Zingale A, Ponzo G, Ciavola G, Vagnoni G
Department of Neurosurgery, University of Catania, Catania, Italy.
J Neurosurg Sci. 2002 Dec;46(3-4):147-9.
Metastatic involvement of brachial plexopathy is a rare condition that is often associated with advanced systemic breast cancer and the role of surgeon appears to be restricted because radio-chemotherapy is better recommended in this setting. We report a case of a 64-year-old woman that presented a very delayed breast cancer metastatic lower trunks lesions without associated radiation injury, treated by surgery. MRI of plexus and CT of chest and axilla are methods of choice in preoperative radiological evaluation. Neurosurgeon effort is restricted to provide pathologic diagnosis (confirm of metastasis), adequate pain control and improvement of neurological function. So that surgical exploration and neurolysis should be performed as soon as possible after appearance of neurological deficits before denervation signs occurs. General surgeon presence should be warranted for more radical removal of remain lymph nodes and metastatic nodal infiltration of adjacent anatomical structures (vessels and so on) when detected by preoperative radiological work-up.
臂丛神经病变的转移累及是一种罕见情况，常与晚期全身性乳腺癌相关，由于在这种情况下更推荐放化疗，外科医生的作用似乎受限。我们报告一例64岁女性病例，该患者出现非常延迟的乳腺癌转移性下干病变且无相关放射损伤，接受了手术治疗。神经丛磁共振成像（MRI）以及胸部和腋窝计算机断层扫描（CT）是术前影像学评估的首选方法。神经外科医生的工作局限于提供病理诊断（确认转移）、充分控制疼痛以及改善神经功能。因此，应在神经功能缺损出现后且在失神经征象出现之前尽快进行手术探查和神经松解。当术前影像学检查发现有残留淋巴结以及相邻解剖结构（血管等）的转移性淋巴结浸润时，应确保有普通外科医生在场以便更彻底地切除。
