From Dissection to Neuromodulation: Anatomical–Clinical Brachial Plexus Framework for Pain Management in Plexopathies ^†

Introduction: Brachial plexopathies often associated with refractory neuropathic pain. Treatment by techniques such as peripheral nerve stimulation (PNS), dorsal root ganglion stimulation (DRG), spinal cord stimulation (SCS), and dorsal root entry zone ablation (DREZotomy) depends on precise anatomical targets and adequate pain phenotyping. However, gaps persist between dissection findings and therapeutic decision-making. The objective of the present study is to present an anatomical–clinical framework, which translates dissective observations into applicable rules for the choice of the modality, definition of safe windows, and standardization of the decision flow in painful plexopathies. Methodology: Systematic dissection of the upper cadaveric limb was performed with photodocumentation and recording of anatomical findings relevant to interventional practice. Results: Safe windows for PNS of the suprascapularis nerves, axillary nerve, median nerve, ulnar nerve, and radial nerve were described. The C5–T1 dermatomes for GRD, principles of coverage in cervical SCS (C3–C7), and anatomical landmarks of the dorsal root entry zone (posterolateral groove and superficial laminae of the posterior horn) were mapped as a reference for DREZotomy, as indicated in preganglionic avulsion. The final product includes an applied atlas; a decision-making matrix that integrates painful phenotype and topography with technique, target, window, and risks; in addition to operative flow such as phenotyping, technique selection, target definition, window choice, coverage evaluation, trial, and rehabilitation. Conclusion: The proposed framework, through its atlas and decision matrix, offers a structured model for teaching and standardizing interventional approaches in painful plexopathies. It emphasizes its educational value, with clinical efficacy and safety yet to be validated.