gms | German Medical Science

Objective: Tumors of the brachial plexus are relatively rare and present a clinical challenge for the nerve surgeon. The majority of the patients show pain with minimal or no neurological deficits. The dignity can hardly be predicted preoperatively, even in MRI. Only fast growing masses and rest pain reveal a higher probability of malignity. PET-CT can give more information concerning malignancy of these tumors.

Method: Over a period of ten years (2002-2013), 55 patients with tumors involving the brachial plexus were operated upon in our neurosurgical department. Among this group we found 23 benign neural sheath tumors, 10 neurofibromas, 7 malignant neural sheath tumors, 4 lipomas, 3 metastases, 2 aggressive fibromatosis, 1 leimyosarkoma and 1 non hodgkin lymphoma. The preoperative MRIs showed contrast enhancement of the tumor masses. T2 is also important in order to disthinguish a tumor from a cyst. Intratumoral inhomegenity can be a sign of malignancy. 6 patients had no neurological symptoms preoperatively, except of pain (5x schwannomas and 1x neurofibroma). 50 patients showed paresthesia, hypaesthesia and weakness. MPNST in particular showed rest pain. 12 subtotal resections were performed (one malignant neural sheath tumor, one leiomyosarkoma, one non hodgkin lymphoma, two perineurinoma, 5 neurofibromas, two metastases – malignant melanoma and breast carcinoma).

Results: In cases of subtotal resection the nerve function was overriding. In 22 cases (40%) neurological outcome was unchanged, in 10 cases (19%) amelioration of weakness, hypaesthesia and pain was achieved. 15 cases (27%) deteriorated. They showed an increase of weakness. The MPNST patients received a combined radiotherapy and chemotherapy. Three of the MPNST patients are still alive. One having had surgery ten years ago (WHO III), one two years ago (WHO IV) and one in August 2013 (WHO IV). Two (WHO IV) died about one year after surgery. In two cases (one WHO IV and one WHO III) there are no long-term results known. In one case (WHO IV) we had a subtotal resection, the patient died after one year.

Conclusions: The majority of our brachial plexus tumors were benign and most of them could be excised with low incidence of additional deficits. Careful workup, surgical technique, and attention to pathological diagnosis optimize management.