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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2017; 36(02): 075-079
DOI: 10.1055/s-0037-1603966
Original Article | Artigo Original
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Endoscopic Sural Nerve Removal in Obstetric Brachial Plexopathy Using Basic Endoscopy Instruments: Technical Note

Retirada endoscópica do nervo sural na plexopatia braquial obstétrica utilizando instrumentos básicos de endoscopia: nota técnica
José Augusto Malheiros
1   Neurological and Neurosurgery Clinic, Hospital Felício Rocho - Fundação Felice Rosso, Belo Horizonte, MG, Brazil
2   Neurosurgery Department, Hospital das Clínicas, Universidade Federal de Minas Gerais (HC-UFMG), Belo Horizonte, MG, Brazil
,
Sérgio Augusto Vieira Cançado
1   Neurological and Neurosurgery Clinic, Hospital Felício Rocho - Fundação Felice Rosso, Belo Horizonte, MG, Brazil
,
João Tiago Alves Belo
1   Neurological and Neurosurgery Clinic, Hospital Felício Rocho - Fundação Felice Rosso, Belo Horizonte, MG, Brazil
,
Luiz Alberto Otoni Garcia
1   Neurological and Neurosurgery Clinic, Hospital Felício Rocho - Fundação Felice Rosso, Belo Horizonte, MG, Brazil
,
Marcelo Magaldi de Oliveira
2   Neurosurgery Department, Hospital das Clínicas, Universidade Federal de Minas Gerais (HC-UFMG), Belo Horizonte, MG, Brazil
,
Martjin J. A. Malessy
3   Department of Neurosurgery, Leids Universitair Medisch Centrum, Leiden, Netherlands
› Author Affiliations
Further Information

Publication History

28 February 2017

02 May 2017

Publication Date:
23 June 2017 (online)

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Abstract

Introduction The sural nerve (SN) is commonly used for grafting following resection of a neuroma-in-continuity in neonatal brachial plexus lesions (NBPL). The main drawbacks of the current open techniques are large scars and contractures in the late postoperative stage, which may, in severe cases, cause equinovarus contractures.

Objective To describe the feasibility and the technical aspects of endoscopic SN harvesting with the use of basic endoscopy instruments and small incisions.

Methods Prospective observational study of NBPL subjected to endoscopic nerve harvesting between February of 2012 and February of 2014 in a consecutive series. Patients were operated at the Felício Rocho Hospital (Hospital Felício Rocho) and the Clinical Hospital, Federal University of Minas Gerais (Hospital das Clínicas UFMG), Belo Horizonte/MG, in Brazil. The study outcomes assessed were: scar size, presence or absence of contractures in the calf, bleeding volume (measured by the number of gauzes used) and number of incisions. Only patients with a follow-up longer than 6 months were included.

Results Seven patients were selected and twelve endoscopic nerves were endoscopically harvested. The average surgery time was 45 minutes. Nine SNs were harvested through two incisions, and three nerves through three incisions. The estimated bleeding was less than 5ml and there were no complications or contractures during the follow-up period of 6 months to 4 years.

Conclusion Sural nerve harvesting in children with NBPL is feasible and it offers the advantage of needing only two or three small incisions using basic endoscopy instruments.

Resumo

Introdução O nervo sural é a melhor opção para enxertia nas reconstruções microcirúrgicas da plexopatia braquial obstétrica. O método clássico aberto com incisão longitudinal desde o tornozelo até a fossa poplítea ou em incisões em degraus possuem as desvantagens de cicatrizes amplas e contraturas em equinovarus (pé torto). Atualmente, o emprego de endoscópios específicos para a retirada de enxertia de nervos e vasos mostra resultados satisfatórios em relação ao encurtamento do tempo cirúrgico e à redução no tamanho das incisões, mas tem como inconveniente o alto custo de aquisição e manutenção.

Objetivo Discutir a viabilidade e descrever nota técnica da retirada do nervo sural utilizando instrumental básico de endoscopia e pequenas incisões.

Métodos Estudo observacional prospectivo em pacientes com plexopatia braquial obstétrica submetidos a retirada do nervo sural por endoscopia no período de fevereiro de 2012 a fevereiro de 2014 no Hospital Felicio Rocho e no Hospital das Clinicas UFMG, Belo Horizonte/MG, Brasil.

Resultados Sete pacientes foram selecionados e foram retirados doze nervos surais por endoscopia. O tempo médio da cirurgia foi de 45 minutos. Nove nervos surais foram retirados por duas incisões, e três nervos foram retirados por três incisões. O sangramento foi inferior a 5ml e não houve complicações no pós-operatório imediato e tardio em acompanhamento entre 6 meses e 4 anos. Não foram observadas contraturas no período observacional.

Conclusão O nervo sural pode ser retirado utilizando duas ou três pequenas incisões por meio de instrumental endoscópico básico em crianças com plexopatia braquial obstétrica.

Keywords

sural nerve - endoscopy - brachial plexus

Palavras-chave

nervo sural - endoscopia - plexo braquial
 

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