Article
Tumors of the brachial plexus– 15 years of experience
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Authors
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Christine Brand
- Universitätsklinikum Ulm, Neurochirurgie, Ulm, Deutschland
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Maria Teresa Pedro
- Universitätsklinikum Ulm, Neurochirurgie, Ulm, Deutschland
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Ralph König
- Universitätsklinikum Ulm, Neurochirurgie, Ulm, Deutschland
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Christian Rainer Wirtz
- Universitätsklinikum Ulm, Neurochirurgie, Ulm, Deutschland
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Gregor Antoniadis
- Universitätsklinikum Ulm, Neurochirurgie, Ulm, Deutschland
| Published: | June 18, 2018 |
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Outline
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Objective: We would like to share our experience of 15 years of plexus tumor surgery. Tumors of the brachial plexus are rare and present a challenge for neurosurgeons. Patients often show no or just mild deficits. A main goal therefore is to remove the tumor completely while preserving the nerve function.
Methods: A retrospective analysis of 89 patients with a tumor of the brachial plexus region was made in our department from 2002 to 2017. Epidemiological data, clinical presentation, diagnostic procedures, surgical techniques and outcomes were evaluated.
Results: Over a 15-year period, 76 patients with a peripheral nerve sheath tumor and 13 patients with a non peripheral nerve sheath tumor of the brachial plexus region were treated. In most cases schwannomas (n= 38) and neurofibromas (n= 20) were diagnosed. Other entities which were included are malignant peripheral nerve sheath tumors (MPNST), perineuriomas, lipomas, sarcomas, lymphomas and metastases. 42 females and 47 males were enrolled with a mean age of 48 years. Electrophysiological testing, ultrasound and MRI were helpful investigations. In 60 cases total resection, in 21 cases subtotal resection and in 8 patients a biopsy were performed. 22 patients were surgically treated in another hospitalpreviously. 61 patients showed a stable neurological situation or improved after surgery. The mean follow up time was 15.8 months.
Conclusion: Plexus tumor surgery is a challenge for neurosurgeons because of the complexity of the anatomy. The prerequisite for achieving good results is an experienced peripheral nerve surgeon. It is of utmost importance during surgery that the neural architecture is properly understood and respected. Intraoperatively, continuous electrophysiological monitoring is absolutely necessary to preserve the functioning neural fascicles in relationship to the tumor, thereby reducing the neurological deficits. In case of malignancy, the goal of surgery is total resection as well but in some cases this is not achievable. Radio- and/ or chemotherapy should be considered.
