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  • The Surgical Management of Symptomatic Benign Peripheral Nerve Sheath Tumors of the Neck & Extremities. An Experience of 442 Cases- A Review

    Final Number:
    580

    Authors:
    Ketan Ishwarlal Desai MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Peripheral nerve sheath tumors (PNSTs) are a subset of neuroepithelial tumors with histological diversity. PNSTs are broadly classified as benign or malignant; the former includes schwannomas and neurofibromas. In the last 3 decades, very few series of surgically treated benign and malignant PNSTs have been reported that describe in detail the surgical experience dealing with this diverse problem involving several nerves. Surgical management of benign PNSTs is challenging, as excision of the tumor with preservation of neurological function is the primary goal of the treatment. In our study, we aimed to better understand the demographic features, clinical presentations, neuroradiological features, surgical and pathological findings, and outcomes with respect to morbidity

    Methods: A retrospective review of clinical and radiological findings of 442 patients with benign PNSTs involving the neck and extremities treated surgically from 2000 to 2014 was performed.

    Results: Results: In our series, benign PNSTs involved the extremities in 290 (65.6%) patients and the brachial plexus in 146 (33%) patients, and 6 (1.4%) patients had tumors of the extracranial portion of the vagus and hypoglossal nerves in the neck. The mean age of patients was 38 years. The presenting features were painful mass and paresthesia. Preoperative motor weakness in the extremity was noted in 15.6% of patients. The common nerves involved by the tumors were the ulnar nerve (15.8%), sciatic nerve (12.7 %), and upper cervical roots (11.5%). The excision was total in 81.2%, gross-total (>90%) in 17.9%, and subtotal (>50%) in 0.9% patients. In 17.6% of patients, there was severe postoperative neurogenic pain. In 28 (6.3%) patients, a new motor deficit was noted following surgery. Recurrence was seen in 2 patients in our series. The mean follow-up was 30.2 months.

    Conclusions: Benign PNSTs have excellent clinical outcome, and the goal for surgical treatment is total to gross-total excision of the tumor with neural preservation.

    Patient Care: In our retrospective review on benign peripheral nerve sheath tumors involving extremities and limbs we have concluded that benign tumors of the peripheral nerves have excellent prognosis in patients with total-radical/ gross-total excision. The incidence of recurrence is also very low. Intra operative use of electrophysiological monitering helps in greatly reducing post operative neurological deficits. Role of preoperative biopsy is debatable and should be avoided and clinical findings and clinical history should be taken in to consideration while planing operative procedure.

    Learning Objectives: To analyze the outcome with respect to the morbidity, extent of resection and recurrence and review and compare our results with that reported in literature.

    References: 1. Montano N, D’Alessandris QG, D’Ercole M, et al. Tumors of the peripheral nervous system: analysis of prognostic factors in a series with long-term follow-up and review and review of the literature. J Neurosurg 2016;125(2)363-371. 2. Go MH, Kim SH, Cho KH. Brachial plexus tumors in a consecutive series of twenty-one patients. J Korean Neurosurg Soc 2012;52(2):138-143. 3. Ganju A, Roosen N, Kline DG, Tiel RL. Outcomes in a consecutive series of 111 surgically treated plexal tumors: a review of the experience at the Louisiana State University Health Science Center. J Neurosurg 2001;95(1):51-60. 4. Levi AD, Ross AL, Cuartas E, Qadir R, Temple HT. The surgical management of symptomatic peripheral nerve sheath tumors. Neurosurgery 2010;66(4):833-840. 5. Kim DH, Murovic JA, Tiel RL, Moes G, Kline DG. A series of 397 peripheral neural sheath tumors: 30-year experience at Louisiana State University Health Science Center. J Neurosurg 2005;102(2):246-255. 6. Goertz O, Langer S, Uthoff D, et al. Diagnosis, treatment and survival of 65 patients with malignant peripheral nerve sheath tumors. Anticancer Res 2014;34(2):777-783. 7. Gachiani J, Kim D, Nelson A, Kline D. Surgical management of malignant peripheral nerve sheath tumors. Neurosurg Focus 2007;22(6):E13. 8. Gosk J, Gutkowska O, Mazurek P, Koszewicz M, Ziolkowski P. Peripheral nerve tumors: 30-year experience in the surgical treatment. Neurosurg Rev 2015;38(3):511-520. 9. Karaman I, Oner M, Kafadar IH, Guney A, Argun M. Surgical excision of peripheral nerve schwannomas: analysis of 11 patients. Acta Orthop Traumatol Turc 2015;49(2):139-143. 10. Adani R, Tarallo L,Mugnai R, Colopi S. Schwannomas of the upper extremity: analysis of 34 cases. Acta Neurochir (Wien) 2014;156(12):2325-2330. 11. Desai KI. Primary benign brachial plexus tumors: an experience of 115 operated cases. Neurosurgery. 2012;70(1):220-233.

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