Tumors and Schwannomas

Information: Localization of Schwannomas Within the Brachial Plexus for Planning of Tumor Resection

Animation: Position of schwannoma in brachial plexus in patient with asymptomatic palpable neck mass.

The oblique coronal view (A)  allows counting and identification of the cervical spinal nerves and establishes that only the C5 root is involved with this Schwannoma. "Nerve perpendicular" image slices can be obtained by using the image from the oblique coronal view to depict the direction of travel of the nerve trunks near the tumor.

The resulting oblique sagittal (B) view demonstrates each of the cervical spinal nerves in cross section and demonstrates their relationship to the tumor.

(C)  Relationship of nerve trunks to tumor. The surgical approach and risks of nerve injury can be greatly influenced by the relative position of nerve and tumor. In many cases, MR Neurography allows the position of the traversing nerve elements relative to the tumor can be clearly established in advance of surgery. This is a "nerve perpendicular" image in which a double oblique image orientation is prescribed so that the image plane crosses most of the plexus elements at right angles in the region of interest.

Brachial Plexitis

Information: Plexitis and other Inflammatory Conditions Affecting the Brachial Plexus

Animation: Image findings in patients with painless pure motor weakness of hand intrinsics.

(A), (B), (C) Image findings in patients with painless pure motor weakness of hand intrinsics  with no sensory findings (Gilliatt-Sumner Hand) there is hyperintensity and swelling in the elements of the lower trunk without mechanical deformation or other evidence of mechanical entrapment. Surgical treatment is unlikely to be effective and an inflammatory or vascular

Post-Irradiation Plexopathy

Information: Plexopathy and Plexitis After Irradiation for Breast Cancer

Nerve Root Avulsions

Information: Pseudomeningocoele after Brachial Plexus Nerve Root Avulsion

Animation: Demonstration of traumatic pseudomeningocoeles.

The MR Neurography imaging technique also provides a useful MR myelogram capable of efficient demonstrations of traumatic pseudomeningocoeles. This term refers to the residual nerve lining left behind when the nerve elements are literally pulled out of the spinal cord by a severe injury

Although, these images are still not always definitive in the confirmation of true nerve root avulsion they are more reliable for making this diagnosis than the other available imaging techniques.

Brachial Plexus Trauma

Information: Diagnosis of Traumatic Discontinuities in Brachial Plexus Elements

Animation: Confirmation of total nerve disruption in trauma.

(A) The right brachial plexus of a 15-year-old with flail arm - lacking any movement or sensation, two months after a motorcycle accident.  The image demonstrates gross discontinuities ro disruptions in the upper plexus elements (ue), meningocoeles proximally (me), and bright swollen nerve trunks (st).

(B) Disconnected and retracted lower trunk (lt) in traumatic injury of brachial plexus.