gms | German Medical Science

Objectives/Interrogation: Tumours of the brachial plexus region are rare. Whilst the majority of tumours are benign, patients can develop devastating neurological deficits and disabling pain. The aim of this study was, firstly, to assess the clinical presentation, and subsequent pathological diagnosis of patient's presenting with brachial plexus tumours and, secondly, to assess motor functional outcomes, patient-reported upper extremity function, and pain following tumour extirpation +/- reconstruction.

Methods: We performed a retrospective analysis of 135 consecutive patients (n=135) who underwent excision of both primary and secondary brachial plexus tumours +/- reconstruction by a single-surgeon over a 20-year period. Data was collated from medical records, neuro-imaging, operative reports, and histopathological findings. Outcomes were assessed using the British Medical Research Council power grading system, quick Disability of Arm, Shoulder and Hand questionnaire, and Pain Visual Analogue Scale (PVAS).

Results and Conclusions: The mean age at presentation was 49.2 years (range: 9 - 89 years). The most common presentation was an expanding lump (87.3%). Additional presenting signs and symptoms included paraesthesia (44%), radicular pain (51%), local pain (15%), and motor weakness (10%). Duration of symptoms ranged from 2 months to 10 years.

Histologically, the cohort comprised a heterogeneous group of lesions, 76.3% (103/135) benign and 23.7% (32/135) malignant. Benign nerve sheath tumours were the predominant sub-type - namely schwannomas (41%) and neurofibromas (35%). Of the malignant tumours, soft tissue sarcomas occurred most frequently, 50% (16/32). The overall recurrence rate was 23.2% for the cohort at latest follow-up, 80% represented by malignant tumour recurrence.

Functionally, post-operative nerve preservation was achieved in 93.1% of patients at long term follow-up. Motor function (BMC) scores improved in 65% of patients. Quick DASH and PVAS response rate was n=56 of n=116 surviving patients (48.3%). At follow-up, the mean quick DASH score for this cohort was 26.1 (range 0-79.5). The mean PVAS score was 29.1 mm (range 3-100 mm).

To conclude, a multidisciplinary approach combined with early referral to specialist services, is vital to optimise outcomes for these potentially debilitating lesions. We report a low complication rate with good functional and patient self-reported outcomes following surgical intervention for brachial plexus tumours.