Surgical excision of peripheral nerve schwannomas: analysis of 11 patients

Öz

Objective: Benign schwannomas are the most common tumour of the peripheral nerves. Symptomatic schwannomas are treated by surgical excision, but new neurological deficits may develop. We performeda retrospective review of cases of schwannomas in the extremities and reviewed the relevant literature.

Methods: We retrospectively reviewed the demographic characteristics of 11 patients with schwannomas treated at our institution. We also reviewed the clinical characteristics and postoperative results of these cases, determined the possible risk factors influencing the development of complications and compared the risk factors with those reported in the literature.

Results: There were five males and six females with a mean age of 37.6 (range: 17–62) years. The mean postoperative follow-up was 54.6 (range: 26–88) months. Three tumours were located in the forearm and the rest were localized in the lower extremity. No recurrences were observed during the follow-up period. New motor and sensory deficits were observed in only one patient.

Conclusion: Schwannomas in the extremities can be excised with acceptable risk of neurological deficits. Meticulous dissection is required during surgery.

Anahtar Kelimeler

• Neurilemmoma
• neuroma
• perineural fibroblastoma
• peripheral nerve
• schwannoma

Periferik sinir schawannomlarının cerrahi eksizyonu: On bir hastanın analizi

Öz

 

Amaç: Benign shcwannom periferik sinirlerin en yaygın tümörüdür. Semptomatik schwannomun tedavisi cerrahi eksizyondur. Cerrahlar yeni nörolojik defisitlerin gelişme olasılığına hazırlıklı olmalıdır. Biz literatürle birlikte ekstremite schwannomlarını içeren olguların geriye dönük bir analizi yaptık.

 

Çalışma planı: Hastanemizde tedavi edilen 11 schawannomlu hastanın verilerini geriye dönük olarak inceledik. Klinik özellikleri ve ameliyat sonrası sonuçları gözden geçirdik ve komplikasyonların gelişimini etkileyen olası risk faktörlerini belirledik ve bunları literatürle karşılaştırdık.

 

Bulgular: Ortalama yaşın 37.6 (17–62) olduğu beş erkek ve altı kadın vardı. Ameliyat sonrası ortalama takip süresi 54.6 (26–88) aydı. Önkolda üç tümör tespit edildi ve diğer tümörler bacak alt kısmındaydı. Takip periyodunda nüks gözlenmedi. Bir hastada yeni motor ve duysal defisit gözlendi.

 

Çıkarımlar: Ekstremite schwannomaları kabul edilebilir nörolojik defisit riski ile eksize edilebilir. Cerrahi sırasında titiz bir disseksiyon gereklidir.

 

Anahtar Kelimeler

• Nörilemmoma; periferik sinir; perinöral fibroblastom; schwannoma.

Kaynakça

1. Verocay J. Zur Kenntnis der ‘Neurofibrome’. Beitr Pathol Anat Allg Pathol 1910;48:1.
2. Kang HJ, Shin SJ, Kang ES. Schwannomas of the upper extremity. J Hand Surg Br 2000;25(6):604–7.
3. Strickland JW, Steichen JB. Nerve tumors of the hand and forearm. J Hand Surg Am 1977;2(4):285–91.
4. Birch R, Bonney G, Wynn Parry CB. The peripheral ner- vous system and neoplastic disease. In: Surgical disorders of the peripheral nerves. Edinburgh: Churchill Living- stone; 1998. p. 335–52.
5. Donner TR, Voorhies RM, Kline DG. Neural sheath tu- mors of major nerves. J Neurosurg 1994;81:362–73.
6. Phalen GS. Neurilemmomas of the forearm and hand. Clin Orthop Relat Res 1976;114:219–22.
7. Oberle J, Kahamba J, Richter HP. Peripheral nerve schwan- nomas-an analysis of 16 patients. Acta Neurochir (Wien) 1997;139:949–53.
8. Kim SM, Seo SW, Lee JY, Sung KS. Surgical outcome of schwannomas arising from major peripheral nerves in the lower limb. Int Orthop 2012;36:1721–5.

9. Levi AD, Ross AL, Cuartas E, Qadir R, Temple HT. The surgical management of symptomatic peripheral nerve sheath tumors. Neurosurgery 2010;66:833–40.
10. Whitaker WG, Droulias C. Benign encapsulated neurile- moma: a report of 76 cases. Am Surg 1976;42:675–8.
11. Sawada T, Sano M, Ogihara H, Omura T, Miura K, Na- gano A. The relationship between pre-operative symp- toms, operative findings and postoperative complications in schwannomas. J Hand Surg Br 2006;31:629–34.
12. Söderlund V, Göranson H, Bauer HC. MR imaging of benign peripheral nerve sheath tumors. Acta Radiol 1994;35:282–6.
13. Bhatti AM, Alo GO, Power DM, Masood A, Thuse MG. Lobulated schwannoma of the median nerve: pitfalls in di- agnostic imaging. J Comput Assist Tomogr 2005;29:330– 2.
14. Ogose A, Hotta T, Morita T, Yamamura S, Hosaka N, Ko- bayashi H, et al. Tumors of peripheral nerves: correlation of symptoms, clinical signs, imaging features, and histo- logic diagnosis. Skeletal Radiol 1999;28:183–8.
15. Knight DM, Birch R, Pringle J. Benign solitary schwan- nomas: a review of 234 cases. J Bone Joint Surg Br 2007;89:382–7.
16. Rhanim A, El Zanati R, Mahfoud M, Berrada MS, El Yaa- coubi M. A rare cause of chronic sciatic pain: Schwannoma of the sciatic nerve. J Clin Orthop Trauma 2013;4:89–92.
17. Jenkins Sa. Solitary tumours of peripheral nerve trunks. J Bone Joint Surg Br 1952;34-B:401–11.
18. Woodruff JM, Selig AM, Crowley K, Allen PW. Schwan- noma (neurilemoma) with malignant transformation. A rare, distinctive peripheral nerve tumor. Am J Surg Pathol 1994;18:882–95.