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

Kap Jung Kim; Sang Ki Lee; Jae Yeon Hwang; Young Sub Chun; Yong Ho Kim

doi:10.4055/jkoa.2017.52.3.225

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Kim, Lee, Hwang, Chun, and Kim: Surgical Outcomes of Schwannoma Occurring at Major Peripheral Nerves of Extremity: A Single Institution Analysis

Original Article

Journal of the Korean Orthopaedic Association 2017; 52(3): 225-231.

Published online: 27 June 2017

DOI: https://doi.org/10.4055/jkoa.2017.52.3.225

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

Kap Jung Kim, M.D., Sang Ki Lee, M.D., Jae Yeon Hwang, M.D., Young Sub Chun, M.D., Yong Ho Kim, M.D.

Department of Orthopaedic Surgery, College of Medicine, Eulji University, Daejeon, Korea.

Correspondence to: Kap Jung Kim, M.D. Department of Orthopaedic Surgery, Eulji University Hospital, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Korea. TEL: +82-42-611-3280, FAX: +82-42-611-3283, oskkj@eulji.ac.kr

Received 7 November 2016 Revised 9 December 2016 Accepted 27 December 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: peripheral nerve, schwannoma, neurological complications

Figures and Tables

Figure 1

Overall symptom recoveries with elapse time.

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.

Table 1

Anatomical Distribution of the Involved Nerves

SPN, superficial peroneal nerve; CPN, common peroneal nerve; LFCN, lateral femoral cutaneous nerve.

Table 2

Preoperative Symptoms or Signs of Total 51 Schwannomas

Table 3

Statistical Analysis between Variables and Postoperative Neurologic Deficits

++++, 4; +++, 3; ++, 2; +, 1.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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