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  • A cadaveric micro-anatomic study of intra-fascicular topography of brachial plexus

    Final Number:

    Sumit Sinha MS MCh; Sanjeev Lalwani MBBS, MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: The functional outcome after nerve surgery depends on reestablishment of original inter-fascicular connections. The nerve surgeon can influence axonal routing by connecting related fascicles in proximal and distal stumps.

    Methods: The brachial plexus of 10 adult male cadavers was dissected out. All roots were tagged on ventral aspects by 10-0 nylon, about 5 mm distal to their exit from foramen. The fixed specimens were dissected and interfascicular longitudinal dissection performed under microscope. The dissection was conducted proximally to the level of the nylon stitch and distally till the plexal branches. The area occupied by different nerve fascicles was then expressed as percentage of the total cross-sectional area of the roots.

    Results: The suprascapular nerve derived its fibers mainly from C5, occupying 49% of the total cross-sectional area, between 9 o’clock and 12 o’clock from the surgeon’s intraoperative perspective. In C8 root, medial root of median nerve and ulnar nerve occupied 86% area. In T1 root, medial cutaneous nerve of arm, medial cutaneous nerve of forearm and medial pectoral nerve occupied 36% area, while the rest of area was occupied by ulnar fascicles in the middle (37%) and medial root of median nerve (23%).

    Conclusions: In plexal reconstruction with nerve grafts, coaptation should be performed only in area of the related fascicles. This will minimize axonal misrouting and may improve outcome.

    Patient Care: This research will map the different fascicles in the different areas of the brachial plexus. on the basis of this knowledge, hand surgeons can directly anastomose that fascicle to the damaged nerve. this should result in better outcomes after nerve repair in these devastating injuries.

    Learning Objectives: To study fascicular topography and variations in surgical anatomy of brachial plexus.


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