Brachial plexus tumors extending into the cervicothoracic spine: a review with operative nuances and outcomes

Background The rarity and anatomical complexity of brachial plexus tumors (BPTs) impose many challenges onto surgeons performing surgical resections, especially when these tumors invade the cervicothoracic spine. Treatment choices and surgery outcomes heavily depend on anatomical location and tumor type. Methods The authors performed an extensive review of the published literature (PubMed) focusing on “brachial plexus tumors” that identified invasion of the cervicothoracic spine. Result The search yielded 2774 articles pertaining to “brachial plexus tumors”. Articles not in the English language or involving cervicothoracic spinal invasion were excluded. Conclusions Recent research has shown that the most common method used to resect tumors of the proximal roots is the dorsal subscapular approach. Despite its association with high morbidity rate, this technique offers excellent exposure to the spinal roots and intraforaminal portion of the spinal nerve. The dorsal approach is used to resect recurrent lower trunk tumors and dumbbell-shaped neurofibromas, yet it is also the least common overall approach used in brachial plexus tumor resections. The ventral or anterior technique is commonly used to resect tumors at the cord to division level, and root to trunk level. Motor complications, transient nerve palsy, and bleeding are among the most common complications of the anterior supraclavicular approach. Further controlled studies are needed to fully determine the optimal surgical approach used to obtain the best outcomes and least complications for each type of brachial plexus tumor (AU)

Brachial plexus tumors extending into the cervicothoracic spine: a review with operative nuances and outcomes.

BACKGROUND: The rarity and anatomical complexity of brachial plexus tumors (BPTs) impose many challenges onto surgeons performing surgical resections, especially when these tumors invade the cervicothoracic spine. Treatment choices and surgery outcomes heavily depend on anatomical location and tumor type. METHODS: The authors performed an extensive review of the published literature (PubMed) focusing on "brachial plexus tumors" that identified invasion of the cervicothoracic spine. RESULTS: The search yielded 2774 articles pertaining to "brachial plexus tumors". Articles not in the English language or involving cervicothoracic spinal invasion were excluded. CONCLUSIONS: Recent research has shown that the most common method used to resect tumors of the proximal roots is the dorsal subscapular approach. Despite its association with high morbidity rate, this technique offers excellent exposure to the spinal roots and intraforaminal portion of the spinal nerve. The dorsal approach is used to resect recurrent lower trunk tumors and dumbbell-shaped neurofibromas, yet it is also the least common overall approach used in brachial plexus tumor resections. The ventral or anterior technique is commonly used to resect tumors at the cord to division level, and root to trunk level. Motor complications, transient nerve palsy, and bleeding are among the most common complications of the anterior supraclavicular approach. Further controlled studies are needed to fully determine the optimal surgical approach used to obtain the best outcomes and least complications for each type of brachial plexus tumor.

[T4/T8 ratio in bronchoalveolar lavage in sarcoidosis--a marker of activity and/or prognosis?]. / T4/T8-Quotient in der bronchoalveolären Lavage (BAL) bei Sarkoidose--Marker von Aktivität und/oder Prognose?

In 158 patients with histologically confirmed intrathoracic sarcoidosis the T4/T8 quotient was checked in broncho-alveolar lavage (BAL) for its informative value with regard to activity and prognosis of the disease. In asymptomatic patients with x-ray type I and normal lung function, in radiological remissions of x-ray types I and improvement in the course of disease in patients whose disease had initially been classified acute, we found statistically significantly higher T4/T8 quotients than in the other patient groups; we did not observe any deterioration in the course of the disease. High T4/T8 quotients will thus not generally point to an active or progressing disease; the information conveyed by these data is of limited clinical usefulness in individual cases only.

[Tracheobronchopathia osteochondroplastica and coexistent mucoepidermoid carcinoma of the lung: Case report]. / Tracheobronchopathia osteochondroplastica und koexistentes Mukoepidermoidkarzinom der Lunge: Fallvorstellung.

Pneumonia of the middle lobe that had been diagnosed by x-ray in a male patient of 51 years of age did not recede completely despite antibiotic treatment. CT showed a space-occupying growth in the middle lobe of about 1.5 cm size, with consecutive atelectasis. Bronchoscopy revealed a pronounced pattern of tracheobronchopathia osteochondroplastica, but it was not possible to confirm the middle lobe syndrome (Brock's syndrome) by histological examination. A mucoepidermoid carcinoma of the middle lobe was histologically established by thoracotomy besides the tracheobronchopathia osteochondroplastica. 9 months post-operatively there is no pointer to any recurrence or metastasising.

[Bronchoalveolar lavage in fibrosing alveolitis--a parameter for evaluating activity and prognosis?]. / Bronchoalveoläre Lavage (BAL) bei fibrosierender Alveolitis--Parameter zur Beurteilung von Aktivität und Prognose?

Bronchoalveolar lavages (BAL) were performed in 19 patients in whom fibrotising alveolitis had been detected and confirmed. The patients were then followed up and controlled clinically for more than 12 months. The courses of the diseases did not reveal any group-specific behaviour (taking lymphocytic and granulocytic lavages into consideration) and were not predictable on the basis of the lavage patterns. With a BAL lymphocytosis, 40% of the patients showed clinical improvement and in 30% the disease became stable whereas in another 30% there was a deterioration. If more than 10% BAL granulocytes were present, 50% of the patients showed clinical deterioration, whereas the course became stable in 37.5% and clinical improvements were recorded in 12.5% of the patients.

[Tuberous sclerosis with pulmonary involvement. Case report]. / Tuberöse Sklerose mit Lungenbeteiligung. Kasuistik.

The presented patient suffered of seizures during childhood and exhibited the typical skin lesions of tuberous sclerosis. However, the diagnosis was not made until the patient was 26 years old. He had involvement of the central nervous system, the skin, the kidneys, and the lungs. After he developed renal failure he underwent hemodialysis for 57 months and suffered an intracerebral hemorrhage followed by cardiorespiratory arrest age 36.

Lack of a diurnal plasma adenosine 3',5'-monophosphate rhythm.

Plasma cAMP levels were measured using a protein-binding radioassay in nine healthy volunteer subjects over a period of 24 h under standardized conditions and also after an hour of orthostatism. No circadian variations of cAMP in plasma were observed. After orthostatism, however, there was a significant rise in cAMP concentrations.

[Polychemotherapy of inoperable bronchogenic carcinoma: preliminary results (author's transl)]. / Polychemotherapie des inoperablen Bronchialkarzinoms--Ergebnisse einer randomisierten und kontrollierten Studie.

Preliminary results indicate that BACO and SAKK are capable of inducing remission in 80-90% of cases of small-cell bronchogenic carcinoma; these remissions last for about 6 months and not only prolong, but improve the quality of, life. In view of the small number of cases so far observed no assessment can as yet be made of the superiority of one or the other method concerning the incidence and duration of remissions and survival time. In cases of squamous cell cancer the two therapeutic methods succeeded in only 30-40% of the patients in inducing partical remissions and they did not appear to improve the quality of life. The question whether the treatment actually prolongs life as compared with the natural course of the disease remains open.

[Examinations to cAMP-levels in plasma (author's transl)]. / Untersuchungen zur Frage einer cAMP-Rhythmik im Plasma.

Plasma cAMP levels were measured by a competetive protein binding method in nine healthy volunteers every 30 minutes over a period of 24 hours under standardized conditions. No circadian variation was observed. Upright posture after 32 hours bedrest increased cAMP significantly.