Role of Magnetic Resonance Neurography on 3-Tesla in Brachial Plexus Injury Management

Abstract

Objective: To study the effect of magnetic resonance neurography on 3 Tesla (MRN-3T) on the outcome of brachial plexus injury management.

Study Design: Prospective comparative study.
Place and Duration of Study: Department of Plastic Surgery, Combined Military Hospital Rawalpindi Pakistan, from Apr 2017 to Mar 2019.

Methodology: Two groups of brachial plexus injury (BPI) were studied over two years. Group-A (n=29) cases whose operative intervention was decided based on history, examination, NCS/EMG and CT scan. Second group-B included (n=33) patients in which MRN-3T (magnetic resonance neurography on 3 Tesla) was the critical diagnostic tool. The comparison of preoperative diagnosis with intraoperative findings and outcome of surgery were made.

Results: Out of 29 cases in group-A, 11 (37.93%) were explored. In these 11, neurolysis was done in one case, direct repair in one case, nerve grafting in 4 patients, nerve transfers with bridging grafts in 2 cases, whereas three patients had negative exploration. Of 33 cases in group-B, 21(63.64%) were explored. From these 21 cases, neurolysis was done in four patients; the direct repair was possible in 7 and in 10 cases bridging nerve grafts were used along with primary nerve transfers.

Conclusion: MRN-3T brachial plexus has significantly improved the diagnosis, preoperative planning and surgical outcome of patients with brachial plexus injury.