Nerve sheath tumor surgery: case-guided discussion of ambiguous findings, appropriateness of removal, repeated surgery, and nerve repairs

Abstract

<jats:p>✓In this article the authors attempt to raise awareness of the pitfalls and controversial issues in nerve tumor surgery. In a case-guided format, examples of ambiguous findings, inappropriate tumor removal, repeated surgery, and nerve repairs are provided. The authors also discuss the need to establish a correct diagnosis preoperatively and to avoid the erroneous identification of malignant peripheral nerve sheath tumors (MPNSTs). They emphasize that not all of the principles of soft tissue sarcoma treatment protocols are applicable to MPNST. A situation of repeated surgery for supposedly malignant tumor is described, and an outline of the indications for, and an approach to, repair after lesion removal is given.</jats:p>

The Importance of Predicting Factors in the Surgical Outcome of Peripheral Nerve Sheath Tumors

“…In other studies, neurofibroma removal was associated with an higher risk of nerve damage and a less favorable surgical outcome. 25,26 MPNSTs are associated with an unfavorable outcome, especially concerning neurologic deficits. 1,3,4 This evident lack of improvement may be attributable to the rapid growth of the tumor, which often causes a significant compression of a large part of the nerve, and to the necessity of an extensive resection to get tumorfree margins, 3,6 thus contributing to greater nerve damage.…”

The Lipid Asset Is Unbalanced in Peripheral Nerve Sheath Tumors

“…The mainstay of PNST treatment is surgical removal [ 1 , 3 , 11 , 12 , 13 , 14 , 15 , 16 ], although this approach is not always feasible, as in the case of huge schwannomas or PNFs. Moreover, although the different subtypes of PNST are considered benign tumors according to the biological behavior, PNFs differ from NFs and schwannomas due to their propensity for malignant degeneration.…”