Walker A T, Chaloupka J C, de Lotbiniere A C, Wolfe S W, Goldman R, Kier E L
Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT 06510, USA.
AJR Am J Roentgenol. 1996 Nov;167(5):1283-7. doi: 10.2214/ajr.167.5.8911196.
Recent advances in neurosurgical treatment of traumatic and birth-related brachial plexus injuries require differentiation of preganglionic nerve rootlet avulsion from postganglionic lesions. The purpose of this study was to evaluate the efficacy of thin-section high-resolution CT myelography for revealing cervicothoracic nerve rootlet avulsion in patients with brachial plexus injuries before surgery.
We evaluated eight patients with posttraumatic or birth-related brachial plexus injury on cervical plain film myelography and high-resolution CT myelography before surgical exploration and repair. CT myelograms were retrospectively evaluated for nerve rootlet avulsion, traumatic pseudomeningocele, and deformity of the subarachnoid space. Results were correlated with surgical exploration and intraoperative somatosensory evoked potentials.
Seventy-two (95%) of 76 imaged cervicothoracic levels were adequately shown on CT myelography. Nerve rootlet avulsion, or preganglionic disruption, was shown at 21 levels. Associated pseudomeningocele, or deformity of the subarachnoid space, was seen at 12 (57%) of the 21 avulsion levels. Surgical exploration and intraoperative somatosensory evoked potentials showed complete preganglionic nerve rootlet avulsion at 22 levels. One of the complete avulsions revealed by surgery was not included on the patient's CT myelogram. Of the 21 imaged levels, 20 were correctly revealed on CT myelography (95% sensitivity, 98% specificity). At surgery, partial nerve rootlet avulsion was found at three other levels. None of the partial avulsions was correctly identified on the CT myelograms.
High-resolution CT myelography with thin contiguous axial section is sensitive for revealing complete nerve rootlet avulsion in patients with brachial plexus birth palsies and brachial plexus injuries after trauma. Preoperative CT myelography in these patients allows a more complete injury evaluation for accurate prognosis and surgical planning.
创伤性及与分娩相关的臂丛神经损伤的神经外科治疗方面的最新进展要求区分节前神经根撕脱与节后病变。本研究的目的是评估薄层高分辨率CT脊髓造影在术前揭示臂丛神经损伤患者颈胸神经根撕脱的有效性。
我们在手术探查和修复前，对8例创伤性或与分娩相关的臂丛神经损伤患者进行了颈椎平片脊髓造影和高分辨率CT脊髓造影评估。对CT脊髓造影图像进行回顾性评估，以确定神经根撕脱、创伤性假性脑脊膜膨出和蛛网膜下腔畸形。结果与手术探查及术中体感诱发电位进行对照。
76个成像的颈胸节段中有72个（95%）在CT脊髓造影中显示良好。21个节段显示有神经根撕脱或节前中断。在21个撕脱节段中的12个（57%）可见相关的假性脑脊膜膨出或蛛网膜下腔畸形。手术探查和术中体感诱发电位显示22个节段存在完全性节前神经根撕脱。手术发现的1例完全性撕脱未包含在患者的CT脊髓造影图像中。在21个成像节段中，20个在CT脊髓造影中被正确显示（敏感性95%，特异性98%）。手术时在另外3个节段发现了部分神经根撕脱。CT脊髓造影图像均未正确识别出任何部分性撕脱。
连续薄层轴向扫描的高分辨率CT脊髓造影对揭示臂丛神经产瘫和创伤后臂丛神经损伤患者的完全性神经根撕脱敏感。这些患者术前的CT脊髓造影可进行更全面的损伤评估，以准确判断预后并制定手术方案。
