Abstract
Purpose
To report a case of brachial plexus injury occurring on the contralateral side in a patient undergoing surgery for acoustic neuroma through translabrynthine approach.
Clinical Features
A 51-yr-old woman underwent surgery for acoustic neuroma through translabrynthine approach in the left retroauricular area. She had a short neck with a BMI of 32. Under anesthesia, she was placed in supine position with Sugita pins for head fixation. The head was turned 45° to the right side and the neck was slightly flexed for access to the left retroauricular area, with both arms tucked by the side of the body. Postoperatively, she developed weakness in the right upper extremity comparable with palsy of the upper trunk of the brachial plexus. Hematoma at the right internal jugular vein cannulation site was ruled out by CAT scan and MRI. The only remarkable finding was considerable swelling of the right stemodeidomastoid and scalene muscle group, with some retropharyngeal edema. An EMG confirmed neuropraxia of the upper trunk of brachial plexus. She made a complete recovery of sensory and motor power in the affected limb over the next three months with conservative treatment and physiotherapy.
Conclusions
Brachial plexus injury is still seen during anesthesia despite the awareness about its etiology. Malpositioning of the neck during prolonged surgery could lead to compression of scalene muscles and venous drainage impedance. The resultant swelling in the structures surrounding the brachial plexus may result in a severe compression.
Résumé
Objectif
Citer le cas d’une atteinte controlatérale du plexus brachial qui s’est produite chez une patiente subissant l’ablation d’un névrome acoustique par voie translabyrinthique.
Éléments cliniques
Une femme de 51 ans a subi l’ablation d’un névrome acoustique rétro-auriculaire gauche par voie translabyrinthique. Elle avait un cou court et un IMC de 32. Sous anesthésie, on l’a placée en en décubitus dorsal et on a fixé sa tête à l’aide de broches de Sugita. Sa tête était tournée vers la droite, de 45° et son cou légèrement fléchi pour permettre un accès facile à la zone rétro-auriculaire gauche tandis que les deux bras étaient collés au corps de chaque côté. Après l’intervention, une faiblesse comparable à une paralysie du premier tronc primaire du plexus brachial s’est développée au membre supérieur droit. La possibilité d’un hématome au site de la canule de la veine jugulaire interne a été écartée à l’examen tomodensitométrique et à I’IRM. La seule constatation notable était un important gonflement du groupe musculaire sterno-cléido-mastoïdien et scalène droit et un certain oedème rétropharyngien. Un EMG a confirmé une paralysie du premier tronc primaire du plexus brachial. Pendant les trois mois qui ont suivi, la récupération motrice et sensitive a été complète dans le membre atteint grâce à un traitement conservateur et à la physiothérapie.
Conclusion
L’atteinte du plexus brachial est toujours possible pendant l’anesthésie même si on a à l’esprit son l’étiologie. Un mauvais positionnement du cou pendant une chirurgie prolongée peut provoquer la compression des muscles scalènes et accroître l’impédance du drainage veineux, la résultante étant un gonflement des structures autour du plexus brachial pouvant causer une sévère compression.
Article PDF
Similar content being viewed by others
References
Cooper DE, Jenkins RS, Bready L, Rockwood CA Jr. The prevention of injuries of the brachial plexus secondary to malposition of the patient during surgery. Clin Orthop 1988; 228: 33–41.
Dawson DM, Krarup C. Perioperative nerve lesions. Arch Neurol 1989; 46: 1355–60.
Kroll DA, Caplan RA, Posner K, Ward RJ, Cheney FW. Nerve injury associated with anesthesia. Anesthesiology 1990; 73: 202–7.
Wiet RJ, Teixido M, Liang J-G. Complications in acoustic neuroma surgery. Otolaryngol Clin North Am 1992; 25: 389–412.
Parks BJ. Postoperative peripheral neuropathies. Surgery 1973; 74: 348–57.
Berwick JE, Lessin ME. Brachial plexus injury occuring during oral and maxillofacial surgery. J Oral Maxillofac Surg 1989; 47: 643–5.
Paschall RM, Mandel S. Brachial plexus injury from percutaneous cannulation of the internal jugular vein (Letter). Ann Emerg Med 1983; 12: 58–60.
Frasquet FJ, Belda FJ. Permanent paralysis of C-5 after cannulation of the internal jugular vein (Letter). Anesthesiology 1981; 54: 528.
Sylvestre DL, Sandson TA, Nachmanoff DB. Transient brachial plexopathy as a complication of internal jugular vein cannulation. Neurology 1991; 41: 760.
Hoffman JC. Permanent paralysis of the accessory nerve after cannulation of the internal jugular vein (Letter). Anesthesiology 1983; 58: 583–4.
Vest JV, Pereira MB, Senior RM. Phrenic nerve injury associated with venipuncture of the internal jugular vein. Chest 1980; 78: 777–9.
Stock MC, Downs JB. Transient phrenic nerve blockade during internal jugular vein cannulation using the anterolateral approach. Anesthesiology 1982; 57: 230–3.
Po BT, Hansen HR. Iatrogenic brachial plexus injury: a survey of literature and of pertinent cases. Anesth Analg 1969; 48: 915–22.
Parikh RK. Horner’s syndrome. A complication of percutaneous catheterisation of internal jugular vein. Anaesthesia 1972; 27: 327–9.
Malamut RI, Marques W, England JD, Sumner AJ. Postsurgical idiopathic brachial neuritis. Muscle Nerve 1994; 17: 320–4.
Dillin L, Hoaglund FT, Scheck M. Brachial neuritis. J Bone Joint Surg 1985; 67: 878–9.
Fibuch EE, Mertz J, Geller B. Postoperative onset of idiopathic brachial neuritis. Anesthesiology 1996; 84: 455–8.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bhardwaj, D., Peng, P. An uncommon mechanism of brachial plexus injury. A case report. Can J Anesth 46, 173–175 (1999). https://doi.org/10.1007/BF03012552
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03012552