Hypoglossal nerve transfer in obstetric brachial plexus palsy.

A cost-benefit analysis was performed of hypoglossal nerve transfer in six patients with obstetric brachial palsy taking into account the factors donor site morbidity and extent of recovery. Hypoglossal nerve transfer was employed in four children for elbow flexion only; in two patients for elbow flexion as well as for elbow extension. The transfer was part of an extended brachial plexus reconstruction for treatment of obstetric brachial plexus palsy.

Transfer of pectoral nerves to the musculocutaneous nerve in obstetric upper brachial plexus palsy.

Objective: To investigate the results of transfer of pectoral nerves to the musculocutaneous nerve for treatment of obstetric brachial palsy.

Methods: In 25 cases of obstetric brachial palsy (20 after breech deliveries), branches of the pectoral nerve plexus were transferred directly to the musculocutaneous nerve. For all patients, the nerve transfer was part of an extended brachial plexus reconstruction.

Extensive somatosensory innervation in infants with obstetric brachial palsy.

In the pre-operative screening of infants with obstetric brachial palsy (OBP), the results of routine electromyography are often overly optimistic when compared to the peri-operative findings. This prompted us to include investigation of the sensory innervation of these infants using the N20 (the first cortical response to a peripheral stimulation) of the somatosensory evoked potentials (SSEP). Three to seven months after birth, SSEP were recorded at the skull after stimulation of the thumb and middle finger in infants with obstetric rupture of the upper trunk or avulsion of roots C5, C6, or C7, and in whom no clinical improvement of motor function was observed in the biceps brachii and deltoid muscles.

Bacterial contamination of femoral head allografts from living donors.

We analyzed the bacterial contamination rate of femoral head allografts from living donors and determined the true bacterial load with cultures from the grafts in their entirety in a specially prepared medium. During 4 years we took swab cultures from 2,679 grafts of which 2,414 (90%) were negative. In a period of 12 months, grafts rejected for reasons other than infectious disease were cultured in their entirety to determine the true bacterial load.

Management of obstetric brachial plexus lesions: state of the art and future developments.

Despite improving perinatal care the incidence of obstetric brachial plexus lesions (OBPL) has not declined. Most babies recover spontaneously. In 10-20% recovery is incomplete.

Obstetric antecedents of surgically treated obstetric brachial plexus injuries.

Objective: To determine whether the anatomy of an obstetric brachial plexus lesion (OBPL) is causally related to the preceding obstetric history.

Design: Anatomical classification of the OBPL during reconstructive neurosurgical treatment in consecutive infants who had surgery for OBPL between 1986 and 1994 and relating these findings with the characteristics of the preceding birth.

Setting: De Wever Hospital, Heerlen, The Netherlands.

Obstetric brachial plexus lesions and their neurosurgical treatment.

The present series of 655 brachial plexus lesions includes 240 obstetric palsies. The results of neurophysiological and radiological examinations in these cases are often disappointing in regard to the evaluation of the severity of the lesion. Timing for surgery was according to the criterium of Gilbert: lack of clinical signs of recovery of the biceps at the end of the third month.

Computer assisted diagnosis and treatment planning of brachial plexus injuries.

PLEXUS is a computer program which has been developed to provide recommendations for diagnosis and treatment planning of brachial plexus injuries. This computer program is meant for neurologists, neurosurgeons and orthopaedic surgeons who are not experienced in the field of brachial plexus injuries. The system detects the locations and severity of brachial plexus lesions.

Sensibility testing after nerve grafting.

This study attempts to establish which sensitivity test is to be preferred for final assessment of recovery of sensibility after nerve grafting. For this purpose seven sensibility tests were performed on patients who had been treated by median nerve transplantation. The findings revealed that the stereognosis test is of greater value for a final evaluation than the two-point discrimination test.

Uncommon third ventricle herniation with cyst formation as a possible result of obstructive hydrocephalus.

An adult man with an unusual cyst formation, originating from the suprapineal recess is described. The cyst may partly be caused by and may partly have contributed to aqueductstenosis.