Intraoperative electrodiagnostic testing as a decision-making tool for neonatal brachial plexus palsy: a scoping review.

Abstract

Neonatal brachial plexus palsy causes upper extremity paralysis owing to birth-related brachial plexus injury. Although intraoperative electrodiagnostic techniques are routinely used to guide nerve repair in adult brachial plexus surgery, their utility in neonatal cases remains unclear. This scoping review examines whether intraoperative electrodiagnosis aids surgical decision-making, particularly in distinguishing cases amenable to neurolysis, from those that may benefit from nerve reconstruction. In adherence to PRISMA guidelines, a systematic review of literature was conducted using PubMed, Embase and Scopus databases. Nine relevant studies were identified, eight retrospective and one prospective, that evaluated intraoperative electrodiagnostic modalities such as nerve action potentials, somatosensory evoked potentials, motor evoked potentials, compound muscle action potentials and electromyography in neonatal brachial plexus palsy surgery. All studies evaluated infants undergoing surgery for poor early functional recovery. Substantial heterogeneity existed in strategies of using intraoperative electrodiagnosis to guide clinical decision-making. Several studies used the presence of nerve action potentials, compound muscle action potentials or muscle contraction with stimulation to pursue neurolysis, whereas absent responses prompted neuroma resection and grafting. Meaningful follow-up data was only available from one study, this suggesting improved functional outcomes and fewer secondary operations in patients undergoing nerve resection and grafting compared with neurolysis alone. Intraoperative electrodiagnosis may offer limited value in neonatal brachial plexus palsy surgery, but there is insufficient evidence to reach robust conclusions. There is a need for standardized diagnostic methods and further prospective studies to improve outcomes.