Schwannoma of the Median Nerve: Diagnosis Sometimes Delayed

Boufettal, Monsef; Azouz, Mohamed; Rhanim, A.; Mohamed, Azah; Mahfoud, Mustapha; Bardouni, Ahmed El; Berrada, Mohamed Saleh; Yaacoubi, M. El

doi:10.4137/ccrep.s16686

Cited by 10 publications

(8 citation statements)

References 15 publications

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“…The tumor enucleation of PPS schwannomas may allow the preservation of the function of the original nerves. Mapping the nerve fiber with an electromyographic (EMG) system may help to decide the incision line on the tumor capsule (33,34). In the present study, an EMG system was used when there was suspicion of a neurogenic tumor, particularly schwannomas, in order to lessen damage to the nerve fibers as much as possible during tumor enucleation.…”

Section: Discussionmentioning

confidence: 99%

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Surgical treatment of parapharyngeal space tumors: A report of 29 cases

Ijichi

Murakami

2017

Oncology Letters

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Abstract. The present study aimed to establish a strategy for parapharyngeal space (PPS) tumor surgery based on preoperative symptoms, clinical signs, imaging and histological examination. A retrospective cohort study was conducted with 29 adult patients who underwent surgery for primary PPS tumors from 2008-2015. The following data was obtained: Preoperative symptoms of the patient, histological type of the tumor, surgical approach and complications. Of the 29 patients who underwent surgery to remove a PPS tumor, 16 presented with neurogenic tumors and 13 with salivary gland tumors. The most common symptom was the presence of a neck mass. Preoperative computed tomography and magnetic resonance imaging were performed to evaluate the size and location of the tumors. The majority of the salivary gland tumors were located in the prestyloid space, whereas all neurogenic tumor cases were poststyloid. A total of 21 of the 29 patients (72.4%) underwent a preoperative fine needle aspiration (FNAC) examination. FNAC contributed to preoperative diagnosis in 9 of these cases (42.9%). In parotid tumors of the prestyloid space, facial nerve palsy was a common postoperative complication. In the case of neurogenic tumors, a common complication was the postoperative palsy of the nerve of tumor origin. The strategy for PPS surgery, from the preoperative diagnosis to the operative method, remains controversial. The data on pre-and postoperative symptoms, imaging and histological diagnosis, and the selection of surgical method depending on a neurogenic or salivary tumor origin in the present study indicated that improving the method of examination, carefully selecting the method of approach and accurately managing surgery leads to complete tumor removal, and that the use of nerve-preserving techniques may reduce the likelihood of complications.

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Section: Discussionmentioning

confidence: 99%

“…When a nerve bundle is visible, the tumor should be incised where it is separated from the nerve fiber. When the nerve bundle is not visible, the tumor should be incised where it swells (33,34). An EMG system is particularly useful to map the nerve fibers of motor nerves.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of parapharyngeal space tumors: A report of 29 cases

Ijichi

Murakami

2017

Oncology Letters

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“…[24][25][26][27] The median nerve appears to be one of the most affected nerves for schwannoma. 28,29 The recommended treatment of malignant PNST is the same as with dogs, with surgical excision, including amputation, the treatment of choice. 30 Adjuvant radiotherapy is also recommended, as it may also be beneficial for local control and longterm survival.…”

Section: Discussionmentioning

confidence: 99%

“…Benign PNST are much more common than their malignant counterpart, with the schwannoma the most common in the hand and upper extremity 24–27 . The median nerve appears to be one of the most affected nerves for schwannoma 28,29 . The recommended treatment of malignant PNST is the same as with dogs, with surgical excision, including amputation, the treatment of choice 30 .…”

Section: Discussionmentioning

confidence: 99%

A peripheral nerve sheath tumour in the median nerve of a dog

Anderson

Langley‐Hobbs

2022

Vet Record Case Reports

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A 6‐year‐old, female, spayed, flat‐coated retriever cross presented with a 4‐month history of progressive left thoracic limb lameness that was unresponsive to medical treatment. Initial advanced imaging with computed tomography did not identify a cause, and the dog was discharged on rest and analgesia. The dog re‐presented three weeks later with worsening lameness, discomfort and a painful, palpable mass on the medial aspect of the left thoracic limb just proximal to the elbow. Further investigations included electrodiagnostics and ultrasonography, which identified a lesion of the median nerve. A surgical biopsy was taken and histopathology diagnosed a peripheral nerve sheath tumour. The dog underwent surgery for thoracic limb amputation and nerve resection, with complete margins achieved. The dog went on to recover well with no signs of relapse 39 months later. This report describes the findings and treatment of a peripheral nerve sheath tumour in the thoracic limb of a dog.

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“…Our comparison did not reveal significant differences between the effects of complete and intracapsular resection on postoperative nerve function; however, the sample of intracapsular cases was quite small. In the future, the widespread application of electromyographic (EMG) mapping of nerve fibers may substantially reduce damage to nerve fibers during surgical enucleation of neuromas [17][18][19]. The enucleation of pleomorphic adenomas is also controversial among authors due to the risk of tumor spillage and recurrence.…”

Section: Discussionmentioning

confidence: 99%

Tumor, host and surgery related factors predisposing to cranial nerve deficits after surgical treatment of parapharyngeal space tumors

Rzepakowska

Osuch‐Wójcikiewicz

Žůrek

et al. 2020

Eur Arch Otorhinolaryngol

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Propose Identification of relevant features acquired on preoperative evaluation of parapharyngeal space (PPS) tumors or related to the performed surgical approach that are predictive of the most important complication of surgical treatment of these tumors, cranial nerve palsy. Methods This was a retrospective analysis of 68 patients with PPS tumors treated with surgical resection in a tertiary referral center from 2009 to 2019. The preoperative clinical symptoms, age, sex, tumor size, location, histopathological type, surgical approach, radical resection, intraoperative bleeding and the occurrence of complications were collected, evaluated and compared. Results Cross-table and chi-square test results revealed that cranial nerve deficits were more common in neurogenic tumors than in other types, including malignant tumors (χ 2 = 6.118, p = 0.013); the cervical approach was selected more often for neurogenic tumors (χ 2 = 14.134, p < 0.001); neurogenic tumors were more frequently removed intracapsularly (χ 2 = 6.424, p = 0.011); and neurogenic tumors were more likely to be located in the poststyloid area (χ 2 = 17.464, p < 0.001). The twosample t test revealed a significant correlation between age and the prevalence of cranial nerve complications (t = 2.242, p = 0.031). The mean age in the group of patients with cranial nerve palsy was 45.89 years, and that of the group without complications was 54.69 years. The results of logistic regression confirmed that the risk of nerve deficits was almost 8 times higher for neurogenic tumors (OR = 7.778, p = 0.01). None of the other analyzed variables related to tumor or surgery was significantly correlated with an increased risk of cranial nerve dysfunction. Conclusion Surgical resection of tumors other than neurogenic tumors of the PPS reveals no significant risk for permanent neural dysfunction. Tumor size also had no significant effect on the risk of postoperative nerve palsy.

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Schwannoma of the Median Nerve: Diagnosis Sometimes Delayed

Cited by 10 publications

References 15 publications

Surgical treatment of parapharyngeal space tumors: A report of 29 cases

Surgical treatment of parapharyngeal space tumors: A report of 29 cases

A peripheral nerve sheath tumour in the median nerve of a dog

Tumor, host and surgery related factors predisposing to cranial nerve deficits after surgical treatment of parapharyngeal space tumors

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