# A Case of Brachial Plexus Injury Induced by Intraoperative Positioning during Thoracoscopic Resection of a Mediastinal Tumor

## TL;DR

A patient developed brachial plexus injury during thoracic surgery due to improper positioning, highlighting the importance of careful intraoperative limb and neck alignment.

## Contribution

This case report highlights the risk of brachial plexus injury during thoracoscopic surgery due to improper positioning and emphasizes preventive measures.

## Key findings

- A 40-year-old female developed brachial plexus injury after thoracoscopic resection due to improper positioning.
- MRI confirmed brachial plexus swelling and high signal intensity, with full recovery achieved after conservative treatment.
- Preventive measures like preoperative simulation and intraoperative reassessment are critical to avoid such injuries.

## Abstract

Brachial plexus injury is a rare but serious complication of thoracic surgery performed in the lateral position. Improper positioning of the upper limb or neck can increase the risk of nerve damage. Risk factors include excessive abduction of the upper limb and hyperextension of the neck. Preventive measures—such as preoperative simulation of surgical positioning, regular intraoperative reassessment of limb and neck alignment, and close collaboration among surgeons, anesthesiologists, and nursing staff—are critical for ensuring patient safety.

A 40-year-old female diagnosed with an anterior mediastinal neuroendocrine tumor underwent thoracoscopic resection in the left lateral position. During intraoperative repositioning, fixation of the right upper limb became dislodged, resulting in external rotation of the arm and neck extension. Postoperatively, she developed right upper limb weakness and sensory disturbances consistent with brachial plexus injury. MRI revealed swelling and high signal intensity of the brachial plexus on short tau inversion recovery imaging. Conservative treatment with oral mecobalamin and rehabilitation was initiated. Her symptoms gradually improved, and full recovery was achieved by POD 60.

Brachial plexus injury, although rare, is a potentially serious complication of surgery that may cause long-term sequelae. Greater awareness of position-related nerve injury is essential for safer thoracic surgical practice and improved postoperative outcomes.