Object The aim of this study was to describe the presentation of patients harboring soft tissue sarcomas involving the nerves, most of which were malignant peripheral nerve sheath tumors (MPNSTs), and provide an algorithm for their treatment. Methods The authors retrospectively analyzed data on 43 surgically treated soft tissue sarcomas involving the nerves, 34 (79%) of which were MPNSTs. Tumor classifications are presented, together with patient numbers, locations of MPNSTs, surgical techniques, and adjunctive treatments. Results The 34 MPNSTs were surgically treated during a period of 40 years. Most of these lesions (19 MPNSTs [56%]) were located in the brachial plexus, whereas the rest were located on other major nerves. Neurofibromatosis Type 1–associated tumors (12 lesions) represented 35% of the total number of MPNSTs. Although the main goal of surgery was complete excision, it was successful in only 16 patients (47%). Of the available records, 18 patients (53%) died due to disease progression. Conclusions Malignant peripheral nerve sheath tumors are rare. Surgical removal with margins when possible coupled by adjuvant radiotherapy offers the best chance of survival. The role of chemotherapy is still being defined.

Posterior cranial vault distraction is recognized as a viable initial approach to patients with syndromic craniosynostosis. It offers advantages to initial anterior vault surgery and to traditional 1-stage advancements. Reports of posterior vault distraction have thus far focused on the use of standard titanium distractors. We present a case of posterior vault distraction with resorbable distraction devices, obviating the need for a second surgery and anesthetic for distractor removal. Distraction was performed successfully without complications or device-related issues.

Object The authors present the results of a retrospective review of 37 surgically treated metastases to nerve (malignant peripheral non–neural sheath nerve tumors). Tumor frequencies, presentations, management, and prognosis are discussed. Methods Thirty-seven patients who were treated for metastases to nerve between 1969 and 2006 at the Louisiana State University Health Sciences Center were identified in a review of patient records. Notes regarding patient history and physical examination findings were reviewed to provide information on presenting symptoms and signs. Imaging and histopathological examination results were also reviewed. Cases were analyzed depending on the primary tumor and the location of metastasis. Results There included 37 surgically treated lesions, 16 of which originated in the breast and 10 of which originated in the lung. In two cases melanomas had metastasized to nerve, and one tumor each had metastasized from the bladder, rectum, skin, head and neck, and thyroid, and from a primary Ewing sarcoma. There was a single lymphoma that had metastasized to the radial nerve and one chordoma and one osteosarcoma, each of which had metastasized to the brachial plexus. Conclusions The nervous system is involved in numerous ways by oncological process. Direct involvement of the peripheral nervous system occurs mostly from direct extension, although it occasionally occurs because of distant spread from the primary tumor to nerve. Surgical excision of the metastatic lesion with margins has been useful mostly in the control of pain. Nevertheless, patients eventually succumb to their primary malignancy.

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