Carvalho G A, Nikkhah G, Matthies C, Penkert G, Samii M
Neurosurgical Department, Nordstadt Hospital, Hannover, Germany.
J Neurosurg. 1997 Jan;86(1):69-76. doi: 10.3171/jns.1997.86.1.0069.
Surgical management and prognosis of traction injuries of the brachial plexus depend on the accurate diagnosis of root avulsion from the spinal cord. Myelography, computerized tomography (CT) myelography, and recently magnetic resonance (MR) imaging have become the main radiological methods for preoperative diagnosis of cervical root avulsions. Most of the previous studies on the accuracy of CT myelography and MR imaging studies have correlated the radiological findings with the extraspinal surgical findings at brachial plexus surgery. Surgical experience shows that in many cases extraspinal findings diverge from intradural determinations. Consequently, only correlation with the intradural surgical findings will allow assessment of the factual accuracy of CT myelography and MR imaging studies. In a prospective study, 135 cervical roots (C5-8) were evaluated by CT myelography and/or MR imaging and further explored intradurally via a hemilaminectomy. The accuracy of the preoperative CT myelography-based diagnosis in relation to the intraoperative findings was 85%. On the other hand, MR imaging demonstrated an accuracy of only 52%. The most common reasons for false-positive or false-negative findings were: 1) partial rootlet avulsion; 2) intradural fibrosis; and 3) dural cystic lesions. Computerized tomography myelography scans using 1- to 3-mm axial slices prove to be the most reliable method to evaluate preoperatively the presence of complete or partial root avulsion in traumatic brachial plexus injuries. Because extradural judgment of cervical root avulsion can be unreliable, accurate assessment of intraspinal root avulsion enormously simplifies the decision concerning the choice of donor nerves for transplantation and/or neurotization during brachial plexus surgery.
臂丛神经牵拉伤的手术治疗及预后取决于脊髓神经根撕脱的准确诊断。脊髓造影、计算机断层扫描（CT）脊髓造影以及最近的磁共振（MR）成像已成为术前诊断颈神经根撕脱的主要影像学方法。此前大多数关于CT脊髓造影和MR成像准确性的研究，都将影像学检查结果与臂丛神经手术的椎体外手术结果进行了关联。手术经验表明，在许多情况下，椎体外的检查结果与硬膜内的判断并不一致。因此，只有将其与硬膜内手术结果进行关联，才能评估CT脊髓造影和MR成像研究的实际准确性。在一项前瞻性研究中，通过CT脊髓造影和/或MR成像对135条颈神经根（C5 - 8）进行了评估，并通过半椎板切除术在硬膜内进一步探查。基于术前CT脊髓造影的诊断与术中发现的准确性为85%。另一方面，MR成像显示的准确性仅为52%。假阳性或假阴性结果的最常见原因是：1）部分神经根撕脱；2）硬膜内纤维化；3）硬膜囊性病变。使用1至3毫米轴向切片的CT脊髓造影扫描被证明是术前评估创伤性臂丛神经损伤中完全或部分神经根撕脱情况最可靠的方法。由于对颈神经根撕脱的椎体外判断可能不可靠，准确评估硬膜内神经根撕脱极大地简化了臂丛神经手术中关于选择供体神经进行移植和/或神经化的决策。
