The Surgical Management of Symptomatic Peripheral Nerve Sheath Tumors
| Autor: | Esteban Cuartas, Andrew L. Ross, H. Thomas Temple, Rabah Qadir, Allan D. Levi |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Neurosurgery Schwannoma Preoperative care Nerve Sheath Neoplasms Central nervous system disease Young Adult Biopsy Humans Medicine Neurofibroma Neurofibromatosis Aged Retrospective Studies Aged 80 and over medicine.diagnostic_test business.industry Mortality rate Cancer Middle Aged medicine.disease Magnetic Resonance Imaging Surgery Treatment Outcome Female Neurology (clinical) business Neurilemmoma |
| Zdroj: | Neurosurgery. 66:833-840 |
| ISSN: | 0148-396X |
| DOI: | 10.1227/01.neu.0000367636.91555.70 |
| Popis: | OBJECTIVE: To determine the clinical presentation and morbidity of the surgical management of peripheral nerve sheath tumors (PNSTs). METHODS: We performed a retrospective chart review of surgically treated PNSTs at the University of Miami between 1991 and 2008. RESULTS: There were a total of 140 cases, including 87 schwannomas, 34 neurofibromas, and 19 malignant peripheral nerve sheath tumors (MPNSTs). The average age of the total study group was 49.0 years; it was significantly lower for patients with neurofibroma. There was a high correlation between neurofibroma tumors and neurofibromatosis-1. Most patients with benign tumors presented with a painful mass, paresthesias, or numbness without significant weakness. Patients who had previously undergone attempted resections and preoperative biopsy had a significantly increased risk (41 %) for developing postoperative neurologic deficits when compared with patients who presented with de novo tumors (15%). Intraoperative monitoring appeared to reduce the risk of postoperative motor deficit, particularly in neurofibromas. Most MPNSTs (>80%) were diagnosed at stage IIB or higher and had a combined mortality rate of 31.6% at 78 months. Tumor size was the best predictor of adverse outcome, as all MPNST mortalities occurred in patients with a tumor size of more than 7 cm. CONCLUSION: PNSTs are a heterogeneous group of lesions. Benign tumors respond well to marginal excision, whereas MPNSTs are aggressive sarcomas that require multimodal management. There was a significantly increased risk of postoperative neurologic deficits in patients who had undergone a previous biopsy, and thus tertiary referral without biopsy is recommended when a PNST is suspected. |
| Databáze: | OpenAIRE |
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