ABSTRACT
A new method of indirect intraoperative evaluation of axonal quality in a proximal
nerve stump by immediate observation of the myelin sheath is presented. Using this
method in 18 cases of brachial plexus injuries, the proximal stumps of particular
roots or trunks were classified as unfavorable, favorable, or fair. This histologic
grading was compared to the clinical result obtained after surgical repair of these
nerves in the corresponding territory.
In three cases, the proximal stump of the brachial plexus root was sacrificed because
of an unfavorable grade, and a nerve transfer was performed: the results were useful
in two cases and “academic” in one case. Among 12 cases with favorable histologic
grades, nine were associated with useful function and three were “academic”. Among
three cases with a fair histologic grade, two were associated with an “academic” result
and one was useful in a nine-year-old child.
Retrospective comparison with classic examination after axon staining showed that
intraoperative histopathologic grading was somewhat too optimistic in six cases and
was relevant in 12 cases. This method may be helpful in choosing proper methods for
brachial plexus repair. A normal or almost normal histopathologic condition in the
proximal stump of the nerve is mandatory for obtaining a useful clinical result after
repair.
