Our experience with surgical treatment of the tumours of peripheral nerves in extremities and brachial plexus

Abstract

Outline: The paper presents the results of 33 microsurgical removal of 33 tumours of brachial plexus and of peripheral nerves in extremities performed on 31 patients during the period of 11 years, from 1990 to 2001.

Patient group and methods: The patient group included 26 patients treated for removal of 28 tumours of peripheral nerves in extremities and 5 patients treated for removal of 5 tumours of brachial plexus. Three of these brachial plexus tumours showed intraspinal spread. 32 tumours of neural sheath included 20 schwannomas and 12 neurofibromas. 6 of these 12 neurofibromas were observed in 4 patients suffering from Reklinghausen disease (VRD). One patient had a tumour of non-neural elements--lipoma. We did not encounter any malign tumours of neural sheaths or other neural sheath-derived tumours (benign or metastatic malign ones) that would compress or invade the nerves or plexus. The results were evaluated according to Donner classification of motor and sensory functions.

Results: Motor functions improved or remained unchanged in 18 (90%) patients with schwannoma. 5 patients (83.3%) with pain in the distribution of the affected nerve reported complete or partial improvement of the symptoms. Regarding neurofibroma patients, 3 exhibited either an improvement or unchanged motor functions, and all of them reported partial or complete retreat of pain symptoms. 4 patients with VRD were subjected to the removal of 6 tumours of peripheral nerves in extremities; all of them exhibited improved or stabilised motor functions and partial or complete retreat of pain symptoms. The outcome of treatments was generally better in smaller tumours of neural sheaths with more distal localisation.

Conclusion: Patients should be treated in the early stage of tumour development when the size remains smaller and neurological deficits are absent.