Brachial plexus tumors extending into the cervicothoracic spine: a review with operative nuances and outcomes

El-Farra, Mohamed H.; Dahan, Alden; Endres, Philine; Taka, Taha M; Delgado, Luis

doi:10.1007/s12094-020-02549-7

Cited by 4 publications

(6 citation statements)

References 36 publications

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“…MPNST, on the other hand, is associated with an extremely poor outcome. Most MPNSTs tend to grow rapidly, leading to sudden loss of both motor and sensory function 43 . Accordingly, the overall estimated 5-year survival rate ranges from 15 to 50% 44 .…”

Section: Discussionmentioning

confidence: 99%

Patient demographics, tumor characteristics, and outcomes following surgical treatment of benign and malignant brachial plexus tumors: a systematic review

Shekouhi

Chim

2023

International Journal of Surgery

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Background: Various treatment options have been introduced for the management of primary tumors of the brachial plexus (BP), ranging from conservative therapy to wide local excision with/without postoperative chemoradiotherapy. However, no consensus exists regarding optimal treatment strategies based on collated and published data. Objective: The aim of this study was to investigate the clinicopathological characteristics and outcome of patients with primary tumors of the BP who underwent surgical treatment. Data sources: A systematic search of the four main online databases, including Web of Science (WOS), PubMed, Scopus, and Google Scholar, was conducted. Study selection: All related articles addressing the clinical outcome and role of surgical interventions for management of primary tumors of the BP. Intervention: Optimal surgical and radiotherapeutic interventions for benign and malignant lesions based on the pathologic characteristics and location of primary BP tumors. Results: A total of 687 patients (693 tumors) with a mean age of 41.7±8.7 years old were evaluated. In total, 629 (90.8%) tumors were benign, and 64 (9.2%) were malignant, with a mean tumor size of 5.4±3.1 cm. The location of the tumor was reported for 639 patients. For these tumors, 444 (69.5%) originated from the supraclavicular region, and 195 (30.5%) were infraclavicular. The trunks were the most common location for tumor involvement, followed by the roots, cords, and terminal branches. Gross total resection was achieved in 432 patients and subtotal resection (STR) was performed in 109 patients. With neurofibromas, STR still resulted in good outcomes. The outcomes following treatment of malignant peripheral nerve sheath tumors were poor regardless of the type of resection. In general, symptoms related to pain and sensory issues resolved rapidly postoperatively. However, the resolution of motor deficits was often incomplete. Local tumor recurrence occurred in 15 (2.2%), patients and distant metastasis was observed in only eight (1.2%) cases. The overall mortality was 21 (3.1%) patients among the study population. Limitations: The main limitation was the lack of level I and II evidence. Conclusions: The ideal management strategy for primary BP tumors is complete surgical resection. However, in some cases, particularly for neurofibromas, STR may be preferable to preserve maximal neurological function. The degree of surgical excision (total or subtotal) mainly depends on the pathological characteristics and primary location of the tumor.

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Section: Discussionmentioning

confidence: 99%

Patient demographics, tumor characteristics, and outcomes following surgical treatment of benign and malignant brachial plexus tumors: a systematic review

Shekouhi

Chim

2023

International Journal of Surgery

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“…Surgery for cervical spinal tumors with both intra and extracanalar extension still represents a topic of great debate within the neurosurgical community regarding which should be the best route to approach this kind of lesion. [ 1 2 3 4 5 6 7 8 9 10 11 12 ]…”

Section: Discussionmentioning

confidence: 99%

“…Surgery for cervical spinal tumors with both intra and extracanalar extension still represents a great matter of debate in terms of which approach should be the best to adopt in terms of minimizing morbidity and enriching exposure. [ 1 2 3 4 5 6 7 8 9 10 11 12 ]…”

Section: Introductionmentioning

confidence: 99%

Anterior selective scalenectomy for periforaminal exposure in the ventral supraclavicular approach

Gagliardi,

Medone,

Giordano

et al. 2023

Journal of Craniovertebral Junction and Spine

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Aims and Objectives: Route of choice to access cervical paravertebral lesions with foraminal involvement is the anterolateral corridor with its variants. Main limitation of these techniques is represented by the limited surgical access to periforaminal area due to the bulk generated by the anterior scalene muscle (ASM). Over the years, alternative techniques for ASM surgical management have been developed, which are still today a matter of debate. Most popular include ASM scalene complete section (SCS) and ASM medial detachment (SMD). Authors describe an innovative, minimally invasive muscle section technique, the anterior selective scalenectomy (ASS), which reduces the risk of iatrogenic morbidity and optimizes exposure of periforaminal area in anterolateral cervical routes. Materials and Methods: A laboratory investigation was conducted. Technique was applied in a surgical setting, and an illustrative case was reported. Results: ASS is a quick and easy technique to perform. It allows optimization of surgical visibility and control on the periforaminal area in the cervical anterolateral corridor. It respects muscle anatomy and vascularization, favoring functional recovery and management of peri-operative pain; it reduces the risk of morbidity on phrenic nerve and pleura. Considering the minimally invasive nature of the technique, it allows for a slightly more limited exposure compared to traditional techniques while ensuring optimal surgical maneuverability on the target area. Conclusions: ASS represents an effective and safe alternative to traditional ASM section techniques for the exposure of periforaminal area in anterolateral cervical routes. It is indicated in case of lesions with paravertebral development and minimal intraforaminal component in the C3-C6 segment.

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“…Management of primary brachial plexus tumors is surgical in most cases [10,12]. Complete surgical excision is generally feasible in schwannomas, as these tumors often displace the nerve structures and are separated from the nerve fascicles by a fibrous capsule.…”

Section: Surgerymentioning

confidence: 99%

“…Surgical access to the brachial plexus can be achieved through different approaches. The choice for the approach primarily depends on tumor location: dorsal subscapular approach for tumors arising from the spinal roots with possible intra-foraminal extension, anterior supraclavicular approach for tumors arising from roots to trunks, and anterior infraclavicular approach for tumors arising from divisions to cords [10,12].…”

Section: Surgerymentioning

confidence: 99%

Management of the brachial plexus in head and neck cancer

Fockens¹,

Kraak²,

Leemans³

et al. 2022

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of reviewThe brachial plexus is an important anatomical structure that is regularly encountered by head and neck surgeons and radiation oncologists. Surgical or radiation-induced brachial plexus injury have great impact on arm function and quality of life. Anatomical variations and management of the brachial plexus in head and neck cancer treatment are discussed. Recent findingsThe brachial plexus consists of spinal roots from C5--C8 and T1. The most prevalent anatomical variations in brachial plexus anatomy include the prefixed brachial plexus (additional contribution from C4) in 11%, the roots of C5 and C6 piercing the belly of the anterior scalene muscle in 6.8%, and presence of the scalenus minimus muscle in 4.1--46%. Due to its location, the brachial plexus is at risk of inadvertent division or neuropraxia during surgical procedures such as neck dissection or robot-assisted transaxillary thyroid surgery (RATS). In case of inadvertent division, nerve reconstruction surgery is warranted and may lead to improved function. The risk of radiation-induced brachial plexus injury is dose-dependent and occurs in approximately 12--22%. Currently, no successful treatment options exist for radiation-induced injury.

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Brachial plexus tumors extending into the cervicothoracic spine: a review with operative nuances and outcomes

Cited by 4 publications

References 36 publications

Patient demographics, tumor characteristics, and outcomes following surgical treatment of benign and malignant brachial plexus tumors: a systematic review

Patient demographics, tumor characteristics, and outcomes following surgical treatment of benign and malignant brachial plexus tumors: a systematic review

Anterior selective scalenectomy for periforaminal exposure in the ventral supraclavicular approach

Management of the brachial plexus in head and neck cancer

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