Subscribe to RSS
Neurological Deficits before and after Surgical Resection of Schwannomas in the Upper Extremities
14 September 2015
17 December 2015
12 February 2016 (online)
Background Schwannomas are the most common primary solitary tumor among peripheral nerve sheath tumors. The occurrence of transient or permanent neurological deficits after schwannoma resection is more common than previously recognized. Here, the neurological deficits before and after surgical resection of schwannomas in the upper extremities were examined.
Methods The study included 43 upper-extremity schwannomas that were treated surgically between January 2000 and July 2013. The neurological status of each patient (such as pain, sensory disturbances, and motor disturbances) was evaluated preoperatively, immediately postoperatively, and at the final postoperative follow-up.
Results Out of the 43 cases, 34 cases exhibited neurological symptoms before the operation, and in 31 of the 34 cases, neurological symptoms were either reduced or disappeared after the surgery. In 20 of the 43 cases, new neurological deficits that had not been observed preoperatively were noted immediately postoperatively; the newly acquired neurological deficits disappeared over time in 5 of the 20 cases. Significantly, more newly acquired neurological deficits remained in cases where the tumor was located in the upper arm and elbow than in cases where the tumor was located in the distal forearm.
Conclusion New neurological deficits occurred after surgery in about half of the cases. This ratio was higher than expected, suggesting that schwannoma resection is not always a complication-free operation. Therefore, patients should be informed preoperatively about the possibility of neurological deficits. Furthermore, extreme care should be taken not to damage the affected and uninvolved nerves during surgery.
- 1 Cutler EC, Gross RE. The surgical treatment of tumors of the peripheral nerves. Ann Surg 1936; 104 (3) 436-452
- 2 Kehoe NJ, Reid RP, Semple JC. Solitary benign peripheral-nerve tumours. Review of 32 years' experience. J Bone Joint Surg Br 1995; 77 (3) 497-500
- 3 Phalen GS. Neurilemmomas of the forearm and hand. Clin Orthop Relat Res 1976; (114) 219-222
- 4 Strickland JW, Steichen JB. Nerve tumors of the hand and forearm. J Hand Surg Am 1977; 2 (4) 285-291
- 5 Oberle J, Kahamba J, Richter HP. Peripheral nerve schwannomas—an analysis of 16 patients. Acta Neurochir (Wien) 1997; 139 (10) 949-953
- 6 Ozdemir O, Ozsoy MH, Kurt C, Coskunol E, Calli I. Schwannomas of the hand and wrist: long-term results and review of the literature. J Orthop Surg (Hong Kong) 2005; 13 (3) 267-272
- 7 Park MJ, Seo KN, Kang HJ. Neurological deficit after surgical enucleation of schwannomas of the upper limb. J Bone Joint Surg Br 2009; 91 (11) 1482-1486
- 8 Sawada T, Sano M, Ogihara H, Omura T, Miura K, Nagano A. The relationship between pre-operative symptoms, operative findings and postoperative complications in schwannomas. J Hand Surg [Br] 2006; 31 (6) 629-634
- 9 Donner TR, Voorhies RM, Kline DG. Neural sheath tumors of major nerves. J Neurosurg 1994; 81 (3) 362-373
- 10 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) 1997; 139 (12) 1108-1116