The vascular features of plexiform neurofibroma with some observations on the importance of pre-operative angiography and the value of pre-operative intra-arterial embolisation

Littlewood, A. H. M.; Stilwell, John

doi:10.1016/0007-1226(83)90140-6

Cited by 48 publications

(35 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Plexiform neurofibroma is neurofibromatosisi is a generalized overgrowth of neural tissue occurring in subcutaneous tissue [2][3][4][5]. Its cellular lineage is uncertain, and may derive from Schwann cells, other perineural cell lines, or fibroblasts.…”

Section: Discussionmentioning

confidence: 99%

Large Neurofibroma of Trunk

Agarwal

Agarwal²,

Sil

et al. 2011

Indian J Surg

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Large Neurofibroma of Trunk

Agarwal

Agarwal²,

Sil

et al. 2011

Indian J Surg

View full text Add to dashboard Cite

show abstract

“…Pre-operative coil embolisation was used to reduce the blood flow to the tumour and to limit intra-operative blood loss [7,20,21]. The vessels were embolised proximally to reduce flow in the major vascular pedicles at the level of surgical dissection and to reduce skin necrosis associated with a distal embolisation technique.…”

Section: Discussionmentioning

confidence: 99%

“…We avoided particulates owing to the sheer size of the lesion and to limit skin necrosis. Littlewood et al [21] embolised a plexiform neurofibroma; however, there was a significant delay before surgery of 1 month and significant perioperative blood loss occurred. In our case, coils were placed proximally in major feeding vessels immediately prior to surgery and only four units of packed red cells were required intra-operatively.…”

Section: Discussionmentioning

confidence: 99%

Intravascular embolisation and surgical resection of a giant neurofibroma with intratumoural haemorrhage

Jones¹,

Kiatisevi²,

Morris³

et al. 2010

BJR

View full text Add to dashboard Cite

ABSTRACT. The use of pre-operative embolisation has been described for small neurofibromas, but not for giant lesions. Advances in embolisation techniques are extending the indications for this procedure, in particular to assist with operative intervention on a range of lesions. This case report describes a 45-year-old male with a giant neurofibroma who underwent embolisation to stabilise intratumoural haemorrhage and to assist with haemostasis during the subsequent surgical resection. Minimal transfusion was required and the patient has made a good recovery. This case demonstrates that pre-operative embolisation of these large and challenging lesions is technically feasible and appears to be beneficial in reducing perioperative blood loss and morbidity. Neurofibromas are common benign soft-tissue tumours arising within peripheral nerves. Solitary neurofibromas are more common, whereas multiple neurofibromas are often associated with neurofibromatosis type 1 (NF-1) [1]. Plexiform neurofibromas rarely grow to be larger than 5 cm; however, giant neurofibromas can occur and are commonly associated with NF-1. Neurofibromas are difficult to manage surgically as they are extensively infiltrative and highly vascular. Complications of neurofibromas are rare, but include malignant change and potentially life-threatening haemorrhage [2].We report a case of haemorrhage into a giant plexiform neurofibroma of the lower back and buttock causing hypovolaemic shock. This was subsequently managed with intravascular embolisation followed by surgical resection, demonstrating that this technique is technically feasible and should be considered for these lesions. Case reportAn otherwise well 45-year-old Caucasian man presented with bleeding from a solitary large mass over the posterior aspect of his right buttock and lumbar region. Although he initially denied it, he later revealed the mass had been present for over 10 years and had gradually enlarged during this time. Recently, the lesion had increased in size rather rapidly and suffered an overlying skin breakdown. He was bleeding from the surface of the lesion and became hypotensive with some renal impairment, which later recovered. He received a transfusion of 12 units of blood during stabilisation prior to transfer to our centre.Upon arriving at our centre, examination revealed a large, tender, soft mass measuring 70 6 50 6 20 cm extending from the thoracolumbar region to the gluteal fold and overhanging the posterior aspect of his thigh. A large café-au-lait spot covered the lesion (Figure 1). He was haemodynamically stable and the lesion was no longer bleeding from the surface.A CT scan revealed a large soft-tissue mass arising from the subcutaneous tissues of the lower back and extending outside of the available field of view. Loss of fat planes between the mass and the erector spinae muscle was suggestive of possible deep muscular invasion (Figure 2a).MRI was technically difficult and limited by motion artefact; much of the gluteal mass was not included on the field of view...

show abstract

“…Some authors recommend pre-operative angiography and embolisation prior to surgery, although experience with this is limited. 8 In our experience, internal packing with gauze is an effective method of controlling the bleeding when normal measures fail. The life-long risk of malignant transformation for plexiform neurofibromas quoted in the more recent reviews is 2-5%.…”

Section: Management Of Massive Lower Limb Plexiform Neurofibromatosismentioning

confidence: 96%

Management of massive lower limb plexiform neurofibromatosis – when to intervene?

Giannas²,

Babar³

et al. 2007

Ann R Coll Surg Engl

View full text Add to dashboard Cite

Massive plexiform neurofibromatosis is an uncommon manifestation of Type 1 neurofibromatosis. These tumours result in functional disability and severe disfigurement. Due to the variable natural history od these lesions, the optimal management is not well defined and surgery is often delayed until significant disfigurement has occurred. The aim of this report is to discuss the optimum timing of surgical intervention and to highlight the difficulties in dealing with an advanced lesion.

show abstract

The vascular features of plexiform neurofibroma with some observations on the importance of pre-operative angiography and the value of pre-operative intra-arterial embolisation

Cited by 48 publications

References 8 publications

Large Neurofibroma of Trunk

Large Neurofibroma of Trunk

Intravascular embolisation and surgical resection of a giant neurofibroma with intratumoural haemorrhage

Management of massive lower limb plexiform neurofibromatosis – when to intervene?

Contact Info

Product

Resources

About