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  • Tumors of the Brachial Plexus Region: a 25 Year Experience

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    Jared M. Pisapia MD MTR; Giscard Adeclat BA; Sanford Roberts; Li Yun; Zarina S. Ali MD; Gregory George Heuer; Eric L. Zager MD

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    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Neoplasms of the brachial plexus region are rare. In this case series, we review our experience with brachial plexus tumors with emphasis on patterns of presentation, treatment, and outcome.

    Methods: We retrospectively reviewed medical records of patients undergoing surgical resection of brachial plexus region tumors performed by a single neurosurgeon at an academic institution from 2001 – 2016. Baseline characteristics, tumor location, surgical approach, pathological diagnosis, and post-operative motor function at the time of most recent follow-up were collected.

    Results: In 98 patients, 103 brachial plexus region tumors were identified (mean age 47, 50% female). A palpable mass was present in 93 patients (90%), and sensory deficit/paresthesia was the most common presenting symptom (41 patients, 40%). The supraclavicular region was the most common tumor location (56%), and the supraclavicular approach was the most common surgical approach. Schwannoma (45%) and neurofibroma (23%) were the most common tumor types. Greater than 95% resection was achieved in 68 patients (72%). Mean follow-up time was 10 months among 95 tumors in 90 patients. Pain at follow-up was stable or improved in 72 patients (85%), and post-op function was unchanged or improved in 67 patients (75%). Among patients with no pre-operative deficit, motor function was worse in 18 patients (35%). Of these patients, half had motor strength of 4/5 at most recent follow-up. Among patients with a pre-operative motor deficit, strength was worse in 4 patients (10%).

    Conclusions: We present findings from a relatively large series of brachial plexus region tumors to further characterize the epidemiology and outcome of such neoplasms. Tumor resection is associated with improved post-operative pain and is not commonly associated with severe post-operative motor deficit, especially in cases in which pre-operative motor deficits are already present.

    Patient Care: By reporting additional data on the epidemiology of brachial plexus region tumors, clinicians will be better equipped to provide prognostic information to patients, especially regarding motor function after surgery.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the most common presenting symptoms of brachial plexus tumors, 2) Discuss, in small groups, the location, types, and surgical approaches to brachial plexus tumors, 3) Identify patterns of post-operative motor function based on the presence or absence of a pre-operative motor deficit.


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