Arch Hand Microsurg.  2019 Mar;24(1):87-95. 10.12790/ahm.2019.24.1.87.

Outcome of Schwannoma Resection at Upper Extremity with Preservation of Nerve Fascicle

• Choi JH
• Yang TY
• Lee TK
• Woo SH

• KMID: 2440617
• DOI: http://doi.org/10.12790/ahm.2019.24.1.87

Abstract

PURPOSE
To analyze the risk factors and the rate of neurological complication occurring after micro-surgical enucleation of schwannoma, and the relationship between single fascicle resection and neurological deficiency.
METHODS
From January 2010 through September 2018, a total of 65 patients underwent micro-surgical enucleation for schwannoma in the forearm and hand. The factors affecting new neurological deficiency after surgery were analyzed, and the differences in neurological incidence were compared between those that preserved the fascicle and those that were unavoidable to resect the fascicle at surgery.
RESULTS
Immediately neurological complications were reported in 16 patients (24.6%) after the surgery, with 4 patients (6.2%) remaining in the final outcome. Neurological complication (50.0%) was higher in case of resection of fascicle at surgery (hazard ratio, HR=18.791, p < 0.05). The preoperative misdiagnosis also increased the incidence of neurological complications (HR=10.693, p < 0.05).
CONCLUSION
Accurate diagnosis before surgery and preservation of the nerve fascicle at surgery are important to reduce postoperative neurological complications in the treatment of schwannoma. For accurate diagnosis, detailed history taking, physical examination and magnetic resonance imaging should be actively done, and during surgery, efforts should be made to preserve the nerve fascicle as much as possible by using microscopic surgical techniques.

Keyword

Schwannoma; Upper extremity; Fascicle preservation; Neurilemmoma

MeSH Terms

Diagnosis
Diagnostic Errors
Forearm
Hand
Humans
Incidence
Magnetic Resonance Imaging
Neurilemmoma*
Physical Examination
Risk Factors
Upper Extremity*

Figure

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  Fig. 1 (A) Ultrasonographic imaging of a 78-year-old male patients shows hypoechogenic mass with small vascularity. (B) On magnetic resonance imaging, sagittal T1-weighted image revealed a homogenously enhancing tumor expanding the superficial branch of radial nerve. (C) Magnetic resonance neurography image demonstrated high signal of the tumor and longitudinal course of the nerve. (D) Intraoperative photograph showing the tumor prior to capsulotomy and enucleation. (E) Under microscope, completely intra-capsular enucleation was done. (F) After enucleation, all nerve fascicle was preserved.

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  Fig. 2 Gross photography of specimens. (A) Completely intracapsular enucleated tumor. (B) Incompletely intra-capsular enucleation with resection of fascicle.

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  Fig. 3 Locations of the schwannomas and the nerves involved (left: forearm, right: hand, red: radial nerve, yellow: median nerve, blue: ulnar nerve).

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