Obstetric brachial plexus lesions : a framework for therapy

Abstract

An obstetric brachial plexus lesion (OBPL) is a traction injury of a peripheral nerve network resulting in function loss of the upper limb – which may be permanent. The aim of this thesis is to provide a conceptual framework for treatment of infants with an OBPL. The research is largely based on our own patient cohort of the LUMC Department of Neurosurgery, which serves as a tertiary referral center in the Netherlands. Each year, 25-35 infants are treated with nerve surgery.

Part 1 consists of a general introduction, a historical overview, and a critical analysis of selection criteria for surgery advocated by different surgeons.

Part 2 describes obstetric factors related to the severity of OBPL in our own patient cohort. In addition, a systematic literature review of the natural history is presented.

Part 3 evaluates the use of electrodiagnostic studies (EMG, NAP, CMAP) in the preoperative and intra-operative assessment of lesion severity.

Part 4 consists of four outcome studies of nerve surgery. Three chapters describe results of the LUMC patient cohort, and one chapter presents the results of an innovative technique performed by Prof Gilbert, one of the OBPL pioneers.

Part 5 consists of a summary and discussion of all chapters.