Management of benign nerve sheath tumors of the brachial plexus: relevant diagnostic and surgical features. About a series of 17 patients (19 tumors) and review of the literature
| Autor: | Gilles Reuter, François Gérardy, Bruno Kaschten, Annie Dubuisson, Tudor Racaru, Maximilien Steinmetz, Didier Martin |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Percutaneous Schwannoma Nerve Sheath Neoplasms 03 medical and health sciences 0302 clinical medicine Cervical lymphadenopathy medicine Humans Brachial Plexus 030212 general & internal medicine Neurofibromatosis Schwannomatosis Neuroradiology Retrospective Studies business.industry Disease Management General Medicine Middle Aged medicine.disease Nerve sheath tumor Female Neurology (clinical) Radiology medicine.symptom business Brachial plexus 030217 neurology & neurosurgery |
| Zdroj: | Acta neurologica Belgica. 121(1) |
| ISSN: | 2240-2993 |
| Popis: | Brachial plexus (BP) tumors are rare, potentially difficult-to-manage lesions. The method is retrospective chart analysis. Among the 17 patients, four had neurofibromatosis and one schwannomatosis (NF +). The latter has bilateral BP tumors that remain stable on MRI at a 6.5 year follow-up. Another NF + patient has bilateral non-operable BP plexiform neurofibromas. The complaints of the 15 operated patients were radiated pain, a mass, local pain, paresthesia, a neurological deficit (n = 15, 12, 7, 10, 7). On MRI, the tumors appeared as nodular or ovoid large masses. Four operated tumors were proximal, reaching the foramen. The FDG-PET scan (n = 4) always showed tumor hypermetabolism. A preoperative percutaneous biopsy was done in three patients before neurosurgical consultation; one of them developed neurogenic pain and a sensory deficit following two percutaneous biopsies for a misinterpreted cervical lymphadenopathy. Surgery was performed using a supra-, infra-, supra- + infra-clavicular or posterior subscapular approach (n = 8, 3, 3, 1). Intraoperative electrophysiology was used in all patients. Complete or gross total resection was achieved in 14 patients. Two patients had fascicle reconstruction with grafts. Pathology revealed 13 schwannomas and two neurofibromas. Neurogenic pain transiently developed or worsened after surgery in five patients. At last follow-up, a mild deficit remained in four patients (preexisting in three). No recurrence had occurred. We conclude that a thorough examination of any patient with a cervical or axillary mass is crucial to avoid misinterpretation as a lymphadenopathy. MRI is the best imaging modality. Most BP benign tumors can be completely and safely resected through the use of microsurgical techniques and intraoperative electrophysiology. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink