American Society for Peripheral Nerve
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Surgical Management of Radiation-Induced Brachial Plexopathy: A Review of Literature
Mira Shoukry, BS; Shelley S. Noland, MD
Mayo Clinic, Phoenix, AZ

INTRODUCTION
Radiation-induced brachial plexopathy (RIBP) is a rare but devastating long-term complication of radiation therapy, often causing significant reduction in quality of life for affected patients. While a standard of treatment for RIBP is yet to be established, management consists mostly of symptom management through the use of medications. However, options remain limited with a lack of discussion surrounding the efficacy of surgical treatment. This review of existing literature explores the treatment options available to those affected by RIBP with a focus on the role of surgery.
MATERIALS & METHODS
A review of literature discussing management of brachial plexopathy secondary to radiation therapy was conducted.
RESULTS
A search of the PubMed database revealed few publications referencing surgery in the setting of RIBP. Omentoplasty, a commonly discussed option, was found to be effective in eliminating neuropathic pain while leaving motor function the same or worse[1]. Myocutaneous and adipofascial flaps have also been used to relieve pain with particularly improved results seen in cases of concomitant neurolysis[2,3]. However, no significant improvement to motor function was observed. One publication detailed a promising procedure involving a free functioning gracilis muscle transfer which resulted in recovery of elbow flexion as well as wrist and finger extension in a patient with RIBP[4]. Moreover, there have only been two reported instances in which nerve transfer was used to treat RIBP. The cases involved fascicular transfers of median and/or ulnar nerves to the affected nerves resulting in the complete resolution of severe neuropathic pain with significant improvement of strength observed in the affected muscles[5,6].
CONCLUSIONS
While limited, existing literature reveals promising surgical interventions such as nerve transfers for relief of neuropathic pain associated with RIBP as well as restoration of motor function in select patients. Further research on the benefits and indications for such procedures is warranted.


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