The Role of Surgery for Management of Radiation-Induced Brachial Plexopathy: A Systematic Review
Ramin Shekouhi, MD1, Cameron Gerhold, BS2 and Harvey W Chim, MD3, 1University of Florida, Gainesville, FL, 2Florida State University, Tallahassee, FL, 3Division of Plastic Surgery, University of Florida College of Medicine, Gainesville, FL
Introduction: The role of surgery remains unclear in management of Radiation-induced brachial plexopathy (RIBP), with the predominant approach being conservative therapy.
Methods: A literature search was performed using the main online databases to find all related articles. Systematic review was performed including 29 studies (n=580) that described the clinical features of RIBP patients and outcomes after surgery.
Results: The most commonly reported symptom was sensory loss (n=295,59.8%), followed by motor deficits (n=279,56.6%), and neuropathic pain (n=267,54.1%). Sixty-five (56.0%) patients had panplexal involvement, and 51 (44.0%) patients had partial plexus involvement. The most common surgical interventions were neurolysis with omental or other flaps (n=108,45.6%), followed by neurolysis alone (n=71,29.9%). Overall, out of 237 patients that underwent surgery, 125 (52.7%) reported improved neuropathic pain. Motor and sensory deficits were improved in 46 (19.4%) and 39 (16.4%) patients, respectively. In patients that underwent surgical neurolysis with omental or other flaps, 57 (52.8%) patients had improvement in pain, followed by improvement in sensory and motor deficits in 17 (15.7%) and 13 (12.0%) patients, respectively. In patients that underwent surgical neurolysis alone, pain (n= 55, 77.5%) was most commonly improved, followed by motor (n= 17, 23.9%) and sensory deficits (n= 15, 21.1%), respectively.
Conclusion: Surgery is most effective in in alleviating pain, but has less satisfactory outcomes for motor and sensory improvement. For motor deficits, ulnar nerve fascicular transfer to the biceps branch and cable grafting of the musculocutaneous nerve have shown encouraging results.
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