Optimized 3D brachial plexus MR neurography using deep learning reconstruction.

OBJECTIVE: To evaluate whether 'fast,' unilateral, brachial plexus, 3D magnetic resonance neurography (MRN) acquisitions with deep learning reconstruction (DLR) provide similar image quality to longer, 'standard' scans without DLR. MATERIALS AND METHODS: An IRB-approved prospective cohort of 30 subjects (13F; mean age = 50.3 ± 17.8y) underwent clinical brachial plexus 3.0 T MRN with 3D oblique-coronal STIR-T2-weighted-FSE. 'Standard' and 'fast' scans (time reduction = 23-48%, mean = 33%) were reconstructed without and with DLR. Evaluation of signal-to-noise ratio (SNR) and edge sharpness was performed for 4 image stacks: 'standard non-DLR,' 'standard DLR,' 'fast non-DLR,' and 'fast DLR.' Three raters qualitatively evaluated 'standard non-DLR' and 'fast DLR' for i) bulk motion (4-point scale), ii) nerve conspicuity of proximal and distal suprascapular and axillary nerves (5-point scale), and iii) nerve signal intensity, size, architecture, and presence of a mass (binary). ANOVA or Wilcoxon signed rank test compared differences. Gwet's agreement coefficient (AC2) assessed inter-rater agreement. RESULTS: Quantitative SNR and edge sharpness were superior for DLR versus non-DLR (SNR by + 4.57 to + 6.56 [p < 0.001] for 'standard' and + 4.26 to + 4.37 [p < 0.001] for 'fast;' sharpness by + 0.23 to + 0.52/pixel for 'standard' [p < 0.018] and + 0.21 to + 0.25/pixel for 'fast' [p < 0.003]) and similar between 'standard non-DLR' and 'fast DLR' (SNR: p = 0.436-1, sharpness: p = 0.067-1). Qualitatively, 'standard non-DLR' and 'fast DLR' had similar motion artifact, as well as nerve conspicuity, signal intensity, size and morphology, with high inter-rater agreement (AC2: 'standard' = 0.70-0.98, 'fast DLR' = 0.69-0.97). CONCLUSION: DLR applied to faster, 3D MRN acquisitions provides similar image quality to standard scans. A faster, DL-enabled protocol may replace currently optimized non-DL protocols.

A new classification of the shoulder girdle muscles in domestic fowl based on their innervation from the brachial plexus.

Many studies have described the muscle anatomy of the domestic fowl (Gallus gallus domesticus), a commonly used animal in developmental experiments. However, some major differences in terminology existed among studies, making it difficult to precisely discuss the muscle homologies between domestic fowl and other animals. In this study, the innervations of shoulder girdle muscles in five sides of the domestic fowl were elucidated and the homology of the shoulder girdle muscles between domestic fowl and other tetrapods was discussed using terminology that conforms to Nomina Anatomica Avium (1993). Unlike previous descriptions, the supracoracoideus, being developed in domestic fowl, is thought to have a different muscular origin from the deltoid muscle. The coracobrachialis cranialis, coracobrachialis caudalis and coracobrachialis muscles, previously described as the coracobrachialis muscle group, had different innervations; the coracobrachialis cranialis should be grouped with the deltoid muscles, and the coracobrachialis caudalis appears to belong to the pectoral muscle group. I propose that the subcoracoscapularis in domestic fowl, keeping the reptilian form, is divided into the subcoracoideus and subscapularis muscles. Based on the innervation, the subscapularis in domestic fowl is homologous with the subscapularis in reptiles and a major part of the subscapularis in mammals. Unlike the descriptions in previous studies, the scapulohumeralis cranialis and caudalis in the domestic fowl in this study, being innervated by the common branch, were found to have a close relationship with the subcoracoscapularis muscle. Based on the observations in this study, a new classification of the shoulder girdle muscles in domestic fowl is proposed.

Image analysis comparison of nerve staining with food dye, methylene blue or tissue marker.

OBJECTIVE: Novel locoregional techniques use dye studies to confirm successful nerve targeting. The goal was to objectively quantify and compare nerve staining characteristics of dye mixtures commonly reported in the literature using image analysis software. STUDY DESIGN: Prospective, randomized cadaveric study. METHODS: Thirty-six brachial plexus nerves from unpreserved pig cadavers were randomized into three groups of 12: FD (1:10 mixture of blue food dye and bupivacaine 0.5%), MB (methylene blue 1%) and TM (0.1:10 mixture of blue tissue marker and lidocaine 2%). Nerves were immersed in dye for 1, 15, 30 or 60 minutes (n = 3 each). Images of nerves before immersion (baseline) and at each time point with epineurium intact (superficial staining) and after longitudinal bisection (deep staining) were processed using image analysis software. Color saturation values were divided into quartiles (dark, medium-dark, medium-light or light). Percentage of stained nerve area in each quartile was calculated and compared using two-way anova. RESULTS: Superficially, at minute 1, dark saturation covered 40% of nerve area in FD versus 19% in MB (p = 0.04) and 0% in TM (p < 0.0001). In bisected nerves, dark and medium-dark saturations occurred only in FD; medium-light saturation comprised anywhere from 4% to 22.5% over time in FD versus <1% at any time in MB (p = 1.000; p = 0.343; p = 0.383; p = 0.262). Deep staining was not found in TM at any point. CONCLUSION AND CLINICAL RELEVANCE: Food dye rapidly stains superficial and deep nerve layers. Based on these characteristics, investigators can choose the appropriate dye for their study.

Infraspinatus-teres minor (ITM) interfascial block: a novel approach for combined suprascapular and axillary nerve block.

BACKGROUND: Combined suprascapular and axillary nerve block could be an analgesic option for shoulder pain control. The current description of this technique requires performing the block procedures at two different sites without consideration for catheter placement. We hypothesized that a single site injection to the interfascial plane between the infraspinatus and teres minor would result in an injectate spread to the suprascapular and axillary nerves. METHODS: We performed 10 injections with this approach using 25 mL dye solution in 10 shoulders of five unembalmed cadavers. Also, we described three case reports, two single-injection cases and one catheter-placement case, using this approach in patients with acute postsurgical pain and chronic pain in their shoulder region. RESULTS: In cadaveric evaluations, dye spreading to the suprascapular nerves on the infraspinatus fossa and the spinoglenoid notch cephalad and axillary nerves in the quadrilateral space caudally were observed in all injections. In addition, the most posterolateral part of the joint capsule was stained in 8 out of 10 injections. There was no dye spreading on the nerves to the subscapularis or lateral pectoral nerves. Clinically successful analgesia with no adverse events was achieved in all three cases. CONCLUSION: Our anatomical and clinical observations demonstrated that an injection to the interfascial plane between the infraspinatus and teres minor consistently achieved injectate spreading to both suprascapular and axillary nerves, which innervate the glenohumeral joint.

Anatomical Variations of the Musculocutaneous Nerve in the Human Fetus.

OBJECTIVES: Knowing the motor branches and variations of the musculocutaneous nerve to the muscles along its course will facilitate the treatment of flexor spasticity and supracondylar fractures of the humerus in order to minimize nerve lesion. In fetal cadavers, the purpose of our study was to determine the number and course of the formation variations and motor branches of the musculocutaneous nerve. The significance of studying fetal nerve variations is due to injury to the brachial plexus roots during birth. METHODS: Our study was conducted using the anatomical dissection technique on 102 upper limbs from 51 fetuses ages ranged from 17 to 40 weeks. Throughout its course, the variations and motor branches of the musculocutaneous nerve were analyzed. RESULTS: In 13.7% of cases, the musculocutaneous nerve did not pierce the coracobrachialis. The musculocutaneous nerve gave the muscles 1-3 motor branches. Additionally, motor branches terminated with 1-7 fringes. The biceps brachii motor branches of the musculocutaneous nerve were typed. Accordingly, 15.6% were type 1A, 3.9% were type 1B, 35.4% were type 1C, and 19.6% were type 1D. It was determined that 23.5% of the extremities were type 2 and that 1.9% were type 3. The distance between the musculocutaneous nerve's motor branches and the acromion was proportional to the arm's length. There were no statistically significant differences between the sides and genders for any measurement. CONCLUSIONS: Our study's findings will aid in the diagnosis and treatment of pediatrics, orthopedics, surgical sciences, and radiology conditions. It reduces the risk of iatrogenic injury and postoperative complications. We also believe that our research will serve as a resource for anatomists and other scientists.

Description of the neuroanatomy of the brachial plexus in South American lizards. Phylogenetic implications.

Few studies considered the anatomy of the nerve plexuses and musculature associated with them in ectothermic sauropsids. Based on differentiated Sudan Black B staining and conventional dissections, we describe the neuroanatomy of the brachial plexus, its main associated nerves, and muscles. For that, representatives of the genera Diplolaemus, Liolaemus, Phymaturus, and Tropidurus were selected. Based on this, potentially useful characters for phylogenetic analysis were described. Our results show that the brachial plexus can be formed by four, five, or six nerve branches. The brachial flexor trunk, circumflex, interosseous, median, radial, subscapulocoracoid, supracoracoid, and ulnar nerves were identified. Regarding the muscles innervated by the main nerves, the following muscles were identified: biceps brachii, deltoideus scapularis, latissimus dorsi, levator scapulae, pectoralis, serratus thoracis, trapezius, triceps longus caudalis, and triceps longus lateralis. Phylogenetic analyzes revealed 31 potential synapomorphies. There exists evidence that neuroanatomy studies in a phylogenetic context could provide useful information helping to elucidate the relationships between taxonomic groups.

Coracobrachialis muscle morphology and coexisted neural variants: a cadaveric case series.

PURPOSE: The current cadaveric case series evaluates the coracobrachialis muscle morphology, the related musculocutaneous nerve origin, course, and branching pattern, as well as associated adjacent neuromuscular variants. MATERIALS AND METHODS: Twenty-seven (24 paired and 3 unpaired) cadaveric arms were dissected to identify the coracobrachialis possible variants with emphasis on the musculocutaneous nerve course and coexisted neural variants. RESULTS: Four morphological types of the coracobrachialis were identified: a two-headed muscle in 62.96% (17/27 arms), a three-headed in 22.2% (6/27), a one-headed in 11.1% (3/27), and a four-headed in 3.7% (1 arm). A coracobrachialis variant morphology was identified in 37.04% (10/27). A three-headed biceps brachii muscle coexisted in 23.53% (4/17). Two different courses of the musculocutaneous nerve were recorded: 1. a course between coracobrachialis superficial and deep heads (in cases of two or more heads) (100%, 24/24), and 2. a medial course in case of one-headed coracobrachialis (100%, 3/3). Three neural interconnections were found: 1. the lateral cord of the brachial plexus with the medial root of the median nerve in 18.52%, 2. the musculocutaneous with the median nerve in 7.41% and 3. the radial with the ulnar nerve in 3.71%. Duplication of the lateral root of the median nerve was identified in 11.1%. CONCLUSIONS: The knowledge of the morphology of the muscles of the anterior arm compartment, especially the coracobrachialis variant morphology and the related musculocutaneous nerve variable course, is of paramount importance for surgeons. Careful dissection and knowledge of relatively common variants play a significant role in reducing iatrogenic injury.

The surgical anatomy of the axillary approach for nerve transfer procedures targeting the axillary nerve.

PURPOSE: The exact relational anatomy for the anterior axillary approach, targeting the axillary nerve for nerve transfers/grafts, has not been fully investigated. Therefore, this study aimed to dissect and document the gross anatomy surrounding this approach, specifically regarding the axillary nerve and its branches. METHODS: Fifty-one formalin-fixed cadavers (98 axilla) were bilaterally dissected simulating the axillary approach. Measurements were taken to quantify distances between identifiable anatomical landmarks and relevant neurovascular structures encountered during this approach. The musculo-arterial triangle, described by Bertelli et al., to aid in identification on localization of the axillary nerve, was also assessed. RESULTS: From the origin of the axillary nerve till (1) latissimus dorsi was 62.3 ± 10.7 mm and till (2) its division into anterior and posterior branches was 38.8 ± 9.6 mm. The origin of the teres minor branch along the posterior division of the axillary nerve was recorded as 6.4 ± 2.9 mm in females and 7.4 ± 2.8 mm in males. The musculo-arterial triangle reliably identified the axillary nerve in only 60.2% of the sample. CONCLUSION: The results clearly demonstrate that the axillary nerve and its divisions can be easily identified with this approach. The proximal axillary nerve, however, was situated deep and therefore challenging to expose. The musculo-arterial triangle was relatively successful in localising the axillary nerve, however, more consistent landmarks such as the latissimus dorsi, subscapularis, and quadrangular space have been suggested. The axillary approach may serve as a reliable and safe method to reach the axillary nerve and its divisions, allowing for adequate exposure when considering a nerve transfer or graft.

Origin variations and brachial plexus relationship of the dorsal scapular artery.

The dorsal scapular artery can either be a direct branch of the subclavian artery or a branch of the transverse cervical artery. Origin variation is related to its relationship with the brachial plexus. Anatomical dissection was performed on 79 sides of 41 formalin-embalmed cadavers in Taiwan. The origin of the dorsal scapular artery and the variations of its brachial plexus relationship were scrutinized and analyzed. Results showed that the dorsal scapular artery originated most frequently from the transverse cervical artery (48%), followed by the direct branch from the third part (25%) and the second part (22%) of the subclavian artery and from the axillary artery (5%). Only 3% of the dorsal scapular artery passed through the brachial plexus if its origin was the transverse cervical artery. However, 100% and 75% of the dorsal scapular artery passed through the brachial plexus when they were direct branches of the second and the third part of the subclavian artery, respectively. Suprascapular arteries were also found to pass through the brachial plexus when they were direct branches from the subclavian artery, but all passed over or under the brachial plexus if they originated from the thyrocervical trunk or transverse cervical artery. Variations in the origin and course of arteries around the brachial plexus are of immense value not only to the basic anatomical knowledge but also to clinical practices such as supraclavicular brachial plexus block and head and neck reconstruction with pedicled or free flaps.

Histologic evidence of brachial plexus compression sites at the thoracic inlet and variations in formation of the lower trunk in cadavers.

BACKGROUND: In thoracic "outlet" syndrome (TOS), pathologic evidence is well documented for vascular but not neurologic compression. We hypothesized that histologic evidence of compression would be identified at sites where the upper trunk was impacted by the anterior scalene muscle and the lower trunk by anatomic anomalies or the first rib. The purpose of this study was to investigate this hypothesis in human cadavers. MATERIALS AND METHODS: Twenty-five cadavers' brachial plexuses were dissected and excised. Histologic and descriptive analysis was directed at juncture 1, the upper trunk and anterior scalene muscle, and juncture 2, C8 and T1 nerve roots (lower trunk) with the posterior border of the first rib. Measurements were obtained at the juncture of the T1 nerve root with the C8 nerve root in relationship to the first rib. RESULTS: Histologic analysis demonstrated epineurial and perineurial fibrosis, myelin thinning, and Renaut bodies at junctures 1 and 2. Lower trunk formation occurred on or lateral to the first rib in 66% of specimens, with asymmetry in 32% of cadavers. A muscle of Albinus was present in 18% of cadavers. A large dorsal scapular artery coursed through 36% of plexuses with a high, arched subclavian artery. CONCLUSIONS: We report histologic changes consistent with chronic compression of the upper and lower plexus in the thoracic inlet at hypothesized sites of brachial plexus compression that may correlate with clinical neck/shoulder (upper trunk) and "ulnar nervelike" (C8-T1/lower trunk) symptoms. Anatomic anomalies identified should alert the surgeon to variations of lower trunk formation at compression sites.

Management of the brachial plexus in head and neck cancer.

PURPOSE OF REVIEW: The brachial plexus is an important anatomical structure that is regularly encountered by head and neck surgeons and radiation oncologists. Surgical or radiation-induced brachial plexus injury have great impact on arm function and quality of life. Anatomical variations and management of the brachial plexus in head and neck cancer treatment are discussed. RECENT FINDINGS: The brachial plexus consists of spinal roots from C5-C8 and T1. The most prevalent anatomical variations in brachial plexus anatomy include the prefixed brachial plexus (additional contribution from C4) in 11%, the roots of C5 and C6 piercing the belly of the anterior scalene muscle in 6.8%, and presence of the scalenus minimus muscle in 4.1-46%. Due to its location, the brachial plexus is at risk of inadvertent division or neuropraxia during surgical procedures such as neck dissection or robot-assisted transaxillary thyroid surgery (RATS). In case of inadvertent division, nerve reconstruction surgery is warranted and may lead to improved function. The risk of radiation-induced brachial plexus injury is dose-dependent and occurs in approximately 12-22%. Currently, no successful treatment options exist for radiation-induced injury. SUMMARY: Knowledge of anatomical variations is important for head and neck surgeons to minimize the risk of brachial plexus injury. Limiting radiation therapy dose to the brachial plexus is desirable to decrease the risk of brachial plexus injury.

A rare variation of radial nerve coexisting with the intercalated ectopic muscle from latissimus dorsi muscle / Una rara variación del nervio radial que coexiste con el músculo ectópico intercalado del músculo latísimo del dorso

SUMMARY: The axilla is the main communication channel connecting the upper limbs, the neck and chest. Stabilization of the internal structure is essential for upper limb and shoulder mobility. In this case, we observed and recorded the characteristics of the variation of the radial nerve as well as the intercalated ectopic muscle from latissimus dorsi muscle. The position relationship between both, was also particularly noted by us. In view of the presence of the variation we reported, related clinical research, surgery and disease diagnosis are expected to take this case into account.

La axila es el principal canal de comunicación que conecta los miembros superiores, el cuello y el tórax. La estabilización de la estructura interna es fundamental para la movilidad del miembro superior y del hombro. En este caso observamos y registramos las características de la variación del nervio radial así como del músculo ectópico intercalado del músculo latísimo del dorso. La relación de posición entre ambas también fue significativa en este estudio. En vista de la presencia de la variación que informamos, se espera que la investigación clínica relacionada con la cirugía y el diagnóstico de la enfermedad tengan en cuenta este caso.

Prevalence and anatomy of the anomalous subclavius posticus muscle and its clinical implications with emphasis in neurogenic thoracic outlet syndrome: Scoping review and meta-analysis.

BACKGROUND: The subclavius muscle runs underneath the clavicle. However, there have been a few reports of a duplicated subclavius muscle which is commonly referred to as subclavius posticus muscle due to its orientation being posterior to the proper subclavius muscle. Its occurrence seems to potentially create a narrowing interval at the superior thoracic aperture as it crosses over the brachial plexus. It might also have functional influence on the shoulder girdle. PURPOSE: To provide comprehensive gross anatomy description of the variant "subclavius posticus muscle" and to investigate its reported clinical implications with emphasis on its involvement in causing brachial plexus compression. BASIC PROCEDURES: A scoping review with meta-analysis of the gross anatomy of the subclavius posticus muscle was conducted along with investigating its correlation to the thoracic outlet syndrome. Forty-seven articles were pooled through two rounds of the selection process. The relevant information was extracted and meta-analyzed. MAIN FINDINGS: The scoping review and meta-analysis of the 47 articles revealed a total prevalence of 11/2069 (4.9%); 10/1369 (5.1%) in cadaveric studies, and 1/700 (5.0%) in MRI studies. The subclavius posticus muscle is a short triangular muscle with an average length of 12 cm and an average width of 1 cm. It originates from the sternal end of the first rib in most cases with reported variants of one case originating from the costoclavicular ligament and one case where it was fused with the proper subclavius muscle. Its insertion is more variable: on the superior border of the scapula with variable length in 71.35%, on the coracoid process of the scapula in 25.42%, and on the clavicle in 0.90%. The subclavian nerve seems to be the dominant nerve supply with a 57.6% prevalence, while 25.8% are innervated by the suprascapular nerve. Other reported nerves were the nerve to the myolohyoid (4.5%), accessory phrenic nerve (4.5%), and a direct branch from the brachial plexus (2.0%). The blood supply was reported (only once) to be from the suprascapular artery. However, the venous drainage was not established at all. PRINCIPAL CONCLUSIONS: The subclavius posticus muscle is a variant muscle occurring with a reported overall prevalence of 4.9%. It can compress the brachial plexus as it runs across at the space of the superior thoracic aperture with exquisite contact, and this can lead to a neurogenic thoracic outlet syndrome. It also can be involved in the vascular thoracic outlet syndrome. Lastly, it is important not to omit its potential influence in shoulder joint instability to some extent.

Morphological significance of the medial brachial cutaneous nerve: An anatomical study of the brachial plexus in primates.

The medial brachial cutaneous nerve (MBC) originates from the medial cord of the brachial plexus and innervates the skin sensory in the medial posterior surface of the upper arm. Considering previous reports of the primate brachial plexus, the MBC appeared to be the sole branch in the brachial plexus that only some primates possess. However, the detailed descriptions and records regarding the morphology of the MBC and related nerves, their origins and distributions (dermatomes) in particular, were frequently lacked in the previous reports, and it remains unclear why the difference in the MBC appearance exists among primates. In this study, the brachial plexus and its branches were first re-evaluated and certainly identified in several primates, humans, chimpanzee, macaque monkey, lutung, tamarin, squirrel monkey, and spider monkey. The MBC was identified in humans, chimpanzee, spider monkey, and squirrel monkey. In the other species, the intercostobrachial nerve (ICB) originating from some of 1st to 3rd intercostal nerves developed and distributed instead of the MBC. According to the kinesiological and behavioral studies, the former species possessing MBC show high shoulder joint mobility associated with their locomotive patterns. We speculate that the MBC corresponds to transformed ICB; specifically, where it originates presumably transfers from the 1st and/or 2nd intercostal nerves to the brachial plexus, which allows it to reach the upper arm by coursing the shortest distance even if the forelimb is raised high. Therefore, MBC may embody phylogenetic morphogenesis of the nerve associated with the locomotive evolution and adaptation in primate forelimb.

A rare bilateral variant of the coracobrachialis muscle with supernumerary heads and coexisted variant branching patterns of the brachial plexus and the axillary artery.

PURPOSE: The study report describes a rare bilateral variant of a six- and five-headed coracobrachialis muscle (CB). The musculocutaneous nerve (MCN) (bilaterally) and the median nerve (MN) lateral root (unilaterally) pierced CB heads, separating superficial from deep heads. METHODS: The variant bilateral CB was identified in a 78-year-old formalin-embalmed male cadaver, derived from a body donation program after a signed informed consent. RESULTS: At the right side: The 6-headed CB was pierced by the MCN, while the MN lateral root pierced the one superficial and deep head. CB was supplied by the lateral cord and the MCN. At the left side: A 5-headed CB was identified with three superficial distinct origins that fused into a common superficial head coursing anterior to MCN. The variant CB bilaterally (with 11 heads in total) coexisted with a MN variant formation, an atypical course of the MN lateral root through CB (right side), a connection of the MN lateral root with the MCN (left side) and a variant axillary artery branching pattern (bilaterally). CONCLUSIONS: Course and direction of the accessory CB heads may occasionally entrap the MCN and/or adjacent structures (brachial artery and MN). The MCN compression results in problems in the glenohumeral joint flexion and adduction, and tingling or numbness of the elbow joint, the forearm lateral parts and the hand.

Entrapment of subscapular artery by the splitting of radial nerve- putative clinical implications.

The third part of the axillary artery has an intimate relationship with the cords of the brachial plexus. The subscapular artery, the largest branch of the axillary artery, arises from its third part. The radial nerve is a branch of the posterior cord of the brachial plexus and its supplies the extensors of the arm, forearm and dorsum of the hand. During routine undergraduate dissection of the axilla of a formalin-fixed cadaver of about 70 years, the subscapular artery was found sandwiched between two divisions of the radial nerve. These anterior and posterior divisions of the radial nerve arose immediately after the formation of the radial nerve and encircled the subscapular artery and fused to form a single nerve subsequently. This variant anatomy can lead to conditions like subscapular entrapment causing ischemia of the scapular region and radial nerve compression causing weakness of the extensors of the upper limb. Injury to the nerve and vessel can occur while performing diagnostic and therapeutic procedures in the area. Knowledge of these variations provides a precautious approach by surgeons and other interventionists while working on this area.

Nerve root transfer from C4 to C5 in brachial plexus injuries. Anatomical study and description of the surgical technique / Transferência nervosa da raiz de C4 para C5 em lesões do plexo braquial. Estudo anatômico e descrição de técnica cirúrgica

Abstract Objective This is an anatomical study of C4 and C5 roots for nerve transfers in upper brachial plexus injuries, with surgical technique demonstration. Methods Fifteen brachial plexuses from both male and female cadavers were dissected. Morphological features of C4 and C5 roots were recorded and analyzed, followed by a neurotization simulation. Results In all dissections, C4 and C5 roots morphological features allowed their mobilization and neurotization with no need for a nerve graft. The surgical technique spared important regional nerve branches. Conclusion Based on these data, we conclude that C4-C5 nerve transfers are feasible and result in no additional neurological deficit in upper brachial plexus injuries.

Resumo Objetivo Estudo anatômico das raízes usadas na transferência nervosa de C4 para C5 nas lesões altas do plexo braquial, com demonstração da técnica cirúrgica. Métodos Dissecção de 15 plexos braquiais de cadáveres de ambos os sexos, registro e análise das características morfológicas das raízes de C4 e C5 e simulação de neurotização. Resultados As características morfológicas encontradas nas raízes de C4 e C5 em todas as dissecções permitiram a mobilização das mesmas e a realização de uma neurotização sem a necessidade de usar enxerto nervoso. A técnica cirúrgica permitiu preservar ramos nervosos importantes na região abordada. Conclusão Com base nos dados encontrados no presente estudo, podemos concluir que é possível realizar a transferência entre C4 e C5 sem provocar déficit neurológico adicional nas lesões altas de plexo braquial.