Analysis of surgical outcome and review of literature of schwannomas arising from the extremities
Keywords:Nerve sheath tumours, Neurilemoma treatment, Schwannoma excision, Schwannoma
Background: Schwannoma is a benign peripheral nerve sheath tumour derived from Schwann cells. Also known as Neurilemoma, it can affect any nerve in the body. They usually present as a painless swelling or paresthesia over the sensory distribution of the affected nerve. Although it is classically described that schwannomas are well encapsulated and can be completely enucleated during excision, many of them have fascicular involvement and could not be completely shelled out. The aim of this work is to present our experience in operative management of schwannomas located in extremities.
Methods: Authors conducted a retrospective review for 18 adult patients with schwannoma, from June 2012 to June 2018. There were 10 men and 8 women, ranging from 20 to 68 years of age, with a mean age of 46 years old. All patients had excision done for the tumour and histopathological examination confirmed schwannoma. All patients were preoperatively evaluated both clinically and radiologically. FNAC was also done to confirm the origin of the swelling.
Results: The mean follow up period has been 2 years. Complete excision with preservation of nerve was done in all cases except for one case in which nerve graft was used.
Conclusions: Use of preoperative MRI, magnification and good surgical technique will help to enucleate the tumour completely without any collateral damage or recurrence. The possibility and option of nerve graft should be discussed with patients prior to schwannoma excision, so that nerve grafting could be directly proceeded with patient consent in case there is fascicular involvement of tumour found intraoperatively.
Rosenberg AE, Dick HM, Botte MJ. Benign and malignant tumors of peripheral nerve, in Operative Nerve Repair and Reconstruction. JB Lippincot Company, Philadelphia, Pa, USA. 1991;2:1587-619.
Zhou J, Man XY, Zheng M, Cai SQ. Multiple plexiform schwannoma of a finger. Euro J Dermatol. 2012;22(1):149-50.
Forthman CL, Blazar PE. Nerve tumors of the hand and upper extremity. Hand Clin. 2004;20(3):233-42.
Ozdemir O, Kurt C, Coskunol E, Calli I, Ozsoy MH. Schwannomas of the hand and wrist: long-term results and review of the literature. J Orthop Surg. 2005;13(3):267-72.
Adani R, Baccarani A, Guidi E, Tarallo L. Schwannomas of the upper extremity: diagnosis and treatment. La Chir Organi Mov. 2008;92(2):85-8.
White NB. Neurilemomas of the extremities. J Bone Joint Surg Am. 1967;49(8):1605-10.
Donner TR, Voorhies RM, Kline DG. Neural sheath tumors of major nerves. J Neurosurg. 1994;81(3):362-73.
Ergun T, Lakadamyali H, Derincek A, Tarhan NC, Ozturk A. Magnetic resonance imaging in the visualization of benign tumors and tumor-like lesions of hand and wrist. Curr Probl Diagn Radiol. 2010;39(1):1-6.
Thawait SK, Chaudhry V, Thawait GK, Wang KC, Belzberg A, Carrino JA, et al. High-resolution MR neurography of diffuse peripheral nerve lesions. Am J Neuroradiol. 2011;32(8):1365-72.
Vilanova JC, Woertler K, Narváez JA, Barceló J, Martínez SJ, Villalón M, et al. Soft-tissue tumors update: MR imaging features according to the WHO classification. Euro Radiol. 2007;17(1):125-38.
Pęksa RE. zycka-´Swieszewska, IR, Szurowska RE. Central and peripheral nerve markers – morphological, immunohistochemical and vascular analysis. Ann Acad Med Gedanensis. 2008;38(1):71-8.
Trăistaru RO, Enăchescu VI, Manuc D, Gruia C, Ghiluşi MI. Multiple right schwannoma. Rom J Morphol Embryol. 2008;49(2):235-9.
Kang HJ, Shin SJ, Kang ES. Schwannomas of the upper extremity. J Hand Surg. 2000;25(6):604-7.
Kim SM, Seo SW, Lee JY, Sung KS. Surgical outcome of schwannomas arising from major peripheral nerves in the lower limb. Int Orthop. 2012;36(8):1721-5.
Rockwell GM, Thoma A, Salama S. Schwannoma of the hand and wrist. Plastic Reconstructive Surg. 2003;111(3):1227-32.
Lee JA, Boles CA. Peripheral schwannoma lacking enhancement on MRI. Am J Roentgenol. 2004;182(2):534-35.
Ziadi A, Saliba I. Malignant peripheral nerve sheath tumours of intracranial nerves: a cases series review. Auris Nasus Larynx. 2010;37(5):539-45.
Stull MA, Moser RP, Kransdorf MJ, Bogumill GP, Nelson MC. Magnetic resonance appearance of peripheral nerve sheath tumors. Skeletal Radiol. 1991;20(1):9-14.
Phalen GS. Neurilemomas of the forearm and hand. Clin Orthop Relat Res. 1976;114:219-22.
Hussain MA, Jhattu H, Pandya A, Chan Q, Pandya WCA. A precise excision technique for schwannomas. Euro J Plastic Surg. 2013;36(2):111-4.
Date R, Muramatsu K, Ihara K, Taguchi T. Advantages of intra-capsular micro-enucleation of schwannoma arising from extremities. Acta Neurochir. 2012;154(1):173-8.