Cirugía de oberlin en parálisis braquial obstétrica. Nota técnica

Nota técnica. Premio Junior. XV Jornadas Argentinas de Neurocirugía 2019

Abstract

Introduction: Obstetrical brachial plexus palsy (OBPP) is a rare complication of labor. Most patients recover spontaneously, however, in some cases neurosurgery must be perform to re innervate muscles and restore functions. The most frequent affected roots are C5-C6. Oberlin first described a type of nervous transfer in 4 adult patients, using fascicles of the ulnar nerve to reanimate the biceps muscle. The objective of this paper is to make a technical note about Oberlin's surgery regarding OBPP. This technical note emerges from the analysis of 4 pediatric surgeries and 14 fetal upper limbs dissections.
Technical description: Patient was place in dorsal decubitus, with the compromised upper limb extended in supination and 90 ° abduction. Skin incision of 4 cm long is made along the medial aspect of the arm, until the brachial fascia is identified. Subsequently, the motor branch of the biceps muscle and fascicles of the ulnar nerve are dissect. Under microscopic magnification, both nerves are approached and the neurorrhaphy is performed.
Discussion: There are multiple nerve transfer techniques described; but bibliography in pediatric patients is limited. Oberlin surgery can be performed in pediatrics.
Conclusion: The steps of the nerve transfer surgery described by Oberlin presented can be applied in the case of obstetrical brachial plexus palsy, the technical details and the anatomical repairs for its realization are outlined.