Kindl Radek P, Patel Krunal, Trivedi Rikin A
Department of Neurosurgery, Addenbroke's Hospital Cambridge University NH Trust, Cambridge, United Kingdom.
Oper Neurosurg. 2019 May 1;16(5):634-635. doi: 10.1093/ons/opy209.
Brachial plexus tumors are uncommon lesions in young adults. The majority of these are benign peripheral sheath tumors. In this 3-dimensional video, we present a case of a 19-yr-old female who presented to the neurosurgical outpatients with an anterior neck lump. It has been present for months, causing occasional numbness and paraesthesia in the distribution of the left ring finger. There was no objective weakness in finger flexion with normal long flexors reflexes. The cervical spine and supraclavicular brachial plexus were investigated with a magnetic resonance imaging (Gadolinium) scan (Figure 1). It demonstrated 30 × 20 × 20 mm lesion adjacent to the C8 nerve arising from the neural foramen, however, mostly occupying the space lateral to it. The patient was consented for resection of the tumor. This was done via the supraclavicular brachial plexus approach. The brachial plexus nerves were macroscopically demonstrated lateral to the anterior scalene muscle. The intraoperative electrophysiology was used to directly stimulate the nerves, which aided in accurate tracking during the dissection. The tumor was exposed after tracing the C8 nerve deep and medial to the anterior scalene muscle. It was resected down to the foramen, reaching the level of the epidural venous plexus, while C8 was spared. The patient recovered with no neurological deficit. The histopathology confirmed grade 1 schwannoma. Subsequently, there was no radiological follow-up performed. This case demonstrates the surgical dissection of supraclavicular brachial plexus in 3-dimensions while describing the unusual dissection medial to scalenus anterior muscle.
臂丛神经肿瘤在年轻成年人中是罕见的病变。其中大多数是良性周围神经鞘瘤。在这段三维视频中，我们展示了一例19岁女性病例，该患者因颈部前方肿块就诊于神经外科门诊。肿块已存在数月，导致左手环指分布区域偶尔出现麻木和感觉异常。手指屈曲时无客观肌无力，长屈肌反射正常。通过磁共振成像（钆增强）扫描对颈椎和锁骨上臂丛神经进行了检查（图1）。扫描显示在神经孔处有一个30×20×20毫米的病变，起源于C8神经，但大部分占据其外侧空间。患者同意切除肿瘤。手术通过锁骨上臂丛神经入路进行。在斜角肌前方外侧可宏观显示臂丛神经。术中使用电生理直接刺激神经，这有助于在解剖过程中进行精确追踪。在将C8神经追踪至斜角肌前方深部和内侧后暴露肿瘤。肿瘤被切除至神经孔，到达硬膜外静脉丛水平，同时保留了C8神经。患者恢复良好，无神经功能缺损。组织病理学证实为1级神经鞘瘤。随后，未进行影像学随访。本病例展示了锁骨上臂丛神经的三维手术解剖过程，同时描述了在斜角肌前方内侧进行的不寻常解剖。
