A radiological classification system for intraneural vascular anomalies: assessment of potential for resection with high-resolution MRI

Abstract

We believe that the subparaneurial compartment-a potential space between the epineurium and paraneurium-provides a tissue plane within which benign vascular lesions can occur. Hemangiomas and vascular malformations are complex and can occupy different intraneural and extraneural compartments. The anatomic framework aids surgical decision-making and ensures that all components of the lesion are considered. We advocate a multimodal approach in the treatment of these rare lesions.

Nerve Tumors: What the MSK Radiologist Should Know

“…Rare benign lesions affecting peripheral nerves are perineurioma (differentiated perineurial cells inside or outside a nerve), intraneural lipoma and/or lipofibromatous hamartoma (fibrofatty tumor characterized by the proliferation of mature adipocytes within the epineurium and the perineurium of the peripheral nerves), [7][8][9] and intraneural vascular malformations. 10,11 These are called purely benign because they have no predilection for malignant transformation. Detailed description of these very rare entities are beyond the scope of this practical review.…”

Ultrasonographic and Imaging Appearance of Peripheral Intraneural Vascular Anomalies: Report of Two Cases and Review of the Literature.

“…Pathology For 30 cases (55.55%) the final diagnosis was hemangioma, based on histopathological analysis. Of these tumors, 24 were located at the level of upper limb, affecting the median nerve (11 cases) [3,9,13,15,18,[23][24][25]30,32], ulnar nerve (8 cases) [8,16,19,26,31,33], digital branches of ulnar and radial nerves (4 cases) [7,20,29,31] and the inferior trunk of brachial plexus (1 case) [22]. The other 6 tumors were located at the level of lower limb, involving the sciatic nerve (2 cases) [27,31], peroneal nerve (3 cases) [5,11,19] and posterior tibial nerve (1 case) [14].…”

“…Of these tumors, 24 were located at the level of upper limb, affecting the median nerve (11 cases) [3,9,13,15,18,[23][24][25]30,32], ulnar nerve (8 cases) [8,16,19,26,31,33], digital branches of ulnar and radial nerves (4 cases) [7,20,29,31] and the inferior trunk of brachial plexus (1 case) [22]. The other 6 tumors were located at the level of lower limb, involving the sciatic nerve (2 cases) [27,31], peroneal nerve (3 cases) [5,11,19] and posterior tibial nerve (1 case) [14]. These lesions were named differently by the authors: hemangioma [3,11,13,16,[18][19][20]22,24,26,31,33], intraneural hemangiomas [5,[7][8][9]15,23,29], endoneural hemangioma, intrinsic hemangioma [25] or capillary h...…”

“…The other 6 tumors were located at the level of lower limb, involving the sciatic nerve (2 cases) [27,31], peroneal nerve (3 cases) [5,11,19] and posterior tibial nerve (1 case) [14]. These lesions were named differently by the authors: hemangioma [3,11,13,16,[18][19][20]22,24,26,31,33], intraneural hemangiomas [5,[7][8][9]15,23,29], endoneural hemangioma, intrinsic hemangioma [25] or capillary hemangioma [27,30,32]. Konet al [7] described one case in which the coexistence of an intraneural hemangioma and an extraneural cavernous hemangioma at the level of the digital branches of the ulnar nerve was observed.…”

“…The term "vascular malformation" without specifying its nature, was used in 3 of the reviewed cases [21,31].…”