• da Costa PereiraMaristella ReisMRNeurosurgery Service, Army Central Hospital, Rio de Janeiro, Brazil., Felipe G Marsicano, Gabriel Elias Sanches, de CamposLucas Mannarino SantosLMSDepartment of Surgery, Division of Neurosurgery, Gaffrée e Guinle University Hospital, School of Medicine, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil., and Fernando Guedes.
• Neurosurgery Service, Army Central Hospital, Rio de Janeiro, Brazil.
• World Neurosurg. 2022 May 1; 161: e101-e108.

BackgroundTraumatic brachial plexus injuries are devastating lesions, and neurotization is an usually elected surgical therapy. The phrenic nerve has been harvested as a motor fibers donor in brachial plexus neurotization, showing great results in terms of motor reinnervation. Unfortunately, these interventions lack solid evidence regarding long-term safety and possible late respiratory function sequelae, raising crescent concerns after the COVID-19 pandemic onset and possibly resulting in reduced propensity to use this technique. The study of the distal anatomy of the phrenic nerves may lead to a better understanding of their branching patterns, and thus the proposition of surgical approaches that better preserve patient respiratory function.MethodsTwenty-one phrenic nerves in 10 formalized cadavers were scrutinized. Prediaphragmatic branching patterns were inspected through analysis of the distance between the piercing site of the nerve at the diaphragm and the cardiac structures, number of divisions, and length from the point where the main trunk emits its branches to the diaphragm.ResultsThe main trunk of the right phrenic nerve reaches the diaphragm near the inferior vena cava and branches into 3 major divisions. The left phrenic nerve reaches the diaphragm in variable locations near the heart, branching into 2-5 main trunks. Moreover, we noticed a specimen presenting 2 ipsilateral parallel phrenic nerves.ConclusionsThe right phrenic nerve presented greater consistency concerning insertion site, terminal branching point distance to this muscle, and number of rami than the left phrenic nerve.Copyright © 2022 Elsevier Inc. All rights reserved.

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