gms | German Medical Science

Due to recent improvements in ultrasound scanning techniques, an increasing number of nerves can be investigated to uncover peripheral nerve tumours. We further investigated this method in order to improve the pre-operative diagnosis and plan the optimal surgical strategy.

In the last 30 months, we treated eleven patients (3 female and 8 males) with peripheral nerve tumours: 6 neurofibromas, 1 perineurioma, 1 lipofibroma, 1 neurinoma and 1 malignant schwannoma. The pre-operative diagnosis included electromyography combined with nerve conduction studies and MR imaging. High-resolution ultrasonography was performed to detect morphological changes in the peripheral nerve, to assess the adjacent soft tissue, muscles and vessels and to investigate the respective nerve in function. A special focus was laid on the comparison of ultrasonography to MRI.

The surgical approach was tailored according to the nerve and the tumour location. The nerve or element leading into and out of the tumour, adjacent vessels and adherent structures were exposed. The fascicular anatomy at both proximal and distal poles of the lesion were microsurgically worked out. In three cases of benign tumours, an interfascicular graft repair was necessary after tumour resection. In one case of a malignant neural sheath tumour, we favoured a limb-sparing but wide local resection of the neural tumour and the adjacent tissue. The results of the pre-operative ultrasound exactly defined the resection area and were, in all cases, in accordance with MRI and the intraoperative findings.

High-resolution ultrasonography facilitates the preoperative diagnosis, reveals the topographic relation and ensures the detection of morphologic changes within the neural tissue. The equivalent results of MRI investigations favour ultrasonography as the initial method in the evaluation of nerve tumours.