Results of Surgical Treatment of Schwannomas Arising from Extremities

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.

UK guidelines for the management of soft tissue sarcomas

“…Surveillance may be considered in asymptomatic schwannomas, or other neural tumours with no malignant features [158]. For benign tumours resection with minimisation of residual neurological deficit is the aim, and in many cases can result in improvement in peripheral nerve function [159]. Malignant peripheral nerve sheath tumours (MPNST) are aggressive tumours with a relatively poor prognosis [160].…”

A benign ancient schwannoma of the tibia nerve

“…MRI is another preferred tool that can define the nerve–tumour relationship. The lesion presents as a well-defined mass, usually fusiform in shape, located within the nerve, isointense to surrounding muscles on T1-weighted images and hyperintense on T2-weighted images 3. Ultrasonography, CT and MRI are all useful modalities in the preoperative diagnostic work up of this nerve tumour, however, each of these imaging studies has limitations in distinguishing between the different types of nerve sheath tumours aside from problems differentiating between benign and malignant lesions.…”

Median Nerve Schwannoma of the Hand and Wrist: 3 Cases

“…Schwannomatosis comprises multiple non-cutaneous Schwannomas, but a very rare condition with 38 cases has been reported in the literature so far [4]. Schwannomas are benign in the vast majority of cases and malignant transformation or relapse post-excision is almost non-existent [5,6]. They are usually asymptomatic in the early stages, and are not noticed, until they either become palpable, or develop nerve compression [7].…”

“…Computerized tomography and ultrasound were originally used as the main imaging modalities, yet recently, Magnetic resonance imaging has become the gold standard in imaging [8]. Treatment consists of intralesional excision by sparing the fascicles where possible, with predictable pain relief and low complication rate/recurrence [6].…”