Smith Brandon W, Chang Kate W C, Yang Lynda J S, Spires Mary Catherine
Departments of1Neurosurgery and.
2Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan.
J Neurosurg Pediatr. 2019 Jan 1;23(1):119-124. doi: 10.3171/2018.7.PEDS18193. Epub 2018 Oct 5.
OBJECTIVEThe incorporation of ancillary testing in the preoperative setting for patients with neonatal brachial plexus palsy (NBPP) remains controversial, but the recommendation for early nerve reconstruction when a baby has a preganglionic lesion at the lower nerve roots is generally accepted. At some specialty centers, nerve surgeons use preoperative electrodiagnostic testing (EDX) and imaging to aid in lesion localization and the preoperative planning of the nerve reconstruction. EDX and imaging have been evaluated for their abilities to detect pre- and postganglionic lesions, but their accuracies have never been compared directly in the same set of patients. The aim of the present study was to evaluate the accuracy of imaging and EDX in an NBPP population.METHODSA retrospective review was conducted of 54 patients with operative NBPP seen between 2007 and 2017. The patients underwent EDX and imaging: EDX was performed, and the results were reviewed by board-certified electrodiagnosticians, and imaging was reviewed by board-certified neuroradiologists. The gold standard was considered to be the findings at surgical exploration. Descriptive and analytical statistics were utilized to compare the accuracies of imaging and EDX.RESULTSThe mean age at surgery was 6.94 mos (± 4 mos). Fifteen patients (28%) were Narakas grade I-II, and 39 (72%) were Narakas grade III-IV. For all nerve roots, the overall accuracy of detecting preganglionic lesions was 74% for EDX and 69% for imaging. The overall sensitivity of detecting preganglionic lesions by EDX was 31%, but the specificity was 90%. The overall sensitivity of detecting preganglionic lesions by imaging was 66%, and the overall specificity was 70%. However, at C8, EDX was 37.5% sensitive and 87.5% specific, whereas imaging was 67.7% sensitive but only 29.4% specific.CONCLUSIONSEDX outperformed imaging with regard to specificity and accuracy of identifying preganglionic injuries. This finding is especially relevant in the lower nerve roots, given that lower plexus preganglionic lesions are an accepted indication for early intervention.
目的
对于新生儿臂丛神经麻痹（NBPP）患者，术前辅助检查的应用仍存在争议，但当婴儿下神经根存在节前损伤时早期进行神经重建的建议已被普遍接受。在一些专科中心，神经外科医生使用术前电诊断检查（EDX）和影像学检查来辅助病变定位及神经重建的术前规划。EDX和影像学检查检测节前和节后损伤的能力已得到评估，但它们的准确性从未在同一组患者中直接比较过。本研究的目的是评估NBPP人群中影像学检查和EDX的准确性。
方法
对2007年至2017年间接受手术治疗的54例NBPP患者进行回顾性研究。患者接受了EDX和影像学检查：进行了EDX检查，结果由具备委员会认证的电诊断医生进行评估，影像学检查结果由具备委员会认证的神经放射科医生进行评估。金标准被认为是手术探查的结果。采用描述性和分析性统计方法比较影像学检查和EDX的准确性。
结果
手术时的平均年龄为6.94个月（±4个月）。15例患者（28%）为Narakas I-II级，39例（72%）为Narakas III-IV级。对于所有神经根，EDX检测节前损伤的总体准确率为74%，影像学检查为69%。EDX检测节前损伤的总体敏感性为31%，但特异性为90%。影像学检查检测节前损伤的总体敏感性为66%，总体特异性为70%。然而，在C8水平，EDX的敏感性为37.5%，特异性为87.5%，而影像学检查的敏感性为67.7%，但特异性仅为29.4%。
结论
在识别节前损伤的特异性和准确性方面，EDX优于影像学检查。鉴于下丛节前损伤是早期干预的公认指征，这一发现对于下神经根尤为重要。
