FAST SPIN-ECHO MAGNETIC-RESONANCE-IMAGING FOR RADIOLOGICAL ASSESSMENTOF NEONATAL BRACHIAL-PLEXUS INJURY

Neurosurgical management of birth-related brachial plexus palsy involv es observing the patient for a period of several months. Operative int ervention is usually undertaken at 3 to 6 months of age or more in inf ants who have shown little or no improvement in affected muscle groups . Ancillary tests such as electromyography and nerve conduction studie s are occasionally useful. No radiological study has been consistently helpful in operative planning, except for contrast computerized tomog raphy (CT) myelography, which requires general anesthesia in infants. This is because the infant's small size exceeds the functional resolut ion of the imaging modalities. This report describes the use of a spec ial sequence of magnetic resonance (MR) imaging entitled ''fast spin e cho'' (FSE-MR). Unlike CT myelography, this technique provides high-sp eed noninvasive imaging that allows clinicians to evaluate preganglion ic nerve root injuries without the use of general anesthesia and lumba r puncture. The utility of this technique is illustrated in three case s, mio involving either infraclavicular exploration or a combination o f infraclavicular and supraclavicular exposure based on FSE-MR finding s. The FSE-MR imaging offers an excellent alternative to contrast CT m yelography in evaluation of infants with birth-related brachial plexus injuries.