Early microsurgical reconstruction in birth palsy.

Most patients with birth palsy can be expected to recover spontaneously. But in some patients the recovery is unsatisfactory and the functional results are disappointing. One possible way to improve the prognosis for such patients is early surgical nerve reconstruction. In six infants, exploration of the brachial plexus was carried out at about six months after delivery, when there were no signs of recovery in shoulder and elbow joint movements. Preoperative metrizamide myelography, computerized tomography with intrathecal metrizamide (CT myelography), and axon reflex test (histamine test) were followed by intraoperative electrophysiologic examinations of root sensory evoked potential (SEP), nerve action potential (NAP), and evoked muscle response (M-response). Microsurgical nerve repair was performed on the basis of intraoperative diagnosis. Metrizamide myelography showed 13% false-positive root avulsion. Reliability of the histamine test was 80%. The intraoperative electro-diagnosis is essential for understanding the actual condition of the brachial plexus lesion and obtaining better results from microsurgical reconstruction in birth palsy. The surgical results, with an average follow-up evaluation of two years and four months, have been encouraging enough to continue this diagnostic and therapeutic program, though its superiority to natural recovery has not yet been clarified.