Management of Intrathoracic Benign Schwannomas of the Brachial Plexus

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Abstract

Primary tumours of the brachial plexus are rare entities. They usually present as extrathoracic masses located in the supraclavicular region. This report describes two cases of benign schwannomas arising from the brachial plexus with an intrathoracic growth. In the first case the tumour was completely intrathoracic and it was hardly removed through a standard posterolateral thoracotomy. In the second case the tumour presented as a cervicomediastinal lesion and it was resected through a one-stage combined supraclavicular incision followed by left video-assisted thoracoscopic surgery. A brachial plexus tumour should be suspected not only in patients with a supraclavicular or cervicomediastinal mass but also in those with intrathoracic apical lesions. A preoperative magnetic resonance imaging study of brachial plexus should be performed in such cases in order to plan the correct surgical approach.

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Most cited references 6

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Management of brachial plexus region tumours and tumour-like conditions: relevant diagnostic and surgical features in a consecutive series of eighteen patients.

M G Siqueira, Sylvia L M Teixeira, Ilídio Martins (2009)

Tumours of the brachial plexus region are rare and most publications are case reports or studies with a small series of patients. The aim of this study is to present our experience in managing these lesions. We review 18 patients with tumours in the brachial plexus region submitted to surgical treatment in a 6 year period, including their clinical presentation, neuro-imaging data, surgical findings and outcome. The tumours comprised a heterogeneous group of lesions, including schwannomas, neurofibromas, malignant peripheral nerve sheath tumour (MPNST), sarcomas, metastases, desmoids and an aneurysmal bone cyst. The most common presentation was an expanding lump (83.33%). Eleven tumours were benign and 7 were malignant. Neurofibromatosis was present in only 2 patients (11.11%). Gross total resection was achieved in 14 patients and sub-total resection in the others. Only 3 patients presented with new post-operative motor deficits. The incidence of complications was low (16.5 %). The majority of tumours were benign and most of them could be excised with a low incidence of additional deficits. Some of the malignant tumours could be controlled by surgery plus adjuvant therapy, but this category is still associated with high morbidity and mortality rates.

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Resection of a benign brachial plexus nerve sheath tumor using intraoperative electrophysiological monitoring.

Michel Kliot, Christopher B Davis, Angela K. Kwok (2007)

Benign peripheral nerve sheath tumors arising from the brachial plexus are rare. Neurosurgeons often lack the clinical and surgical experience to optimize the management of these uncommon tumors. We filmed a video depicting the surgical resection of a benign peripheral nerve sheath tumor involving the brachial plexus. An illustrative case was used to demonstrate the proper management of a brachial plexus nerve sheath tumor including the important role of intraoperative electrophysiological neuromonitoring during tumor resection. Using an illustrative case, we describe a systematic approach in the evaluation and surgical management of patients with a brachial plexus nerve sheath tumor. The importance of taking a thorough clinical history, performing a thorough physical examination, applying high-resolution magnetic resonance imaging techniques to visualize the pathology, and using intraoperative electrophysiological neuromonitoring during surgical exposure and resection of the tumor are stressed. Combined with appropriate postoperative treatment, these techniques minimize the risks and increase the likelihood of achieving a good clinical outcome. Brachial plexus nerve sheath tumors are challenging mass lesions that should be evaluated and surgically resected by an experienced team of physicians to optimize clinical outcome.

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Diagnostic value and surgical implications of the magnetic resonance imaging in the management of adult patients with brachial plexus pathologies.

Simonetta Gerevini, Carlo Mandelli, Marcello Cadioli … (2008)

The imaging of the brachial plexus (BP) cannot easily be achieved because of the extension of the region to be studied, the different tissue compositions of the adjacent anatomic structures and the necessity to work with thin tissue slices. Here is a description of the brachial plexus MRI (bpMRI) protocol that we use for the pre-operative evaluation of patients affected by the following brachial plexus (BP) pathologies: neoplastic, post-traumatic, inflammatory. The surgical implications are discussed. A survey was done on 115 patients (66 males; 49 females; mean age 46.4 years old), which underwent a bpMRI over a 32-month period (32 post-traumatic, 26 neoplastic, 25 affected by inflammatory diseases). Our bpMRI protocol is evaluated according to each mechanism of disease. The bpMRI provides a topographic localization of the tumour showing the nerve dislocations or infiltration by the neoplasm. In traumatic patients we suggest that the bpMRI could be useful to detect the degree of axonal damage when the nerve lesion is in continuity. We also consider the diagnosis and the possible surgical implications for the inflammatory plexopathies. In conclusion, a standardized bpMRI protocol has an invaluable diagnostic value for the surgeons and neurologists. It is only limited by its duration (at least 45 min).

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Author and article information

Journal

Journal ID (nlm-ta): Case Rep Surg

Journal ID (iso-abbrev): Case Rep Surg

Journal ID (publisher-id): CRIS

Title: Case Reports in Surgery

Publisher: Hindawi Publishing Corporation

ISSN (Print): 2090-6900

ISSN (Electronic): 2090-6919

Publication date (Print): 2014

Publication date (Electronic): 22 July 2014

Volume: 2014

Electronic Location Identifier: 130492

Affiliations

¹Department of Thoracic Surgery, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy

²Department of Neurosurgery, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy

³Department of Neuroradiology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy

Author notes

*Alessandro Bandiera: bandiera.alessandro@ 123456hsr.it

Academic Editor: Oded Olsha

Author information

Alessandro Bandiera http://orcid.org/0000-0002-1962-0045

Carlo Mandelli http://orcid.org/0000-0003-1863-8750

Simonetta Gerevini http://orcid.org/0000-0002-2374-194X

Article

DOI: 10.1155/2014/130492

PMC ID: 4129927

PubMed ID: 25143855

SO-VID: e599c1ee-9d7d-4853-84c3-99ef70b036d5

License:

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 28 May 2014

Date accepted : 8 July 2014

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