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Aytuluk HG, Colak T. [The need for supplemental blocks in single versus triple injections in infraclavicular brachial plexus blocks with a medial approach: a clinical and anatomic study]. Rev Bras Anestesiol 2020; 70:28-35. [PMID: 32178891 DOI: 10.1016/j.bjan.2019.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 11/24/2019] [Accepted: 12/01/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To evaluate the single-injection and triple-injection techniques in infraclavicular blocks with an ultrasound-guided medial approach in terms of block success and the need for supplementary blocks. METHODS This study comprised 139 patients who were scheduled for elective or emergency upper-limb surgery. Patients who received an infraclavicular blocks with a triple-injection technique were included in Group T (n=68). Patients who received an infraclavicular blocks with a single-injection technique were included in Group S (n=71). The number of patients who required supplementary blocks or had complete failure, the recovery time of sensory blocks and early and late complications were noted. RESULTS The block success rate was 84.5% in Group S, and 94.1% in Group T without any need for supplementary nerve blocks. The blocks were supplemented with distal peripheral nerve blocks in 8 patients in Group S and in 3 patients in Group T. Following supplementation, the block success rate was 95.8% in Group S and 98.5% in Group T. These results were not statistically significant. A septum preventing the proper distribution of local anesthetic was clearly visualized in 4 patients. The discomfort rate during the block was significantly higher in Group T (p <0.05). CONCLUSION In ultrasound-guided medial-approach infraclavicular blocks, single-injection and triple-injection techniques did not differ in terms of block success rates. The need for supplementary blocks was higher in single injections than with triple injections. The presence of a fascial layer could be the reason for improper distribution of local anesthetics around the cords.
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Affiliation(s)
- Hande G Aytuluk
- Kocaeli Derince Training and Research Hospital, Department of Anesthesiology and Reanimation, Kocaeli, Turquia; Kocaeli University Faculty of Medicine, Department of Anatomy, Kocaeli, Turquia.
| | - Tuncay Colak
- Kocaeli University Faculty of Medicine, Department of Anatomy, Kocaeli, Turquia
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2
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Rueda Rojas VP, Meléndez Flórez HJ, Orozco Galvis E. Analysis of previous training with simulated models on the success rate of ultrasound-guided supraclavicular block. Prospective cohort study. ACTA ACUST UNITED AC 2019; 66:241-249. [PMID: 30876677 DOI: 10.1016/j.redar.2019.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The teaching based on simulation and acquisition of skills is changing the paradigm of education and restructuring the clinical residences, with the aim of acquiring better skills, increasing procedural success, reducing complications, as well as providing safe, effective, and efficient and focused care of the patient. Peripheral nerve blocks have advanced as techniques for anatomical repairs, use of neurostimulator, and ultrasound. The posgraduate anaesthesiology program implemented a teaching program that included phases of theoretical teaching, training with simulated models, and application in real scenarios. OBJECTIVE To analyse the success, the management of the ultrasound equipment and the incidence of complications of ultrasound-guided supraclavicular blocks (BSE) in the clinical scenario, performed by residents of anaesthesiology previously trained with a theoretical and simulated model. METHODS Prospective cohort study among residents of anaesthesiology (R1, R2, R3, R4), who received previous theoretical-practical training on simulated models. The evaluation was performed by expert anaesthesiologists, with video analysis of the ultrasound screen performed at the time of BSE initiation. RESULTS The evaluation included 16 residents, who performed 156 BSE. None had previous experience in ultrasound-guided blocks. The success of the block was 96.15%. The team management was excellent (from 86% to 95%), with no significant differences among the residents. (P=.61) The incidence of complications was 0.64%, corresponding to arterial puncture. CONCLUSIONS In BSE, previous training with a theoretical and simulated model could increase the probability of success and reduce complications. With adequate training, first year residents managed to successfully carry out the procedure.
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Affiliation(s)
- V P Rueda Rojas
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Santander, Universidad Industrial de Santander, Bucaramanga (Santander), Colombia.
| | - H J Meléndez Flórez
- Departamento de Anestesiología y Reanimación, Especialidad de Medicina Crítica y Terapia Intensiva, Docencia Universitaria, Epidemiología, Universidad Industrial de Santander, Bucaramanga (Santander), Colombia
| | - E Orozco Galvis
- Departamento de Anestesiología y Reanimación, Universidad Industrial de Santander, Bucaramanga (Santander), Colombia
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Mansilla B, Isla A, Román de Aragón M, Hernández B, García Feijoo P, Palpán Flores A, Santiago S. Intraneural cyst of the supraescapular nerve: Atypical cause of peripheral nerve entrapment syndrome. Case report and literature review. Neurocirugia (Astur) 2017; 29:240-243. [PMID: 29170006 DOI: 10.1016/j.neucir.2017.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/10/2017] [Accepted: 09/19/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Intraneural cysts are benign lesions located within the epineurium of some peripheral nerves and their aetiopathogenesis is controversial. Most are located at the level of the lower limbs. In the upper limbs, the most frequently affected nerve is the ulnar nerve. Suprascapular nerve entrapment syndrome due to the formation of an intraneural cyst is rare. In this article, we show a new case and perform a literature review of intraneural cysts located in the suprascapular nerve. METHODS We present a 49-year-old woman with pain in the lateral shoulder region of several months' evolution. A brachial plexus MR showed a tumour of approximately 2×1.5cm, with a cystic appearance, in relation to the upper trunk of the right brachial plexus. RESULTS We used a supra-infraclavicular approach. The cystic tumour affected the suprascapular nerve. After locating a zone on the surface without nervous fascicles, we performed a partial resection of the capsule and emptying of the cyst, with a xanthochromic gelatinous content. The anatomopathological examination confirmed the diagnosis of intraneural cyst. CONCLUSION The suprascapular nerve is a mixed nerve, coming from the upper trunk. It provides the motor branches to the supraspinatus and infraspinatus muscle. Compression of the suprascapular nerve leads to atrophy of these muscles. This entity is one of the differential diagnoses in a patient with pain irradiating to the shoulder, and its correct treatment often results in complete remission of symptoms.
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Affiliation(s)
- Beatriz Mansilla
- Servicio de Neurocirugía, Hospital Universitario La Paz, Madrid, España.
| | - Alberto Isla
- Servicio de Neurocirugía, Hospital Universitario La Paz, Madrid, España
| | | | - Borja Hernández
- Servicio de Neurocirugía, Hospital Universitario La Paz, Madrid, España
| | | | | | - Susana Santiago
- Sección de Neurofisiología, Hospital Universitario La Paz, Madrid, España
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García Ron A, Gallardo R, Huete Hernani B. Utility of ultrasound-guided injection of botulinum toxin type A for muscle imbalance in children with obstetric brachial plexus palsy: Description of the procedure and action protocol. Neurologia 2017; 34:215-223. [PMID: 28347577 DOI: 10.1016/j.nrl.2016.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/01/2016] [Accepted: 12/20/2016] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Obstetric brachial plexus palsy (OBPP) usually has a favourable prognosis. However, nearly one third of all severe cases have permanent sequelae causing a high level of disability. In this study, we explore the effectiveness of ultrasound-guided injection of botulinum toxin A (BoNT-A) and describe the procedure. PATIENTS AND METHODS We designed a prospective, descriptive study including patients with moderate to severe OBPP who were treated between January 2010 and December 2014. We gathered demographic data, type of OBPP, and progression. Treatment effectiveness was assessed with the Active Movement Scale (AMS), the Mallet classification, and video recordings. RESULTS We gathered a total of 14 133 newborns, 15 of whom had OBPP (1.6 per 1000 live births). Forty percent of the cases had severe OBPP (0.4/1000), a dystocic delivery, and APGAR scores < 5; mean weight was 4038g. Mean age at treatment onset was 11.5 months. The muscles most frequently receiving BoNT-A injections were the pronator teres, subscapularis, teres major, latissimus dorsi, and pectoralis major. All the patients who completed the follow-up period (83%) experienced progressive improvements: up to 3 points on the AMS and a mean score of 19.5 points out of 25 on the Mallet classification at 2 years. Treatment improved muscle function and abnormal posture in all cases. Surgery was avoided in 3 patients and delayed in one. Adverse events were mild and self-limited. CONCLUSIONS Due to its safety and effectiveness, BoNT-A may be used off-label as an adjuvant to physical therapy and/or surgery in moderate to severe OBPP. Ultrasound may increase effectiveness and reduce adverse effects.
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Affiliation(s)
- A García Ron
- Unidad de Neuropediatría, Instituto del Niño y del Adolescente. Hospital Clínico San Carlos, Madrid, España.
| | - R Gallardo
- Residente de Neuropediatría, H.U. Infanta Cristina. Parla, Madrid, España
| | - B Huete Hernani
- Servicio de Pediatría, Unidad de Neuropediatría, H.U. Infanta Cristina, Parla, Madrid, España
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Lim HJ, Hasan MS, Chinna K. Faster onset time of supraclavicular brachial plexus block using local anesthetic diluted with dextrose. Braz J Anesthesiol 2016; 66:341-5. [PMID: 27343781 DOI: 10.1016/j.bjane.2014.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 11/07/2014] [Accepted: 11/11/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A high sodium concentration is known to antagonize local anesthetics when infiltrated around neural tissue. Thus, we hypothesized that the onset time for sensory and motor blockade, in supraclavicular brachial plexus block using ropivacaine diluted with dextrose would be shorter than with saline. METHODS Patients scheduled for upper limb surgery were randomized to receive ultrasound guided supraclavicular brachial plexus block with 0.5% ropivacaine. Evaluation of sensory and motor blockade was performed every 5min for 60min. Patients were followed-up on postoperative day 1, and between days 7 and 10 for the presence of any complications. Twenty-five patients in each group were analyzed. RESULTS Mean time for onset of analgesia for the dextrose group was 37.6±12.9min while the mean time for the saline group was 45.2±13.9min with a p-value of 0.05. The effect size was 0.567, which was moderate to large. No major complications were observed. CONCLUSION We conclude that there was a decrease in onset time of analgesia when dextrose was used as a diluent instead of saline for ultrasound guided supraclavicular block.
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Affiliation(s)
- Hong Jin Lim
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Karuthan Chinna
- Julius Centre University Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Lim HJ, Hasan MS, Chinna K. [Faster onset time of supraclavicular brachial plexus block using local anesthetic diluted with dextrose]. Rev Bras Anestesiol 2016; 66:341-5. [PMID: 27155777 DOI: 10.1016/j.bjan.2016.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 11/11/2014] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A high sodium concentration is known to antagonize local anesthetics when infiltrated around neural tissue. Thus, we hypothesized that the onset time for sensory and motor blockade, in supraclavicular brachial plexus block using ropivacaine diluted with dextrose would be shorter than with saline. METHODS Patients scheduled for upper limb surgery were randomized to receive ultrasound guided supraclavicular brachial plexus block with 0.5% ropivacaine. Evaluation of sensory and motor blockade was performed every 5min for 60min. Patients were followed-up on postoperative day 1, and between days 7 and 10 for the presence of any complications. Twenty-five patients in each group were analyzed. RESULTS Mean time for onset of analgesia for the dextrose group was 37.6±12.9min while the mean time for the saline group was 45.2±13.9min with a p-value of 0.05. The effect size was 0.567, which was moderate to large. No major complications were observed. CONCLUSION We conclude that there was a decrease in onset time of analgesia when dextrose was used as a diluent instead of saline for ultrasound guided supraclavicular block.
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Affiliation(s)
- Hong Jin Lim
- Departamento de Anestesiologia, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malásia
| | - Mohd Shahnaz Hasan
- Departamento de Anestesiologia, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malásia.
| | - Karuthan Chinna
- Julius Centre University Malaya, Departamento de Medicina Preventiva e Social, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malásia
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Cejas C, Rollán C, Michelin G, Nogués M. High resolution neurography of the brachial plexus by 3 Tesla magnetic resonance imaging. Radiologia 2016; 58:88-100. [PMID: 26860655 DOI: 10.1016/j.rx.2015.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 09/23/2015] [Accepted: 12/16/2015] [Indexed: 12/23/2022]
Abstract
The study of the structures that make up the brachial plexus has benefited particularly from the high resolution images provided by 3T magnetic resonance scanners. The brachial plexus can have mononeuropathies or polyneuropathies. The mononeuropathies include traumatic injuries and trapping, such as occurs in thoracic outlet syndrome due to cervical ribs, prominent transverse apophyses, or tumors. The polyneuropathies include inflammatory processes, in particular chronic inflammatory demyelinating polyneuropathy, Parsonage-Turner syndrome, granulomatous diseases, and radiation neuropathy. Vascular processes affecting the brachial plexus include diabetic polyneuropathy and the vasculitides. This article reviews the anatomy of the brachial plexus and describes the technique for magnetic resonance neurography and the most common pathologic conditions that can affect the brachial plexus.
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Affiliation(s)
- C Cejas
- Departamento de Imágenes, Fundación para la lucha de las enfermedades neurológicas de la infancia Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina.
| | - C Rollán
- Departamento de Imágenes, Fundación para la lucha de las enfermedades neurológicas de la infancia Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina
| | - G Michelin
- Departamento de Imágenes, Fundación para la lucha de las enfermedades neurológicas de la infancia Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina
| | - M Nogués
- Departamento de Neurología, Fundación para la lucha de las enfermedades neurológicas de la infancia Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina
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de Gusmão LCB, Lima JSB, Ramalho JDRO, Leite ALDS, da Silva AMR. Evaluation of brachial plexus fascicles involvement on infraclavicular block: unfixed cadaver study. Braz J Anesthesiol 2015; 65:213-6. [PMID: 25925034 DOI: 10.1016/j.bjane.2014.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/02/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study shows how the diffusion of the anesthetic into the sheath occurs through the axillary infraclavicular space and hence proves the efficacy of the anesthetic block of the brachial plexus, and may thereby allow a consolidation of this pathway, with fewer complications, previously attached to the anesthesia. MATERIALS AND METHODS 33 armpits of adult cadavers were analyzed and unfixed. We injected a solution of neoprene with latex dye in the infraclavicular space, based on the technique advocated by Gusmão et al., and put the corpses in refrigerators for three weeks. Subsequently, the specimens were thawed and dissected, exposing the axillary sheath along its entire length. RESULTS AND DISCUSSION Was demonstrated involvement of all fasciculus of the plexus in 51.46%. In partial involvement was 30.30%, 18.24% of cases the acrylic was located outside the auxiliary sheath involving no issue. CONCLUSIONS The results allow us to establish the infraclavicular as an effective and easy way to access plexus brachial, because the solution involved the fascicles in 81.76% partially or totally, when it was injected inside the axillary sheath. We believe that only the use of this pathway access in practice it may demonstrate the efficiency.
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Gusmão LCBD, Lima JSB, Ramalho JDRO, Leite ALDS, Silva AMRD. [Evaluation of brachial plexus fascicles involvement on infraclavicular block: unfixed cadaver study]. Rev Bras Anestesiol 2014; 65:213-6. [PMID: 25435416 DOI: 10.1016/j.bjan.2014.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/02/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study shows how occurs the diffusion of the anesthetic into the sheath through the axiliary infraclavicular space and hence prove the efficacy of the anesthetic block of the brachial plexus, and may thereby allow a consolidation of this pathway, with fewer complications, previously attached to the anesthesia. MATERIALS AND METHODS 33 armpits of adult cadavers were analyzed and unfixed. We injected a solution of neoprene with latex dye in the infraclavicular space, based on the technique advocated by Gusmão et al., and put the corpses in refrigerators for three weeks. Subsequently, the specimens were thawed and dissected, exposing the axillary sheath along its entire length. RESULTS AND DISCUSSION Was demonstrated involvement of all fasciculus of the plexus in 51.46%. In partial involvement was 30.30%, and 18.24% of cases the acrylic was located outside the auxiliary sheath involving no issue. CONCLUSIONS The results allow us to establish the infraclavicular as an effective and easy way to access plexus brachial, because the solution involved the fascicles in 81.76% partially or totally, when was injected inside the axillary sheath. We believe that only the use of this pathway access in practice it may demonstrate the efficiency.
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Martínez F, Pinazzo S, Moragues R, Suarez E. [Complications in brachial plexus surgery]. Neurocirugia (Astur) 2014; 26:73-7. [PMID: 25159122 DOI: 10.1016/j.neucir.2014.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 06/30/2014] [Accepted: 07/03/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Although traumatic brachial plexus injuries are relatively rare in trauma patients, their effects on the functionality of the upper limb can be very disabling. The authors' objective was to assess the complications in a series of patients operated for brachial plexus injuries. MATERIAL AND METHOD This was a retrospective evaluation of patients operated on by the authors between August 2009 and March 2013. RESULTS We performed 36 surgeries on 33 patients. The incidence of complications was 27.7%. Of these, only 1 (2.7%) was considered serious and associated with the procedure (iatrogenic injury of brachial artery). There was another serious complication (hypoxia in patients with airway injury) but it was not directly related to the surgical procedure. All other complications were considered minor (wound dehiscence, hematoma, infection). There was no mortality in our series. CONCLUSIONS The complications in our series are similar to those reported in the literature. Serious complications (vascular, neural) are rare and represent less than 5% in all the different series. Given the rate of surgical complications and the poor functional perspective for a brachial plexus injury without surgery, we believe that surgery should be the treatment of choice.
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Affiliation(s)
- Fernando Martínez
- Policlínica de Patología de Nervios Periféricos, Servicio de Neurocirugía, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
| | - Samantha Pinazzo
- Policlínica de Patología de Nervios Periféricos, Servicio de Neurocirugía, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Rodrigo Moragues
- Policlínica de Patología de Nervios Periféricos, Servicio de Neurocirugía, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Elizabeth Suarez
- Cátedra de Fisiatría, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
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Giner J, Isla A, Hernández B, Nistal M. [Myxoid/round cell liposarcoma of the brachial plexus]. Neurocirugia (Astur) 2014; 25:290-3. [PMID: 25126709 DOI: 10.1016/j.neucir.2014.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 06/10/2014] [Indexed: 12/25/2022]
Abstract
Myxoid/round cell liposarcoma is a soft tissue sarcoma that is extremely rare in the brachial plexus. We report a case of a myxoid/round cell liposarcoma originating in the brachial plexus that was surgically resected and evolved well, with no deficit or recurrence after 2 years of follow-up. To date, there has been no other case of this sarcoma in the literature.
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Affiliation(s)
- Javier Giner
- Servicio de Neurocirugía, Hospital Universitario La Paz, Madrid, España.
| | - Alberto Isla
- Servicio de Neurocirugía, Hospital Universitario La Paz, Madrid, España
| | - Borja Hernández
- Servicio de Neurocirugía, Hospital Universitario La Paz, Madrid, España
| | - Manuel Nistal
- Servicio de Anatomía Patológica, Hospital Universitario La Paz, Madrid, España
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