Bridging the Nerve Gap with Skeletal Muscle and Silicone Tube after Schwannoma Resection in Brachial Plexus: A case report

Eun, Seok Chan; Oh, Suk Joon; Chung, Chul Hoon; Burm, Jin Sik; Kim, Ju Bong

Abstract

A large gap in peripheral nerve will not allow effective regenaration unless a grafting conduit is used to bridge the defect. Conventionally, nerve tissue has been used as a conduit in nerve reconstruction; however, results from techniques using these grafts are often unsatisfactory. A number of recent investigations have indicated that nerve fibers will regenerate through a nonneural tube. A 45-years-old female patient with a protruding mass on her lateral neck area visited our hospital. She complained of tingling sensation on the lateral aspect of palm, extending to 4, 5th finger. Mild degree of hypothenar muscular atrophy was also observed. Magnetic resonance image showed well-circumscribed mass with homogenous density located in brachial plexus area. We performed tumor excision with conglumerated C7 resection. The histologic finding was schwannoma with mixed type of Antoni A and B. A piece of sternocleidomastoid muscle was used as a conduit to bridge the gap and entubulization, the implantation of silicone guide tubes, was performed as an alternative method to the repair of transected nerves in the silicone tubes. The proximal and distal nerve stumps are introduced into each end of the tube and are held in place by epineural sutures. During three months of follow-up period, neuropathic pain and tingling sensation slowly subsided. Nerve conduction test and electromyography performed at the time of 86th day after the surgery showed much improved pattern compared to those performed on the 14th day after the operation. These results show that basement membrane of muscle fiber and silicone tube are able to orientate and promote peripheral nerve regeneration in a manner analogous to the endoneurial tubes of peripheral nerves.