Pondaag Willem, van der Veken Lieven P A J, van Someren Paul J, van Dijk J Gert, Malessy Martijn J A
Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands.
J Neurosurg. 2008 Nov;109(5):946-54. doi: 10.3171/JNS/2008/109/11/0946.
A typical finding in supraclavicular exploration of infants with severe obstetric brachial plexus lesions (OBPLs) is a neuroma-in-continuity with the superior trunk and/or a root avulsion at C-5, C-6, or C-7. The operative strategy in these cases is determined by the intraoperative assessment of the severity of the lesion. Intraoperative nerve action potential (NAP) and evoked compound motor action potential (CMAP) recordings have been shown to be helpful diagnostic tools in adults, whereas their value in the intraoperative assessment of infants with OBPLs remains to be determined.
Intraoperative NAPs and CMAPs were systematically recorded from damaged and normal nerves of the upper brachial plexus in a consecutive series of 95 infants (mean age 175 days) with OBPLs. A total of 599 intraoperative NAP and 836 CMAP recordings were analyzed. The severity of the nerve lesions was graded as normal, axonotmesis, neurotmesis, or root avulsion, based on surgical, clinical, histological, and radiographic criteria.
The correlation of NAP and CMAP recordings with the severity of the lesion was assessed. The specificity of an absent NAP or CMAP to predict a severe lesion (neurotmesis or avulsion) was > 0.9. However, the sensitivity of an absent NAP or CMAP for predicting a severe lesion was low (typically < 0.3). The severity of the nerve lesion was related to CMAP and NAP amplitudes. Cutoff points useful for intraoperative decision making could not be found to differentiate between lesion types in individual patients.
Intraoperative NAP and CMAP recordings do not assist in decision making in the surgical treatment of infants with OBPLs. The authors' findings in infants cannot be generalized to adults.
在对患有严重产伤性臂丛神经损伤（OBPL）的婴儿进行锁骨上探查时，一个典型的发现是与上干连续性的神经瘤和/或C-5、C-6或C-7神经根撕脱。这些病例的手术策略取决于术中对损伤严重程度的评估。术中神经动作电位（NAP）和诱发复合运动动作电位（CMAP）记录已被证明是成人有用的诊断工具，而它们在患有OBPL的婴儿术中评估中的价值仍有待确定。
在连续的95例患有OBPL的婴儿（平均年龄175天）中，对上臂丛神经受损和正常神经系统地记录术中NAP和CMAP。共分析了599次术中NAP记录和836次CMAP记录。根据手术、临床、组织学和影像学标准，将神经损伤的严重程度分为正常、轴突断裂、神经断裂或神经根撕脱。
评估了NAP和CMAP记录与损伤严重程度的相关性。NAP或CMAP缺失预测严重损伤（神经断裂或撕脱）的特异性>0.9。然而，NAP或CMAP缺失预测严重损伤的敏感性较低（通常<0.3）。神经损伤的严重程度与CMAP和NAP振幅有关。在个体患者中，未能找到有助于术中决策的区分病变类型的临界点。
术中NAP和CMAP记录无助于患有OBPL的婴儿手术治疗的决策制定。作者在婴儿中的发现不能推广到成人。
