gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Giant lipomas as an extremely rare cause for brachial plexus compression

Meeting Abstract

  • Oliver Gembruch - Universitätsklinikum Essen der Universität Duisburg-Essen, Klinik und Poliklinik für Neurochirurgie, Essen, Deutschland
  • Christos Krogias - Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany, Bochum, Deutschland
  • Rebecca Leyrer - Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany, Essen, Deutschland
  • Oliver Müller - Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany, Essen, Deutschland
  • Ulrich Sure - Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany, Essen, Deutschland
  • Karsten Wrede - Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany, Essen, Deutschland
  • Anne-Kathrin Uerschels - Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany, Essen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 125

doi: 10.3205/17dgnc688, urn:nbn:de:0183-17dgnc6889

Published: June 9, 2017

© 2017 Gembruch et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Brachial plexus lipomas are extremely rare benign tumors with only 8 cases reported in the literature that may cause slow progression of neurological deficits. Aim of this report is to present our surgical treatment regime and long-term neurological outcome in two cases of giant brachial plexus lipomas.

Methods: Retrospective analysis of patients treated in our center in the last 3 years revealed giant brachial plexus lipomas causing thoracic outlet syndrome in two cases. Both patients underwent preoperative magnetic resonance imaging (MRI), ultrasound examinations and electrophysiological testing. Tumors were removed microsurgically via anterior, posterior, supraclavicular and infraclavicular approaches. Both patients were accessed postoperatively for early and late MRI and clinical follow-up.

Results: Case One: A 61-year-old male patient presented with a 10 year history of right sided thoracic outlet syndrome causing hypoesthesia of digitus IV and V, a paresis of the triceps brachii muscle, the biceps brachii muscle and the dorsal and palmar interossei muscles. Ultrasound and MRI of the neck depicted a large lipomatous mass compressing the right brachial plexus. Electrophysiological testing showed impairment of the axillary nerve. Total tumor resection via a two-portal supraclavicular/infraclavicular approach and neurolysis finally led to long-term relief of the symptoms.

Case Two: A 62-year-old male patient presented with a left-sided brachial plexus lipoma. The tumor showed progressive and visible growth on the left shoulder over a period of more than 7 years, finally causing atrophy and a paresis of the triceps brachii muscle, the biceps brachii muscle, the deltoid muscle and the supraspinatus muscle. Electrophysiological testing revealed an impairment of the left brachial plexus and MRI showed a giant lipomatous tumor ranging from the area of the triceps brachii muscle towards the supraspinatus muscle, the clavicle and the brachial plexus on the left side. Total tumor resection via a dorsal suprascapular, infraclavicular approach and neurolysis finally led to long-term relief of the symptoms.

Conclusion: Giant brachial plexus lipomas are an extremely rare cause for brachial plexus compression. Total microsurgical removal with intraoperative electrophysiological monitoring is the treatment of choice with excellent long-term MRI and clinical outcome.