Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
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Multigen RF lesion generator .
27-NOVEMBER-2017 LUBOV IVANOVNA BELICHENKO 64
YEARS CA BREAST WITH COMPLETE INVOLVEMENT OF THE RIGHT BRACHIAL PLEXUS.
The patient is my wife, started to complain of
hips pain for 14 months and the edema of the
right upper limb for several days, one year ago.
Radiological studies and fine needle aspiration
confirmed the presence of Ca breast right side
with involvement of the pleural ipsilateral to
tumor with lymph node involvement and scattered
metastasis in the cervical, dorsal, lumbar and
pelvis with tendency to grow inside the bones.
The right shoulder bones were also involved in
the process. The tumor was progesterone positive
and she underwent 6 sessions of combined
chemotherapy followed with femara. The last
month, the femara was ineffective and caused all
the side effects. The tumor regional metastasis
at the right brachial plexus showed drop wrist
for 4 months, then the other branches of the the
brachial plexus took place with the right upper
limb became useless, but with agonizing pain.
2 weeks ago, the plan for lumpectomy and
exploration of the brachial plexus was
anticipated, and preoperative investigations
showed Hb 7 mg/L with ESR and CRP and high
enzymes of the liver. She was given 4 units
blood and 4 units FFP. MRI of the cervical spine
was showing intraossal involvement of the
metastasis with the bony structures acceptable.
MRI of the right brachial plexus showed
escalation of the lymph nodes metastasis
involving the supra and subclavicular region. MR
mammography ruled out the presence of the lump.
During this an intrapleural effusion of the
right chest was noted, for what chest CT-scan
was performed and CT-scan of the cervical spine
was performed. The fluid was evacuated the next
day and sent for investigations. CXS showed no
bacterial growth. Cardiologist was consulted and
he noticed mild pericardial effusion.
Consultation of the oncologist gave green line
for surgery to explore the right brachial
plexus. Since the lump in the breast is not
seen, then lumpectomy discarded from the plan.
Incision behind the right
SCMM and running 2 cm above the right clavicle.
The platysma was bisected and the hard highly
vascular mass was identified. The right IJV was
followed inferior and the omohyiod muscle was
seen and left intact. The phrenic nerve was
followed and the the cleavage between the right
anterior scalene and medial scalene was
identified. The tumor was totally removed. It
was stony hard and pushing the trunks inferior.
It was sent for histopathologic studies.
Inspection of the supra and retroclavicular
regions revealed no remnants of the tumor. The
transverse cervical artery was coagulated and
cut during surgery, because it was feeding the
tumor. During dissection most of the time Inomed
TC bipolar forceps with N50 was used with
continuous stimulation to avoid neural injury. Using MultiGen, bipolar motor stimulation of the
upper trunk gave brisk response to 4.4 V, the
middle trunk for 3.25 V and the lower trunk with
1.8V. MultiGen with 2 Hz with 240 ms duration
and 42 degrees was applied to all three trunks.
Routine closure of the
wound. Before extubation the pleural fluid in
the the right chest was evacuated and around 35
ml was achieved. It was sent to histological
Smooth postoperative recovery.
The patient got some movement of the right upper
limb more pronounced in the distal muscles. She was sent to the ward.
The patient is my wife, and she is urging
for surgery, to alleviate the agonizing pain of her
non-functioning right brachial plexus. All my long-standing
experience I must give her, even if the results are under
This is the 139th case using the BPRF mode
with MultiGen. This procedure regained routine acceptance.
It became a usual part of the spine and peripheral nerves
surgery. Click here for
The plan for infraclavicular exploration
was omitted because the trunks was responding in