gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Pediatric Median Nerve Neurofibroma

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  • presenting/speaker Kahraman Ozturk - Health Sciences University M.S. Baltalimani Bone Diseases, Teaching and Research Hospital, Hand Surgery Clinic, Istanbul, Turkey
  • Bilge Ozkan - Health Sciences University M.S. Baltalimani Bone Diseases, Teaching and Research Hospital, Hand Surgery Clinic, Istanbul, Turkey
  • Ayse Sencan - Health Sciences University M.S. Baltalimani Bone Diseases, Teaching and Research Hospital, Hand Surgery Clinic, Istanbul, Turkey
  • Zeki Gunsoy - Health Sciences University M.S. Baltalimani Bone Diseases, Teaching and Research Hospital, Hand Surgery Clinic, Istanbul, Turkey
  • Rustam Jalilov - Health Sciences University M.S. Baltalimani Bone Diseases, Teaching and Research Hospital, Hand Surgery Clinic, Istanbul, Turkey

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1502

doi: 10.3205/19ifssh0302, urn:nbn:de:0183-19ifssh03024

Veröffentlicht: 6. Februar 2020

© 2020 Ozturk et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

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Objectives/Interrogation: Neurofibromas are benign tumors which originates from neural fascicles. The peak age of presentation of solitary neurofibromas is between 20-40 age and they are rarely seen in childhood. Our case had a large solitary neurofibroma affecting the two fascicles of the median nerve.

Methods: A 15 years old male patient was admitted to our clinic with the complaint of numbness and weakness in the first, second and third fingers of the left hand for the last year. Sensory examination was normal. Left-hand grip strength decreased by 60% compared to the other side. Radiographic evaluation and EMG test were normal. In the MRI, the median nerve at the wrist level of the mass was 3 cm in diameter and 8 cm in length and within the fascicles, the continuity of the median nerve fiber was observed on the ulnar side of the tumor (Figure 1 [Fig. 1]).

Incisional biopsy revealed neurofibroma and excision was performed. During the surgery, it was observed that the mass infiltrated two nerve fascicles and pushed other median nerve fibers. Existing motor branches were divided using nerve stimulator and the two fascicles passing through the mass was considered the cutaneous branch and were excised (Figure 2 [Fig. 2]).

These two fibers were coapted as end-to-side fashion to the median nerve distally. In postoperative follow-up, muscle strength and grip strength were normal in first two lumbrical and thenar muscles. The physical examination of the patient revealed sensory deficits in 2nd ulnar side of the second finger and radial side of the third finger.

Results and Conclusions: Large solitary neurofibromas can also be seen in childhood. The tumoral mass can be removed without causing motor and sensory deficits.