Benign neural sheath tumours of major nerves: Characteristics in 119 surgical cases

Abstract

Peripheral benign nerve sheath tumours are infrequent tumours and affect major nerve trunks. Some authors have indicated a high and prohibitive incidence of neurological injury in resection of these lesions. The authors describe their findings in a retrospective study comprising 119 patients with spontaneous benign nerve sheath tumours of the peripheral nervous system. Seventy-three patients had a schwannoma, 41 had neurofibroma and 5 had plexiform neurofibroma; 25 of the 119 patients suffered from neurofibromatosis. All schwannomas were excised completely and the outcome of patients was 41.0% improved, 6.8% worsened, 52.0% unchanged. Twenty-eight neurofibromas were excised completely and 13 subtotally; the outcome for patients was 19.5% improved, 19.5% worsened and 61% unchanged. All plexiform neurofibromas were removed subtotally and the outcome for patients was 20% improved and 80% unchanged. The best surgical results at average follow-up of 6 years were observed in the patients with schwannoma, the worst in those with plexiform neurofibroma. Our results demonstrated that it is often possible to remove schwannomas as well as neurofibromas with an acceptable risk of injury to the nerve.

Tumors of the peripheral nervous system: analysis of prognostic factors in a series with long-term follow-up and review of the literature

“…3,6 Moreover, data from the literature also support our finding of a strong association between malignant histology and worse prognosis. 11,13,14,19,24,29,35,39,59 PNNST includes different entities, both benign and malignant, that, in our series, showed a higher risk of recurrence compared with BPNST.…”

“…Although Wanebo et al 56 found that NF was associated with better PFS in patients with MPNSTs, data in the literature are otherwise consistent with the finding that a history of NF is associated with a worse prognosis in terms of PFS and OS, 3,21,40,48,56 and recurrence risk. 3,6 Moreover, data from the literature also support our finding of a strong association between malignant histology and worse prognosis.…”

“…Vetrano et al 55 showed that tumors located at the lumbosacral plexus were associated with more postoperative pain than tumors in the extremities, brachial plexus, or spinal roots. Moreover, the same authors 55 showed that a diagnosis of neurofibroma predicts a better functional outcome, although in large series of brachial plexus, 3,17 lumbar plexus, and extremity, 3 and paraspinal tumors, 11 the diagnosis of neurofibroma was associated with a higher risk of developing neurological deficits compared with a diagnosis of schwannoma. However in considering surgical series in which cases of BPNST, MPNST, and PNNST were analyzed together, the histopathological finding of BPNST emerged as a good prognostic indicator for extent of resection, reduced risk of complications, and reduced risk of postoperative deficits.…”

Is Surgery for Brachial Plexus Schwannomas Safe and Effective?

“…A technique consisting of the removal or enucleation of the schwannoma has been reported [1,4,11,13,17,19]. However, extracapsular excision can damage the normal fascicles during dissection of the capsule.…”

Schwannomas of the Hand and Wrist: Long-Term Results and Review of the Literature

“…8 They usually occur in patients aged 30 to 60 years and have no race or sex predilection. [7][8][9] Neurilemmomas originate from the cells of the Schwann sheath and, thus, are also called schwannomas. They arise within the nerve sheath and are surrounded by a true capsule consisting of epineurium.…”