Our Experience with Surgical Treatment of Peripheral Nerve Tum

Czech version

Authors: Marek Sova ¹; E. Neuman ¹; V. Vybíhal ¹; P. Fadrus ¹; A. Šprláková ²; L. Křen ³
Authors‘ workplace: LF MU a FN Brno Neurochirurgická klinika ¹; LF MU a FN Brno Radiologická klinika ²; LF MU a FN Brno Ústav patologie ³
Published in: Cesk Slov Neurol N 2015; 78/111(6): 694-698
Category: Short Communication

Overview

Aim:
The authors present surgical treatment results of peripheral nerve tumors. All the surgical procedures were performed between 2003 and 2013 at the Department of Neurosurgery, The University Hospital Brno. The paper provides an overview of current histological classification and its impact on surgical treatment. The paper also includes a case report describing a surgical procedure used for a rare, bulky tumor of the sciatic nerve in the depth of the gluteal region.

Methods:
In total, 24 patients, 13 men and 11 women, underwent surgical revision. The mean age of the group was 46.5 years (min. 22, max. 74 years). All the surgical procedures were completed using standard microsurgical tools. Perioperative electrophysiological monitoring has been used since 2007. A retrospective analysis according to the localization of the affected nerve, extent of resection and histological classification of the tumor was performed and the final outcome in terms of neurological status was evaluated in the study group.

Results:
A tumor of the tibial nerve was the most frequent target of the surgery in our study group. Benign schwannoma was the most common tumor in our study group (20 cases) and this is in accordance with previously published data. Other tumors were classified as neurofibroma (one case) and intraneural ganglion cyst (one case). Histology confirmed the presence of a rare extraosseous Ewing’s sarcoma in one case. Finally, one patient suffered from chronic inflammation.

Conclusion:
In our study group, total resection was performed in all patients except one. Revision with open biopsy was performed in a patient with nerve inflammation. Complete extended resection of the affected nerves was necessary in a patient with malignant Ewing’s sarcoma. This resulted in total motor and sensitive deficit of the corresponding area. Neurological status has also worsened after the surgery in two other cases, one had light paresis and the other had permanent hypoesthesia. The clinical symptoms disappeared after surgery in all other cases.

Key words:
tumor of the peripheral nerve – sciatic nerve schwannoma – neurofibromatosis

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Sources

1. Midha R, Zager EL. Surgery of peripheral nerves. 1st ed. New York: Thieme Medical Publishers, Inc. 2008.

2. Fletcher Ch. WHO classification of tumours of soft tissue and bone. 4th ed. Lyon: IARC Press 2013.

3. Ferner RE, O’Doherty MJ. Neurofibroma and schwannoma. Curr Opin Neurol 2002; 15(6): 679– 684.

4. Evans DG, Baser ME, McGaughran J, Sharif S, Howard E, Moran A. Malignant peripheral nerve sheath tumours in neurofibromatosis 1. J Med Genet 2002; 39(5): 311– 314.

5. Sirinoglu H, Sönmez A, Sav A, Numanoglu A. Lipofibromatous hamartoma of the median nerve. Ann Plast Surg 2010; 65(2): 174– 176. doi: 10.1097/ SAP.0b013e3181c9c41b.

6. Ghaly RF. A posterior tibial nerve neurilemoma unrecognized for 10 years: a case report. Neurosurgery 2001; 48(3): 668– 672.

7. Gorgan M, Sandu AM, Bucur N, Neacsu A, Pruna V, Voina A et al. Sciatic nerve schwannoma – case report. Romanian Neurosurgery 2008; 15(1): 27– 31.

8. Zvěřina E, Stejskal L. Poranění periferních nervů. Praha: Avicenum 1979.

9. Náhlovský J et al. Neurochirurgie. Praha: Galén 2006.

10. Duba M, Smrčka M, Lžičařová E. Vliv histologické klasifikace na možnosti chirurgické léčby tumorů periferních nervů. Rozhl Chir 2003; 82( 3): 138– 141.

11. Baehring JM, Betensky RA, Batchelor TT. Malignant peripheral nerve sheath tumor. Neurology 2003; 61(5): 696– 698.

12. Beneš V III, Kramář F, Hrabal P, Kaiser M, Buchvald P. Maligní tumor z pochvy periferního nervu – dvě kazuistiky. Cesk Slov Neurol N 2009; 72/ 105(2): 163–167.

13. Kadaňka Z jr, Hanák J, Gál B. Maligní tumor z pochvy nervu v oblasti cervikálního plexu – kazuistika. Cesk Slov Neurol N 2013; 76/ 109(6): 751– 755.