patients who had nerve surgery, 16 patients improved from preoperative 21.5 points to postoperative 36.3 points in average. Because spontaneous recovery began in average 7.8 months after injury, we think that it would be better to 'wait and see' for at least one year in patients with closed BPI expecting spontaneous recovery.

• Journal of Korean Neurosurgical Society
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• v.30 no.9
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• pp.1120-1126
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• 2001

Objective : The development of magnetic resonance neurography(MRN) has made it possible to produce highresolution images of peripheral nerves themselves, as well as associated intraneural and extraneural lesions. We evaluated the clinical application and utility of high-resolution MRN techniques for the diagnosis and treatment of a variety of peripheral nerve disorder(PND)s. Material and Method : MRN images were obtained using T1-weighted spin echo, T2-weighted fast spin echo with fat suppression, and short tau inversion recovery(STIR) fast spin-echo pulse sequences. Fifteen patients were studied, three with brachial plexus tumors, five with chronic entrapment syndromes, and seven with traumatic peripheral lesions. Ten patients underwent surgery. Results : In MRN with STIR sequences of axial and coronal imagings, signals of the peripheral nerves with various lesions were detected as fairly bright signals and were discerned from signals of the uninvolved nerves. Increased signal with proximal swelling and distal flattening of the median nerve were seen in all patients of carpal tunnel syndrome. Among the eight patients with brachial plexus injury or tumors, T2-weighted MRN showed increased signal intensity in involved roots in five, enhanced mass lesions in three, and traumatic pseudomeningocele in three. Other associated MRI findings were adjacent bony signal change, neuroma, root adhesion and denervated muscle atophy with signal change. Conclusion : MRN with high-resolution imaging can be useful in the preoperative evaluation and surgical planning in patients with peripheral nerve lesions.

• Journal of Acupuncture Research
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• v.32 no.2
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• pp.229-240
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• 2015

Objectives : The purpose of this report is to show the effect of complex traditional Korean medical care focused on warm needling(WN) and bee venom(BV) injection for a patient suffering from traumatic brachial plexus injury(BPI). Methods : A 51-year-old female patient with BPI was suffering from paresis and hypoesthesia with upper-extremity impairment. The patient had been treated once a day from 4 Feb to 11 Apr of 2015 mainly with WN and BV injection on the acupoints near the distribution of the brachial plexus. Improvement of the symptoms was measured by range of motion(ROM), manual muscle test(MMT) grip strength, and with the numeric rating scale(NRS) of tactile and pain sensitivity. Results : After 67 days of treatment, all obtained results showed remarkable improvement. The patient's satisfaction declaration was recorded through an interview at the end of the treatment. Conclusions : The results suggest that anatomically concerned WN and BV treatment can be a valuable option in reducing or normalizing pains from traumatic BPI.

• The Korean Journal of Pain
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• v.6 no.2
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• pp.261-264
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• 1993

A 26 year old male patient had admitted to the department of plastic surgery for the treatment of skin defect of forearm and spastic contracture of right hand, attributable to burn injury following carbon monoxide intoxication. After receiving skin graft the patients tenotomy of flexor tendons, the patients was consulted to pain clinic for further evaluation and treatment of allodynia, hyperalgesia, and hyperpathia with marked emotional insufficiency. The patient was treated with stellate ganglion blocks, intermittent or continuous epidural blocks, and intermittent brachial plexus blocks for 3 months. with this treatment the patient's pain level improved to(VAS 10 to 4~5) and was discharged. The patient was readmitted 3 months later, due to the aggrzvation of pain. Brachial plexus blocks were given again by interscalene, supraclavicular, or axillary route, sometimes using a catheter, together with cervical epidural blocks. Tricyclic antidepressant was also prescribed. The results were remarkably good(VAS 2~3) and the patient did not require any further analgesic medication.

• 대한미세수술학회:학술대회논문집
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• 1995.11a
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• pp.76.1-76.1
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• 1995

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2002.03a
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• pp.79-79
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• 2002

• 대한미세수술학회:학술대회논문집
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• 1999.11a
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• pp.200-201
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• 1999

• 대한미세수술학회:학술대회논문집
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• 1998.11a
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• pp.183-184
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• 1998

• Journal of Genetic Medicine
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• v.8 no.1
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• pp.71-75
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• 2011

A male infant was diagnosed with obstetric brachial plexus injury, congenital muscular torticollis and cleft palate 17 days after birth. His mother presented with gestational diabetes and premature rupture of membranes. Although it is possible that these three disorders arose independently, it is very likely that all three have the same etiologic cause, and we propose that a possible mechanism for this concurrence is related to maternal gestational diabetes. Maternal hyperglycemia mostly affects fetal structures deriving from the neural crest, including the palatine bone, and may have caused the cleft palate observed in this case. Gestational diabetes is also associated with increased frequency of large for gestational age infants and, by extension, with increased risk of birth injuries such as obstetric brachial plexus injury or congenital muscular torticollis associated with large for gestational age infants. Since the children of mothers with gestational diabetes are at increased risk for congenital defects such as cleft palate as well as being large for gestational age, precautions indicated for each respective disorder must be taken during prenatal testing and during birth. However, further studies of more cases are required to evaluate whether the concurrence of obstetric brachial plexus injury, congenital muscular torticollis and cleft palate in this case are complications specifically associated with gestational diabetes or just a simple coincidence.