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

Jin Hee Choi; Tae Yeong Yang; Tae Kyung Lee; Sang Hyun Woo

doi:10.12790/ahm.2019.24.1.87

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Choi, Yang, Lee, and Woo: Outcome of Schwannoma Resection at Upper Extremity with Preservation of Nerve Fascicle

Nerve

Archives of Hand and Microsurgery 2019; 24(1): 87-95.

Published online: 28 February 2019

DOI: https://doi.org/10.12790/ahm.2019.24.1.87

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

Jin Hee Choi, Tae Yeong Yang, Tae Kyung Lee, Sang Hyun Woo

W Institute for Hand and Reconstructive Microsurgery, W General Hospital, Daegu, Korea.

Corresponding author: Sang Hyun Woo. W Institute for Hand and Reconstructive Microsurgery, W General Hospital, 1632 Dalgubeol-daero, Dalseo-gu, Daegu 42642, Korea. TEL: +82-53-550-5000, FAX: +82-53-552-4000, handwoo@hotmail.com

Received 21 November 2018 Revised 26 December 2018 Accepted 28 December 2018

Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve

(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

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.

Keywords: Schwannoma, Upper extremity, Fascicle preservation, Neurilemmoma

Figures and Tables

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.

Fig. 2

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

Fig. 3

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

Table 1

Demographics of the patients with schwannoma of the upper extremity

Values are presented as median (range) or number (%).

^*Group of completely intra-capsular enucleation with preservation of fascicle. ^†Group of incompletely intra-capsular enucleation with resection of fascicle. ^‡Statistically significant.

Table 2

Preoperative symptom rate and positive diagnosis rate in preoperative image study

Values are presented as number (%). Symptoms include Tinel sign, tenderness and spontaneous pain.

US: ultrasonogram, MRI: magnetic resonance imaging.

^*Positive diagnosis rate.

Table 3

Postoperative neurologic deficit as completeness of enucleation in schwannoma patient

Values are presented as number (%).

^*Pearson's chi-squared test. ^†Fisher's exact test.

Table 4

Risk factors for neurologic deficit after schwannoma enucleation

^*Hand vs. Forearm. ^†Statistically significant.

Notes

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

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