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Results of surgical treatment of schwannomas arising from extremities.

Gosk J, Gutkowska O, Urban M, Wnukiewicz W, Reichert P, Ziółkowski P - Biomed Res Int (2015)

Bottom Line: Improvement in motor function was noted in 28.5% of the cases, in sensory function: complete in 70%, and partial in 15%.The most frequently affected major peripheral nerves were the ulnar (11 tumours) and median (5 tumours) nerves.After their resection, definitive healing was achieved.

View Article: PubMed Central - PubMed

Affiliation: Department of Traumatology, Clinic of Traumatology and Hand Surgery, Wroclaw Medical University, Ulica Borowska 213, 50-556 Wrocław, Poland.

ABSTRACT
Schwannomas are benign neoplasms derived from Schwann cells. In this work, we present our experience in operative management of schwannomas and analyse results of treatment. Clinical material consisted of 34 patients, in whom 44 schwannomas located in extremities were excised between 1985 and 2013. Thirty-five tumours originated from major peripheral nerves and 9 from small nerve branches. Postoperatively, in the first group of tumours, pain resolved in 100%, paresthesias in 83.3%, and Hoffmann-Tinel sign in 91.6% of the patients. Improvement in motor function was noted in 28.5% of the cases, in sensory function: complete in 70%, and partial in 15%. The most frequently affected major peripheral nerves were the ulnar (11 tumours) and median (5 tumours) nerves. Schwannomas originating from small nerve branches were removed without identification of the site of origin. After their resection, definitive healing was achieved. Conclusions. (1) Schwannomas located in extremities arise predominantly from major peripheral nerves, most commonly the ulnar and median nerves. (2) Gradual tumour growth causes exacerbation of compression neuropathy, creating an indication for surgery. (3) In most cases, improvement in peripheral nerve function after excision of schwannoma is achieved. (4) The risk of new permanent postoperative neurological deficits is low.

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MJ, age 51, male. Previously operated on in another hospital for schwannoma of the upper trunk of the brachial plexus. Intraoperative view: iatrogenic damage to the upper and middle trunks of the brachial plexus after excessively radical excision of the tumour with a part of healthy neural tissue.
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fig3: MJ, age 51, male. Previously operated on in another hospital for schwannoma of the upper trunk of the brachial plexus. Intraoperative view: iatrogenic damage to the upper and middle trunks of the brachial plexus after excessively radical excision of the tumour with a part of healthy neural tissue.

Mentions: When neurological deficits after excision of schwannomas are considered, awareness must be raised that every surgical intervention in a peripheral nerve is connected with the risk of complications. However, as the analysis of our clinical material and the review of literature revealed, in most cases improvement in nerve function is achieved and onset of new persistent postoperative deficits is limited to isolated cases [5, 10, 12, 37, 46]. At the same time, it must be realized that growth of tumour causes exacerbation of symptoms of compression neuropathy [37]. It has been suggested that slow growth pattern of schwannomas allows for adaptation of nerve function to the pressure effects [7]. However, at a certain point in their growth, most tumours become symptomatic [1, 2, 5, 6, 18]. In our material, only patients in whom tumour growth caused obvious clinical symptoms were scheduled for operation. In our opinion, chances for nerve function improvement after excision of tumour justify the risk related to surgical treatment. As a result of operative treatment, the authors of this work achieved improvement in nerve function in most of the patients. Operative removal of peripheral nerve tumours requires from the surgeon both microsurgical experience and knowledge on mechanisms of tumour development. Lack of this knowledge and adequate experience in treatment of this type of lesions can result in serious iatrogenic damage to nerves (Figure 3).


Results of surgical treatment of schwannomas arising from extremities.

Gosk J, Gutkowska O, Urban M, Wnukiewicz W, Reichert P, Ziółkowski P - Biomed Res Int (2015)

MJ, age 51, male. Previously operated on in another hospital for schwannoma of the upper trunk of the brachial plexus. Intraoperative view: iatrogenic damage to the upper and middle trunks of the brachial plexus after excessively radical excision of the tumour with a part of healthy neural tissue.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4352496&req=5

fig3: MJ, age 51, male. Previously operated on in another hospital for schwannoma of the upper trunk of the brachial plexus. Intraoperative view: iatrogenic damage to the upper and middle trunks of the brachial plexus after excessively radical excision of the tumour with a part of healthy neural tissue.
Mentions: When neurological deficits after excision of schwannomas are considered, awareness must be raised that every surgical intervention in a peripheral nerve is connected with the risk of complications. However, as the analysis of our clinical material and the review of literature revealed, in most cases improvement in nerve function is achieved and onset of new persistent postoperative deficits is limited to isolated cases [5, 10, 12, 37, 46]. At the same time, it must be realized that growth of tumour causes exacerbation of symptoms of compression neuropathy [37]. It has been suggested that slow growth pattern of schwannomas allows for adaptation of nerve function to the pressure effects [7]. However, at a certain point in their growth, most tumours become symptomatic [1, 2, 5, 6, 18]. In our material, only patients in whom tumour growth caused obvious clinical symptoms were scheduled for operation. In our opinion, chances for nerve function improvement after excision of tumour justify the risk related to surgical treatment. As a result of operative treatment, the authors of this work achieved improvement in nerve function in most of the patients. Operative removal of peripheral nerve tumours requires from the surgeon both microsurgical experience and knowledge on mechanisms of tumour development. Lack of this knowledge and adequate experience in treatment of this type of lesions can result in serious iatrogenic damage to nerves (Figure 3).

Bottom Line: Improvement in motor function was noted in 28.5% of the cases, in sensory function: complete in 70%, and partial in 15%.The most frequently affected major peripheral nerves were the ulnar (11 tumours) and median (5 tumours) nerves.After their resection, definitive healing was achieved.

View Article: PubMed Central - PubMed

Affiliation: Department of Traumatology, Clinic of Traumatology and Hand Surgery, Wroclaw Medical University, Ulica Borowska 213, 50-556 Wrocław, Poland.

ABSTRACT
Schwannomas are benign neoplasms derived from Schwann cells. In this work, we present our experience in operative management of schwannomas and analyse results of treatment. Clinical material consisted of 34 patients, in whom 44 schwannomas located in extremities were excised between 1985 and 2013. Thirty-five tumours originated from major peripheral nerves and 9 from small nerve branches. Postoperatively, in the first group of tumours, pain resolved in 100%, paresthesias in 83.3%, and Hoffmann-Tinel sign in 91.6% of the patients. Improvement in motor function was noted in 28.5% of the cases, in sensory function: complete in 70%, and partial in 15%. The most frequently affected major peripheral nerves were the ulnar (11 tumours) and median (5 tumours) nerves. Schwannomas originating from small nerve branches were removed without identification of the site of origin. After their resection, definitive healing was achieved. Conclusions. (1) Schwannomas located in extremities arise predominantly from major peripheral nerves, most commonly the ulnar and median nerves. (2) Gradual tumour growth causes exacerbation of compression neuropathy, creating an indication for surgery. (3) In most cases, improvement in peripheral nerve function after excision of schwannoma is achieved. (4) The risk of new permanent postoperative neurological deficits is low.

Show MeSH
Related in: MedlinePlus