Neurilemoma of the Median Nerve - Surgical Strategies Based on a Case Report

Abstract

The study presented a case of a patient with a neurilemoma of the median nerve. It presented as a six centemeters tumor, at the level of the proximal one third of the arm with only mild paraesthesias within first to third ray of the hand. MRI showed the relationship of the tumor and the median nerve, and allowed for the preliminary diagnose of a benign peripheral neural sheath tumor (neurilemoma or neurofibroma). During the first operation the tumor has not been excised, because nerve reconstruction technique was not available. During the second procedure excision of the tumor has been performed without resection of the median nerve trunk with no postoperative deficiencies. The paper provides a detailed description of a surgical procedure. The presented case, like current publications shows that peripheral neural sheath tumor may be usually excised without resection of the nerve trunk, although the possibility of nerve fascicles injury or the need to excise them in the case of neurofibroma clearly suggest that these type of operations should be carried out in centers with microsurgical facilities.

Ultra-high-frequency Ultrasound to Assess Nerve Fascicles in Median Nerve Traumatic Neuroma

“…Diagnostic imaging tools, such as MRI and ultrasound, are considered fundamental for the success of the operation, preventing postsurgical neurologic deficits [4-5]. Ulatowski and Kaniewska [6] provided some evidence that peripheral neural sheath tumors could be removed with nerve preservation. However, they suggested that these surgeries should be performed in microsurgery centers for careful intraoperative evaluation.…”