J Korean Orthop Assoc.  2017 Jun;52(3):225-231. 10.4055/jkoa.2017.52.3.225.

Surgical Outcomes of Schwannoma Occurring at Major Peripheral Nerves of Extremity: A Single Institution Analysis

• Kim KJ
• Lee SK
• Hwang JY
• Chun YS
• Kim YH

• KMID: 2384552
• DOI: http://doi.org/10.4055/jkoa.2017.52.3.225

Abstract

PURPOSE
We analyzed the surgical result of schwannoma occurring in the major peripheral nerves of the extremity and factors that influence these surgical results.
MATERIALS AND METHODS
Fifty-one patients, who were followed for more than 1 year, were included. The mean age was 51 years. There were 23 male cases and 28 female cases. There were 27 cases of schwannoma in the upper extremity and 24 cases in the lower extremity. The involved nerves were classified. The maximal diameter of excised tumors was measured. Clinical and neurological symptoms were analyzed at preoperative, postoperative, and final follow-up. Risk factors of neurological complications were also analyzed.
RESULTS
The mean follow-up period was 20 months. The average maximal diameter of tumors was 2.9 cm. The most affected nerve in the upper extremity was the ulnar nerve in 10 cases, and tibial nerve in the lower extremity in 10 cases. The most prevalent preoperative symptom was Tinel in 38 cases. Clinical symptoms were improved in more than 90% of patients following the surgery. There were 13 cases with preoperative sensory deficits. Symptom improvement after surgery was observed in 9 cases; and symptoms persisted in 4 cases following surgery. At the final follow-up, sensory deficits disappeared in 2 cases and persisted in 2 cases. There were 2 cases of preoperative motor deficits. There was improvement in 1 case following the surgery and persisted in 1 case until the final follow-up. There was a statistical significance between maximal diameter of schwannoma and postoperative neurological deficits (p<0.05).
CONCLUSION
Schwannoma at the major peripheral nerves of the extremity can be excised with acceptable risk for neurological deficits. Meticulous dissection is required to avoid injuries of the involved nerves.

Keyword

peripheral nerve; schwannoma; neurological complications

MeSH Terms

Extremities*
Female
Follow-Up Studies
Humans
Lower Extremity
Male
Neurilemmoma*
Peripheral Nerves*
Risk Factors
Tibial Nerve
Ulnar Nerve
Upper Extremity

Figure

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  Figure 1 Overall symptom recoveries with elapse time.

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  Figure 2 T1- (A) and T2- (B) weighted coronal image showing round mass involving the radial nerve suggesting schwannoma. (C) Intraoperative photograph showing fascicular injuries of involved nerve due to failure of enucleation.

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