Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Brachial Plexus Tumors in a Consecutive Series of Twenty One Patients

  • Go, Myeong-Hoon (Department of Neurosurgery, Ajou University School of Medicine) ;
  • Kim, Sang-Hyun (Department of Neurosurgery, Ajou University School of Medicine) ;
  • Cho, Ki-Hong (Department of Neurosurgery, Ajou University School of Medicine)
  • Received : 2011.12.28
  • Accepted : 2012.08.19
  • Published : 2012.08.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : This is a retrospective review of 22 surgically treated benign and malignant tumors of brachial plexus region to describe clinical presentation, the characteristics of brachial plexus tumor and clinical outcomes with a literature review. Methods : Twenty-one patients with consecutive 22 surgeries for primary brachial plexus tumors were enrolled between February 2002 and November 2011 were included in this study. The medical records of all patients were reviewed. Results : Eleven male and 10 female patients were enrolled. Mean age was 39 years. Three patients had brachial plexus tumor associated with neurofibromatosis (13.6%). Presenting signs and symptoms included parenthesis and numbness (54.5%), radiating pain (22.7%), direct tenderness and pain (27.2%), palpable mass (77.3%). Twelve patients presented preoperative sensory deficit (54.5%) and 9 patients presented preoperative motor deficit (40.9%). Twenty tumors (90.9%) were benign and 2 tumors (9.1%) were malignant. Benign tumors included 15 schwannomas (68.2%), 4 neurofibromas (18.2%) and 1 granular cell tumor (4.5%). There were 1 malignant peripheral nerve sheath tumor (MPNST) and 1 malignant granular cell tumor. Gross total resection was achieved in 16 patients (72.7%), including all schwannomas, 1 neurofibroma. Subtotal resection was performed in 6 tumors (27.3%), including 3 neurofibromatosis associated with brachial plexus neurofibromas, 1 MPNST and 2 granular cell tumor in one patient. Conclusion : Resection of tumor is the choice of tumor in the most of benign and malignant brachial plexus tumors. Postoperative outcomes are related to grade of resection at surgery and pathological features of tumor.

Keywords

References

  1. Amoretti N, Grimaud A, Hovorka E, Chevallier P, Roux C, Bruneton JN : Peripheral neurogenic tumors : is the use of different types of imaging diagnostically useful? Clin Imaging 30 : 201-205, 2006 https://doi.org/10.1016/j.clinimag.2006.01.023
  2. Artico M, Cervoni L, Wierzbicki V, D'Andrea V, Nucci F : Benign neural sheath tumours of major nerves : characteristics in 119 surgical cases. Acta Neurochir (Wien) 139 : 1108-1116, 1997 https://doi.org/10.1007/BF01410969
  3. Beggs I : Pictorial review : imaging of peripheral nerve tumours. Clin Radiol 52 : 8-17, 1997 https://doi.org/10.1016/S0009-9260(97)80299-1
  4. Cerofolini E, Landi A, DeSantis G, Maiorana A, Canossi G, Romagnoli R : MR of benign peripheral nerve sheath tumors. J Comput Assist Tomogr 15 : 593-597, 1991 https://doi.org/10.1097/00004728-199107000-00013
  5. Chen F, Miyahara R, Matsunaga Y, Koyama T : Schwannoma of the brachial plexus presenting as an enlarging cystic mass : report of a case. Ann Thorac Cardiovasc Surg 14 : 311-313, 2008
  6. Dart LH Jr, MacCarty CS, Love JG, Dockerty MB : Neoplasms of the brachial plexus. Minn Med 53 : 959-964, 1970
  7. Das S, Ganju A, Tiel RL, Kline DG : Tumors of the brachial plexus. Neurosurg Focus 22 : E26, 2007
  8. Filler AG, Kliot M, Howe FA, Hayes CE, Saunders DE, Goodkin R, et al. : Application of magnetic resonance neurography in the evaluation of patients with peripheral nerve pathology. J Neurosurg 85 : 299-309, 1996 https://doi.org/10.3171/jns.1996.85.2.0299
  9. Finkel G, Lane B : Granular cell variant of neurofibromatosis : ultrastructure of benign and malignant tumors. Hum Pathol 13 : 959-963, 1982 https://doi.org/10.1016/S0046-8177(82)80064-6
  10. Fisher RG, Tate HB : Isolated neurilemomas of the brachial plexus. J Neurosurg 32 : 463-467, 1970 https://doi.org/10.3171/jns.1970.32.4.0463
  11. Forte A, Gallinaro LS, Bertagni A, Montesano G, Prece V, Illuminati G : Neurinomas of the brachial plexus : case report. Eur Rev Med Pharmacol Sci 3 : 19-21, 1999
  12. Grant GA, Goodkin R, Maravilla KR, Kliot M : MR neurography : diagnostic utility in the surgical treatment of peripheral nerve disorders. Neuroimaging Clin N Am 14 : 115-133, 2004 https://doi.org/10.1016/j.nic.2004.02.003
  13. Gyhra A, Israel J, Santander C, Acuna D : Schwannoma of the brachial plexus with intrathoracic extension. Thorax 35 : 703-704, 1980 https://doi.org/10.1136/thx.35.9.703
  14. Huang JH, Zaghloul K, Zager EL : Surgical management of brachial plexus region tumors. Surg Neurol 61 : 372-378, 2004 https://doi.org/10.1016/j.surneu.2003.08.006
  15. Kehoe NJ, Reid RP, Semple JC : Solitary benign peripheral-nerve tumours. Review of 32 years' experience. J Bone Joint Surg Br 77 : 497-500, 1995
  16. Khansur T, Balducci L, Tavassoli M : Identification of desmosomes inthe granular cell tumor. Implications in histologic diagnosis and histogenesis. Am J Surg Pathol 9 : 898-904, 1985 https://doi.org/10.1097/00000478-198512000-00006
  17. Khansur T, Balducci L, Tavassoli M : Granular cell tumor. Clinical spectrum of the benign and malignant entity. Cancer 60 : 220-222, 1987 https://doi.org/10.1002/1097-0142(19870715)60:2<220::AID-CNCR2820600217>3.0.CO;2-V
  18. Kim DH, Murovic JA, Tiel RL, Moes G, Kline DG : A series of 146 peripheral non-neural sheath nerve tumors : 30-year experience at Louisiana State University Health Sciences Center. J Neurosurg 102 : 256-266, 2005 https://doi.org/10.3171/jns.2005.102.2.0256
  19. Kim DH, Murovic JA, Tiel RL, Moes G, Kline DG : A series of 397 peripheral neural sheath tumors : 30-year experience at Louisiana State University Health Sciences Center. J Neurosurg 102 : 246-255, 2005 https://doi.org/10.3171/jns.2005.102.2.0246
  20. Kori SH, Foley KM, Posner JB : Brachial plexus lesions in patients with cancer : 100 cases. Neurology 31 : 45-50, 1981 https://doi.org/10.1212/WNL.31.1.45
  21. Lusk MD, Kline DG, Garcia CA : Tumors of the brachial plexus. Neurosurgery 21 : 439-453, 1987 https://doi.org/10.1227/00006123-198710000-00001
  22. Mrugala MM, Batchelor TT, Plotkin SR : Peripheral and cranial nerve sheath tumors. Curr Opin Neurol 18 : 604-610, 2005 https://doi.org/10.1097/01.wco.0000179507.51647.02
  23. Posniak HV, Olson MC, Dudiak CM, Wisniewski R, O'Malley C : MR imaging of the brachial plexus. AJR Am J Roentgenol 161 : 373-379, 1993 https://doi.org/10.2214/ajr.161.2.8392788
  24. Richardson RR, Siqueira EB, Oi S, Nunez C : Neurogenic tumors of the brachial plexus : report of two cases. Neurosurgery 4 : 66-70, 1979 https://doi.org/10.1227/00006123-197901000-00014
  25. Russell SM, Kline DG : Complication avoidance in peripheral nerve surgery : injuries, entrapments, and tumors of the extremities--part 2. Neurosurgery 59 : ONS449-ONS456; discussion ONS456-ONS457, 2006
  26. Saini S, Dhasmana JP : Apical mass presentation of brachial plexus Schwannoma. Indian J Chest Dis Allied Sci 48 : 129-131, 2006
  27. Siqueira MG, Martins RS, Teixeira MJ : Management of brachial plexus region tumours and tumour-like conditions : relevant diagnostic and surgical features in a consecutive series of eighteen patients. Acta Neurochir (Wien) 151 : 1089-1098, 2009 https://doi.org/10.1007/s00701-009-0380-8
  28. Stull MA, Moser RP Jr, Kransdorf MJ, Bogumill GP, Nelson MC : Magnetic resonance appearance of peripheral nerve sheath tumors. Skeletal Radiol 20 : 9-14, 1991
  29. Suh JS, Abenoza P, Galloway HR, Everson LI, Griffiths HJ : Peripheral (extracranial) nerve tumors : correlation of MR imaging and histologic findings. Radiology 183 : 341-346, 1992 https://doi.org/10.1148/radiology.183.2.1561333
  30. Varma DG, Moulopoulos A, Sara AS, Leeds N, Kumar R, Kim EE, et al. : MR imaging of extracranial nerve sheath tumors. J Comput Assist Tomogr 16 : 448-453, 1992 https://doi.org/10.1097/00004728-199205000-00020
  31. Verstraete KL, Achten E, De Schepper A, Ramon F, Parizel P, Degryse H, et al. : Nerve sheath tumors : evaluation with CT and MR imaging. J Belge Radiol 75 : 311-320, 1992
  32. Wanebo JE, Malik JM, VandenBerg SR, Wanebo HJ, Driesen N, Persing JA : Malignant peripheral nerve sheath tumors. A clinicopathologic study of 28 cases. Cancer 71 : 1247-1253, 1993 https://doi.org/10.1002/1097-0142(19930215)71:4<1247::AID-CNCR2820710413>3.0.CO;2-S

Cited by

  1. Visualization of nerve fibers and their relationship to peripheral nerve tumors by diffusion tensor imaging vol.39, pp.3, 2012, https://doi.org/10.3171/2015.6.focus15235
  2. Tumors of the peripheral nervous system: analysis of prognostic factors in a series with long-term follow-up and review of the literature vol.125, pp.2, 2012, https://doi.org/10.3171/2015.6.jns15596
  3. Large malignant granular cell tumor with suprascapular nerve and brachial plexus invasion : A case report and literature review vol.96, pp.44, 2012, https://doi.org/10.1097/md.0000000000008531
  4. The Surgical Management of Symptomatic Benign Peripheral Nerve Sheath Tumors of the Neck and Extremities: An Experience of 442 Cases vol.81, pp.4, 2012, https://doi.org/10.1093/neuros/nyx076
  5. BRACHIAL PLEXUS SCHWANNOMA – CASE REPORT AND LITERATURE REVIEW vol.57, pp.2, 2012, https://doi.org/10.20471/acc.2018.57.02.19
  6. Malignant granular cell tumor of the median nerve: a case report with a literature review of 157 cases vol.48, pp.2, 2012, https://doi.org/10.1007/s00256-018-3017-2
  7. Brachial Plexus Neurofibroma: A Case Report vol.6, pp.1, 2020, https://doi.org/10.21129/nerve.2020.6.1.12
  8. Schwannoma of the brachial plexus with cystic degeneration: A case report schwannoma of the brachial plexus vol.9, pp.4, 2012, https://doi.org/10.1002/ccr3.3922
  9. Brachial plexus tumors extending into the cervicothoracic spine: a review with operative nuances and outcomes vol.23, pp.7, 2021, https://doi.org/10.1007/s12094-020-02549-7
  10. Magnetic resonance imaging of the brachial plexus. Part 1: Anatomical considerations, magnetic resonance techniques, and non-traumatic lesions vol.9, pp.None, 2012, https://doi.org/10.1016/j.ejro.2021.100392