BACKGROUND: The authors present the only known case of a World Health Organization grade II ectopic meningioma occurring in the infraclavicular brachial plexus, causing pain within the axilla not associated with a primary malignant meningioma of the central nervous system. Peripheral nerve sheath tumors are rare entities, the majority of which are schwannomas or neurofibromas. Ectopic meningiomas only represent 1%-2% of all meningiomas. To date, there is one other published case specifically of a primary ectopic meningioma located in the brachial plexus.
METHODS: Following the dissection of the left axilla, a dominant rubbery tumor involving the median nerve was encountered. The tumor capsule contained areas of hemorrhage and a soft core with nerve fascicles coursing through, which were not compromised during internal tumor debulking. The tumor lacked a clear pseudocapsule that is characteristically seen in schwannomas. Histopathological studies confirmed an atypical epithelioid neoplasm with elevated numbers of mitotic figures and BAP1 gene deletion.
CONCLUSIONS: Primary meningiomas arising outside the central nervous system are exceedingly rare. For this unusual higher-grade primary ectopic meningioma located in the distal brachial plexus, surgery with the goal of gross-total resection, adjuvant radiation, additional imaging, and genetics screening were recommended. Close follow-up is warranted. https://thejns.org/doi/10.3171/CASE24226.

Osteolipoma is a rare benign variant of lipoma and constitutes less than 1% of all lipomas, presenting as a well-circumscribed painless mass. It is a tumor known to occur in several regions, usually intraosseous or adjacent to bone tissue, whose pathogenesis is still unclear. Imaging exams are useful in their evaluation and, mainly, in surgical planning, which consists of tumor excision. However, the definitive diagnosis of osteolipoma is made by histopathological examination. Although benign, osteolipomas can compress surrounding structures, leading to important symptomatology, as in this case reported in which it is in contact with the brachial plexus.

C5 palsy is a potential complication of cervical decompression surgery from which many patients do not recover or partially recover function. We present the case of a 48-year-old patient who developed elbow flexion paralysis after anterior decompression surgery with fusion of the C5-C7 levels. Muscle function was not spontaneously restored until eight months after surgery. In this case, we performed an Oberlin procedure to restore the function of the arm. Muscle strength (5/5) and volume were obtained 13 months after surgery. A reasonable waiting period is required after C5 palsy in case spontaneous recovery occurs. Treatment decision should be based on the patient\'s symptoms. Nerve transfers have been shown to be effective when performed after six months, especially in Oberlin transfer.

BACKGROUND The brachial plexus is a complex neural structure providing motor and sensory innervation to structures of the arm, shoulder, and upper chest. The anatomical structure is typically divided into roots, trunks, divisions, and cords. Due to the presence of multiple nerve roots and branches, anatomical variations are common. Awareness of variations from normal anatomy is important in imaging, administration of nerve blocks, and surgical procedures of the neck and shoulder region. CASE REPORT We present a case of multiple anatomic variations of the right brachial plexus identified in a cadaver during routine dissection. To summarize, we identified a prefixed plexus with anomalous contributions from the C4 nerve root. Nerve roots C4 and C5 emerged anterior to the anterior scalene muscle. Furthermore, 4 trunks, rather than the typical 3, gave rise to multiple anomalies in the branching pattern of the distal divisions and cords. To the best of our knowledge, this is the first such case reported in the published literature. CONCLUSIONS The current case report presents a combination of brachial plexus anomalies not previously described in the medical literature - specifically, a prefixed (C4-T1) brachial plexus positioned anterior to the anterior scalene muscle with anomalies of the trunks, divisions, cords, and terminal branches. The variations presented have implications in neurogenic compression, interscalene blocks, and trauma to the upper limb. Knowledge of these anomalies may better equip anatomists and clinicians to understand pathology and intervention of the upper limb.

We present a case of a healthy young male professional water polo player who presented with swelling and pain in the upper arm and elbow after vigorous exercise. Diagnostic workup included an MRI and dynamic duplex ultrasound, which revealed compression of the axillary vein by a hypertrophic pectoralis minor muscle without thrombosis, constituting McCleery syndrome. This is a rare entity within the multiple thoracic outlet syndrome aetiologies. Taking a detailed history and physical examination complemented with diagnostic imaging are vital to the diagnosis. Afterward, the patient was treated with multimodal physical therapy and fully recovered and even exceeded his previous training and play level.

BACKGROUND: Ganglioneuromas are benign neurogenic tumors that arise from the sympathetic ganglia. They are less aggressive compared to the more immature neuroblastomas and ganglioneuroblastomas but can grow to exert mass effect on surrounding tissues.
METHODS: A 7 years old girl who presented with progressive quadriplegia for 4 months. On examination, she had a right supra-clavicular mass with reduced power in the right hand than the left. Power in the lower limbs was also reduced with hyper-reflexia, clonus and Babinski positive. Laboratory investigations were unremarkable and Chest X-Ray showed a widened mediastinum. Magnetic Resonance Imaging (MRI) scan revealed an extra-medullary spinal tumor at C6/C7 extending laterally on the right through the C6/7 neuro-foramen to the para-spinal tissue and brachial plexus. A C6/7 laminectomy with Spinal cord decompression by partial resection of the tumor was done. Histology of the resected tissue showed ganglioneuroma.
CONCLUSIONS: The presentation of Ganglioneuromas is usually asymptomatic until they are huge enough to exert mass effect on surrounding tissue. Most are located in the posterior mediastinum, retro-peritoneum and neck. Due to this, it may be very challenging to achieve total resection especially when they surround major vessels or nerves. A multi-disciplinary approach is needed for the best surgical outcomes but this is not always realized in our setting.
CONCLUSIONS: In resource limited settings, more collaboration and training is needed to realize appropriate management of complex surgical conditions. Although complications are not uncommon, total surgical excision is necessary to prevent recurrence and progression of Ganglioneuromas.

In this case report, a unique instance of delayed isolated anterior branch axillary nerve injury following shoulder dislocation is highlighted. The patient, a 55-year-old manual laborer, presented with severe deltoid wasting and reduced power 18 months postdislocation, necessitating a specialized treatment approach. The use of axillary nerve neurolysis and an innovative upper trapezius to anterior deltoid transfer via a subacromial path posterior to the clavicle, facilitated by an autologous semitendinosus graft, resulted in significant improvement with 160 degrees of abduction and Grade 4+ power Medical Research Council grading (MRC) at the 5-year follow-up.

UNASSIGNED: Vascular anomalies, comprising up to 4.5% of the general population, are aberrations occurring during vascular development. Vascular abnormalities are frequently identified in children and frequently exhibit characteristics similar to nerve sheath tumors. We report a case of 16 years old boy with a arterio-venous (AV) malformation (AVM) affecting the brachial plexus. We discuss the clinical features, diagnosis, treatment, and histopathological findings in this patient and review the relevant literature.
UNASSIGNED: A 16- year-s old boy presented with pain, paresthesia, swelling, and reduced grip strength of the hand. Radiological investigations revealed a vascular lesion encasing C5, C6 nerve roots and displacing the C7 root. Near total surgical excision of the lesion was done with preservation of nerve. Histopathology confirmed arteriovenous AVMmalformation with distinct features.
UNASSIGNED: High-resolution ultrasound is crucial for diagnosing soft- tissue vascular anomalies. Surgeons well versed in micro surgical skill play a vital key role in minimizing neural deficits. In the case of vascular malformations of brachial plexus, near total excision is the most favorable option.

BACKGROUND: Sprengel\'s deformity is a congenital abnormality of the shoulder girdle. Because scapular retraction, such as the Green procedure, is usually performed during childhood to improve esthetics and shoulder function, Sprengel\'s deformity is rarely found in older patients.
METHODS: We presented a unique case of a Japanese female cadaver with Sprengel\'s deformity at the age of 80 years. Anatomical dissection and radiological imaging revealed musculoskeletal anomalies associated with Sprengel\'s deformity, including Klippel-Feil syndrome, presence of an omovertebral bone, and absence of the trapezius muscle. In addition, bilateral cervical ribs were in contact with the brachial plexus. These anomalies may lead to numbness, pain, and limited range of motion of the neck and upper girdle with aging.
CONCLUSIONS: Because most adult patients with Sprengel\'s deformity experience neck pain and limited movement of the shoulder, the presented case is a rare case of neglected Sprengel\'s deformity in an 80-year-old cadaver.

The phrenic nerve innervates the respiratory diaphragm, the primary muscle active during ventilation. The canonical path of the phrenic nerve originates from the cervical spine at C3-C5 spinal nerves and travels inferiorly through the neck and thoracic cavity to reach the diaphragm. During a cadaver dissection, a variation of the phrenic nerve was discovered in a 93-year-old male specimen. A traditional origin of the phrenic nerve was noted; however, the nerve branched into medial and lateral components at the level of the superior trunk of the brachial plexus. The branches reconnected at the apex of the aortic arch and continued inferiorly to innervate the ipsilateral diaphragm. This case study describes a rare type of branching of the phrenic nerve and explores its potential impact on clinical procedures.