Lipofibromatous Hamartoma of the Median Nerve: A Case Report

Abstract

Lipofibromatous hamartoma (LFH) is a rare benign peripheral nerve tumor. The median nerve (MN) is most commonly affected in the upper extremity. We report a case of a 39-year-old male with LFH of the median nerve presented with swelling and symptoms of carpal tunnel syndrome treated successfully with decompression. LFH is reported with various descriptions because of the proliferative nature of its adipocytes and the fibrofatty infiltration within the peripheral nerves. Swelling around the volar aspect of the wrist remains the most frequent presentation of LFH. Surgical decompression without tumor resection can result in symptom improvement. In addition, post-decompression nerve coverage can be a solution to improve the residual hyperesthesia symptoms.

Decompression and collagen wrapping of a fibrolipomatous hamartoma of the median nerve: a new approach for a rare and difficult problem

“…In contrast to our case, flexor tendon tenosynovectomy was not reported in this case. Similar to our case, this patient reported 95% resolution of paresthesia and complete resolution of symptoms at the 6 month and 2 year follow-up visits, respectively [ 9 ]. The application of nerve wraps should be considered to prevent postoperative fibrous healing following decompression or radical excision of FLH.…”

10-Year Clinical Follow-Up after Decompression of Lipofibromatous Hamartoma of the Median Nerve in a 3-Year-Old Patient: Case Report and Review of the Literature

“…There have been several previous studies on techniques for nerve dissections, but their postoperative functions are frequently disappointing [ 8 , 11 ]. In addition, nerve grafting after debulking and interaneural dissection have shown some positive results, but their results relied on short clinical follow-ups [ 12 , 13 ]. Consequently, tumor excision is generally reserved for cases with progressive and recurring pain and neurologic deficits even after carpal tunnel release and nerve decompression [ 14 ].…”

“…Since the discovery of LFH in 1953, there have been approximately 200 cases of LFH of the median nerve and pediatric cases [ 6 ]. There have been about 25 cases of pediatric LFH afflicting those under the age of 18 [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. However, even though most previous studies depended on case reports or small case series with short-term follow-up periods, some reported progressive decline in the sensory and motor functions of the affected nerve in long-term follow-ups of adult patients [ 8 ].…”

Rare benign median nerve angiogenetic lipofibromatous hamartoma: A case report

“…9, 10 Elbayer et al described median nerve carpal tunnel release plus covering the median nerve with dermal substitute and pronator quadratus flaps, an effective new modality of successful surgical management for LFH. 10…”