Benign tumors affecting the median nerve. Case series report of diagnostic and surgical strategies

Abstract

ObjectiveThe aim of this study was to describe the strategies adopted in this institution to diagnose and treat patients with benign tumors affecting the median nerve.MethodsA retrospective chart review study of all patients operated on between 2010 and 2015. Histology, symptoms, complementary exams, surgical techniques performed, and demographic characteristics were analyzed.ResultsFifty-four patients were included in the study. There were three neurofibromas, six schwannomas, 15 lipofibromatous hamartomas, three hemangiomas, 12 lipomas, one benign fibrohistiocytoma, and 14 synovial cysts. Complete tumoral resection was performed in 32 cases, partial resection in five, segmented nerve resection in one, nerve decompression in eight, and amputation for macrodactyly in eight.ConclusionsThe most important recommendations on treating benign tumors of the median nerve are related to the clinical symptoms, tumoral growth, and tumoral nature. The surgical approach resulted in good function for 60% of the patients. However, lipofibromatous hamartomas, hemangiomas, and neurofibromas were associated with preoperative functional deficit. It may be inferred that the diagnosis and treatment of these tumors should be performed earlier.

Patients’ Perspective on Carpal Tunnel Release with WALANT or Intravenous Regional Anesthesia

“…However, sedation brings the risk of postoperative nausea and vomiting, with an incidence up to 24 percent. 5 In our study, patients signed informed consent forms for the anesthesia types and surgery. This contract relies on mutual trust and confidence between patient and surgeon, not only for the surgical procedure itself but also for possible complications and postoperative care.…”

“…4 Those types of lesions can affect the nerve by compressing it, dislocating its structure, and disturbing its vascular flow, and may lead to clinical findings such as pain, paresthesia, and carpal tunnel syndrome. 5 Those types of lesions can affect bony structures or joints. Lesions with such involvements might require deeper anesthesia and analgesia.…”