Peripheral nerve schwannomas ? an analysis of 16 patients

Abstract

16 patients with peripheral nerve neurinomas (benign schwannomas) were operated upon in our hospital between 1990-1995. The largest tumours were found on proximal segments of peripheral nerves (brachial plexus: 15 cm, sciatic nerve: 20 cm). The average duration of symptoms was 1 1/2 years (range: 3 months-15 years). Pain or painful paraesthesias were the main complaints (13/16). Postoperatively, 9 patients were painfree while 4 improved. Similarly, neurological deficits were favourably influenced by the operation: Out of 5 patients with motor deficits 4 had complete, 1 patient had partial recovery. One out of 4 patients with sensory deficits had complete recovery, 2 remained unchanged, while 1 worsened. Two patients developed new motor and 6 patients new sensory deficits, which (in the course of time) did not disappear completely. New deficits developed predominantly in patients with large tumours or longstanding symptoms. Tumour recurrences were not seen during the follow-up period of 23 months. Our findings revealed that in the majority of cases peripheral nerve neurinomas can be excised with good results. Patients should be treated by a neurosurgeon with special expertise in peripheral nerve surgery. The patient should be thoroughly informed pre-operatively about any eventual new neurological deficits following surgery.

Is Surgery for Brachial Plexus Schwannomas Safe and Effective?

“…We agree with Donner et al [5], and all but five of our patients treated using this technique showed improvement of symptoms without a neurologic deficit. Oberle et al [16] suggested that postoperative neurologic deficits occur mostly in patients with large tumors or long-standing symptoms, which is in agreement with our results showing that larger tumors were associated with a greater risk of neurologic deficit after surgery.…”

Surgical outcome of Schwannomas arising from major peripheral nerves in the lower limb

“…For this reason, it is generally believed that a Schwannoma can easily be enucleated from the nerve without producing a neurological deficit. However, even with meticulou s dissection, several Schwannomas may not be separated or enucleated and this increases the risk of transient or permanent neurological damage [7][8][9]. The threshold for iatrogenic injury during surgical dissection tends to be lower in the extremities than in the trunk.…”

Sciatic Schwannoma-Rare Cause of Sciatica: A Case Report

“…In our case we could not see the same MRI characteristics of nerve injury, but other MRI characteristics of the schwannoma helped us to plan our surgery and made a successful excision of the lesion with good recovery. Oberle et al [3] reported 16 cases that had peripheral nerve schwannoma (one sciatic nerve) and performed total excision of the mass without recurrences. They emphasized that the surgeon who would do the procedure must have special expertise in peripheral nerve surgery to reduce the risk of neurological deficits.…”

“…The tumor bearing nerve element was a very thin fascicle. The tumor and the fascicle was en-bloc resected without any disruption of the sciatic nerve as Oberle et al [3] described the surgical technique of excision ( Figure 2). The mass was removed en bloc and histopathologically it was diagnosed as a schwannoma.…”