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Brachial Plexus Injury: Diagnosis of Nerve Root Avulsion Using Multislice CT Myelography

Background: Recent advances in neurosurgical treatment of traumatic and birth-related brachial plexus injuries require differentiation of pre-ganglionic nerve rootlet avulsion from postganglionic lesions. Objective: The purpose of this study was to evaluate the efficacy of thin-section multisclice CT myelography for revealing cervicothoracic nerve rootlet avulsion in patients with brachial plexus injuries before surgery. Methods: CT myelography for 11 patients suffering from brachial plexus injury manifestations was performed by intrathecal injection of the lumbar subarachnoid space by water soluble contrast medium followed by multi-slice axial CT scans then coronal, sagittal and oblique coronal reconstructions were created. The results of CT myelography were evaluated and classified with presence of pseudo-meningocele, intradural ventral or dorsal nerve rootlets injuries. Its diagnostic accuracy was correlated with surgical and clinical correlation in 20 cervical roots in these 11 patients suffering from brachial plexus injury in which avulsion root injury was suspected. Results: Coronal and oblique coronal views were superior to axial views in visualization of the nerve roots and orientation of its exact level. Sensitivity and specificity of CT myelography for diagnosis of intradural ventral or dorsal nerve root injury with or without pseudo-meningocele in pre-ganglionic avulsion were 95% and 95% respectively. Conclusion: The information provided by CT myelography enable to assess the roots of the brachial plexus and added valuable data for helping to decide whether to proceed with exploration, nerve repair, and primary reconstruction or not. [Egypt J Neurol Psychiat Neurosurg. 2011; 48(1): 63-69]