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. 2020 May;13(2):203-208.
doi: 10.21053/ceo.2019.01207. Epub 2020 Apr 4.

Feasibility of Brachial Plexus Schwannoma Enucleation With Intraoperative Neuromonitoring

Doh Young Lee  1 , Jeong-Yeon Chi  2 , Jungirl Seok  2 , Sungjun Han  2 , Min-Hyung Lee  1 , Woo-Jin Jeong  2 , Young Ho Jung  2
Affiliations

Feasibility of Brachial Plexus Schwannoma Enucleation With Intraoperative Neuromonitoring

Doh Young Lee et al. Clin Exp Otorhinolaryngol. 2020 May.

Abstract

Objectives: To evaluate the feasibility of brachial plexus schwannoma enucleation under intraoperative neuromonitoring.

Methods: Five patients who were treated for brachial plexus schwannoma under intraoperative neuromonitoring from 2008 to 2018 were included in this retrospective review. Neuromonitoring was performed with a 100-μV event threshold of the neuromonitoring system (NIM-2 or 3) at the deltoid, biceps brachii, triceps brachii, and brachioradialis muscles. Patient characteristics, tumor size and location, intraoperative neuromonitoring findings, and postoperative function were evaluated.

Results: The intraoperative neuromonitoring findings were in accordance with the preoperative assessment of the included nerve root. Three patients had no postoperative morbidity, one patient had temporary paresthesia of the forearm for 2 months, and one patient mild loss of grip strength for 1 month.

Conclusion: Intraoperative neuromonitoring of the arm and forearm muscles during enucleation of brachial plexus schwannoma promoted confident and successful surgery with minimal postoperative morbidity.

Keywords: Brachial Plexus; Feasibility Study; Neurilemmoma: Enucleation; Neuromonitoring; Schwannoma.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Schematic diagram of the muscles to be monitored, their innervation, and the locations of the tumor in five cases. The table describes the innervation of the arm and the muscles controlled by each of the nerves.
Fig. 2.
Fig. 2.
Surgical technique. Exposure of the shoulder and arm is essential because muscle twitching can be observed during nerve stimulation (A). Neuromonitoring was performed with a two-channel (one case) or four-channel (four cases) nerve integrity monitor (NIM-2 or -3, Medtronic, Memphis, TN, USA) and a unipolar stimulating probe was used to stimulate the tumor or the nerves before identification and enucleation of the mass (B, C). After enucleation of the tumor, stimulation of the nerve was performed to confirm neural integrity (D).
See this image and copyright information in PMC

References

    1. Biswas D, Marnane CN, Mal R, Baldwin D. Extracranial head and neck schwannomas: a 10-year review. Auris Nasus Larynx. 2007 Sep;34(3):353–9. - PubMed
    1. Moukarbel RV, Sabri AN. Current management of head and neck schwannomas. Curr Opin Otolaryngol Head Neck Surg. 2005;13(2):117–22. - PubMed
    1. Shrikrishna BH, Jyothi AC, Kulkarni NH, Mazhar MS. Extracranial head and neck schwannomas: our experience. Indian J Otolaryngol Head Neck Surg. 2016 Jun;68(2):241–7. - PMC - PubMed
    1. Zhang H, Cai C, Wang S, Liu H, Ye Y, Chen X. Extracranial head and neck schwannomas: a clinical analysis of 33 patients. Laryngoscope. 2007 Feb;117(2):278–81. - PubMed
    1. Liu HL, Yu SY, Li GK, Wei WI. Extracranial head and neck Schwannomas: a study of the nerve of origin. Eur Arch Otorhinolaryngol. 2011 Sep;268(9):1343–7. - PMC - PubMed