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Case Reports
. 2014 Aug;75(1):e133-5.
doi: 10.1055/s-0034-1376423. Epub 2014 May 28.

Resection of Primary Brachial Plexus Tumor via a Modified Supraclavicular Approach

Christine Tschoe  1 , James W Holsapple  1 , Emanuela Binello  1
Affiliations
Case Reports

Resection of Primary Brachial Plexus Tumor via a Modified Supraclavicular Approach

Christine Tschoe et al. J Neurol Surg Rep. 2014 Aug.

Abstract

Benign peripheral nerve sheath tumors are generally considered curable lesions, and surgical resection is recommended as the primary line of treatment. When these tumors occur in the brachial plexus, they are most frequently accessed via the supraclavicular approach. Traditional descriptions of this approach have included either transection of sternocleidomastoid (SCM) muscle fibers or disarticulation of the clavicular head of the SCM muscle. This report presents a simple and easy-to-adapt modification of the supraclavicular approach that offers greater preservation of the SCM muscle. The modification primarily consists of the creation of an intramuscular window between the sternal and clavicular heads of the SCM via the splitting and dilation SCM muscle fibers. This technique minimizes the disruption of SCM muscle tissue compared with previous descriptions and may be associated with improved postoperative pain and return to function.

Keywords: brachial plexus tumor; intramuscular window; sternocleidomastoid muscle; supraclavicular approach.

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Figures

Fig. 1
Fig. 1
Magnetic resonance imaging with and without contrast of the brachial plexus demonstrated a 4- to 6-cm homogeneously enhancing lesion (white arrow) on (A) T1-weighted coronal and (B) axial images. The lesion appeared to arise from the C7 nerve root at the middle trunk of the brachial plexus. Imaging was consistent with a benign peripheral nerve sheath tumor, and pathology confirmed it to be a neurofibroma.
Fig. 2
Fig. 2
Intraoperative photograph demonstrating the separation and retraction of the sternal (sSCM) and clavicular (cSCM) heads of the sternocleidomastoid (SCM) muscle. The tumor (T) is easily visualized, just superior to the clavicle (cl). A portion of the anterior scalene (aSC) is visible underneath the SCM. As represented in the inset, the patient was placed in the supine position with the head turned toward the right, and the skin incision ran along the posterior margin of the SCM toward the clavicle and into the deltopectoral groove.
See this image and copyright information in PMC

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