Introduction: We retrospectively review peripheral nerve sheath tumours (PNST) managed surgically at the Toronto Western Hospital (TWH). The incidence of benign PNSTs (BPNST) is classified by anatomic location and predisposition syndrome. Independent predictors of tumour recurrence and symptom resolution are identified.
Methods: All PNSTs treated surgically by the TWH Division of Neurosurgery from 1993-2010 were reviewed. Data was collected on patient age, gender, diagnosis of neurofibromatosis (NF), tumour histopathology, tumour location, tumour volume, and extent of resection. Postoperative motor, sensory and pain outcomes were dichotomized as stable/improved or worse than preoperative scores. Relationships between tumour recurrence, or symptom resolution, and predictor variables were assessed with univariate and multiple logistic regression models.
Results: 175 patients with 201 tumours had adequate follow-up for analysis. There were 182 benign and 19 malignant PNSTs. Of the benign lesions, 133 were Schwannomas, 21 of which were associated with a diagnosis of Schwannomatosis. There were 49 neurofibromas, 26 associated with neurofibromatosis type-1 (NF1). Patients presenting with Schwannomas were significantly older than those with neurofibromas. Schwannomas were more readily resected than neurofibromas, with extent of resection for the former influenced by tumour location. Patients with benign PNSTs presented typically with a painful mass and less frequently with motor deficits. The likelihood of worsened postoperative motor function was decreased in patients with fully resected tumours, or with preoperative deficits. Recurrence of Schwannomas and neurofibromas was seen more frequently in patients diagnosed with NF3 and NF1, respectively; subtotal resection was associated with increased recurrence for all benign lesions.
Conclusions: Outcomes following surgical resection of benign PNSTs depend on tumour histopathology, location and genetic predisposition syndrome. Gross-total resection should be attempted for benign lesions where possible. The management of MPNSTs remains challenging, requiring a multimodal approach.
Patient Care: This research identifies predictors of recurrence and functional outcome following surgical resection of benign peripheral nerve sheath tumours. This will guide surgical goals and decision-making for these tumours, informing surgeons and assisting them in managing patient expectations.
Learning Objectives: 1) Surgical outcomes following resection of benign peripheral nerve sheath tumours
2) Multidisciplinary management of malignant peripheral nerve sheath tumours