DETECTION OF DAMAGE BRACHIAL PLEXUS USING INTRAOPERATIVE NEUROMONITORING. EXPERIENCE OF ALMATY (KAZAKHSTAN)

Dusembekov E., Halimov A., Sadykova Z., Zhaylaubaeva A., Nikolaeva A.
Kazakh Medical University of Continuing Education, Almaty, Kazakhstan Clinical Hospital No7, Almaty, Kazakhstan
 
Keywords: intraoperative neuromonitoring, brachial plexus injury, neuropathic pain, peripheral nerve surgery, peripheral nerve disorders. Introduction. Damage of the brachial plexus (BP) takes a special place among the trauma of the upper limb, also in peripheral nervous system. Disability with brachial plexus injury (BPI) is more than 85%. According to statistics, people of working age make up 70-75%. During microsurgical operations on the brachial plexus difficult to find damaged branches, as they may be surrounded by scar tissue. In this study we show our experience of using intraoperative neuromonitoring (IOM) during the operations on brachial plexus. Methods. We analyzed clinical cases of BPI at the Department of peripheral nerves surgery in the City Clinical Hospital No7 of Almaty. The period of research is 2 years (2015 – 2016 yy). Neurosurgical treatment included: the restoration of trunks BP and neurotization of trunks BP. IOM has been used at the step of separation nerve trunks of the brachial plexus, by direct somatosensory evoked potentials (stimulation with 10-12 mA). Results. Total number of patients was 30 (male - 25, female - 5). Types of surgery that we used: autotransplantation 16% (5 patients), external/internal neurolysis 63% (19 patients), nerve suture 3% (1 patient), neurotization 18% (5 patients). As a result of treatment clinical improvement occurred in 42 % (with partial or complete interruption of nerve) and in 75% (with compressing, traction damage, cicatricial process). Conclusion. Results of surgical treatment depends of BP damage nature. IOM helps find the damaged trunks of the BP and intraoperative stimulation improves clinical outcome.
 

Search