J Korean Soc Surg Hand.  2017 Mar;22(1):41-48. 10.12790/jkssh.2017.22.1.41.

Neurologic Deficits after Surgical Enucleation of Schwannoma in the Upper Extremity

• Kang JW
• Lee YS
• Kim C
• Shin SH
• Chung YG

• KMID: 2375466
• DOI: http://doi.org/10.12790/jkssh.2017.22.1.41

Abstract

PURPOSE
Neurologic deficits after enucleation of schwannoma are not rare. To evaluate the neurologic deficits after surgical enucleation of schwannoma in the upper extremity, we performed a retrospective review of patients with surgically treated schwannoma over a 14-year period at a single institution.
METHODS
Between March 2001 and September 2014, 103 patients underwent surgical enucleation for schwannomas; 36 patients of them had lesions in the upper extremity, and 2 out of 36 patients had multiple schwannomas. Each operation was performed by a single surgeon under loupe magnification. The postoperative neurological deficits were graded as major and minor in both immediate postoperatively and at last follow-up. The major deficit was defined as anesthesia or marked hypoesthesia, motor weakness of grade 3 or less and neuropathic pain. Minor deficit was defined as mild symptoms of mild hypoesthesia, paresthesia and motor weakness of grade 4 or more.
RESULTS
There were 2 major (2 mixed nerve) and 12 minor (4 motor, 7 sensory, 1 mixed nerve) neurologic deficits after surgery. At the last follow-up, one major mixed neurologic deficit remained as major motor and minor sensory, and other major ones changed to mixed minor. And all minor deficits except 1 sensory deficit were recovered spontaneously.
CONCLUSION
Even though high incidence rate of neurologic deficit after enucleation of schwannoma in the upper extremity (38.9%), about three fourths of them were recovered spontaneously. There were 3 permanent neurologic deficits, and one of them was major one. In some cases, surgeon cannot avoid to encounter a neurological deficit. So we recommend more delicate microscopic surgical procedure and preoperative planning and counseling. And surgery is indicated for only symptomatic lesions.

Keyword

Schwannoma; Neurologic deficit; Enucleation; Upper extremity

MeSH Terms

Anesthesia
Counseling
Follow-Up Studies
Humans
Hypesthesia
Incidence
Neuralgia
Neurilemmoma*
Neurologic Manifestations*
Paresthesia
Retrospective Studies
Upper Extremity*

Figure

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  Fig. 1. Neurologic deficit. At the last follow-up examination, among the patients who have had neurologic deficits (major deficit: 1 case, minor deficit: 2 cases), mixed neurologic deficit case ultimately determined to have major motor deficit and minor sensory deficit. Therefore 1 major deficit and 3 minor deficits left finally. Postop, postoperative; Gr., grade. * Definition of major deficit.

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  Fig. 2. Magnetic resonance imaging of 31-year-old female patients shows schwannoma near cubital tunnel of elbow (A, B). One nerve fascicle was entering the tumor, and we could not dissect the fascicle from the tumor. So we left some of the tumor untouched, to avoid nerve injury (C, D).

Reference

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