Neural Sheath Tumors of the Brachial Plexus-22-year experience at Chang Gung Memorial Hospital

Abstract

Background: Tumors of the brachial plexus are relatively rare and present a clinical challenge for the reconstructive plastic surgeon. Aim and objectives: The aim of the present study is to review and analyze the prevalence of the brachial plexus neural sheath tumor in different levels, histological subtypes, characteristics and clinical outcomes in the last twenty years. Materials and methods: This is a retrospective review of 62 peripheral neural sheath tumors (PNST) of the brachial plexus between 1987 and 2008 at the Chang Gung Memorial hospital. 60 cases (96.8%) were benign and 2 (3.2%) were malignant PNST. We classified our brachial plexus tumors into four level groups based on different surgical approaches. (1) level 1group: preganglionic root; (2) level 2 group: postpanglionic spinal nerve; (3) level 3 group: pre- and retro-clavicular; and (4) level 4 group: infraclavicular brachial plexus. Results: Of the 38 patients of schwannoma operation group in our series, no recurrence was observed with a mean follow-up of 2 years. Fourteen patients of solitary neurofibromas were excised and there is one recurrence after 18-year follow-up. 8 neurofibromatosis were excised and 3 have recurrent in a mean follow up of 6 years and one case has malignant change after three time recurrences and operations within 3 years. 18.2% (4/22) of recurrence rate and 4.5% (1/22) of malignant degeneration were found in our neurofibroma group of patients. Conclusion: Benign PNST, including schwannoma and solitary neurofibroma, are usually curative. Histology is different between both, but treatment is almost the same. Malignant PNST must be treated by either radical local resection or conservativeness.