Neurilemmomas of the Hand—A Review of the Clinical Presentation, Surgical Outcome, and Potential Risk Factors: 手部的神經鞘瘤 -- 臨床表現,手術結果和潛在危險因素的綜述

Abstract

IntroductionNeurilemmoma of the hand may not usually present with the classic triad (mass, differential mobility, Tinel's sign). Failure to recognize a neurilemmoma may result in the inadvertent injury of nerves. Preoperative diagnosis is very important and challenging. Materials and methodsA retrospective study of patients who underwent surgery for neurilemmoma of the hand between 2001 and 2013 was conducted. Their clinical presentation, surgical outcome and potential risk factors were reviewed. ResultsTwenty-eight cases of neurilemmoma arising from digits and hands in 28 patients were retrieved for study. Seventeen were male and 11 were female; the mean age at surgery was 57.1 years old and mean follow-up was 15.4 months. Nineteen lesions were on the volar side and the others were on the dorsal side. Volar digital nerve was the most common site of involvement. All patients presented with a mass, with an average duration of symptoms of 41.1 months; 35.7% had local tenderness. Differential mobility and Tinel's sign could be elicited in 39.3% and 21.4%, respectively. Correct preoperative diagnosis was made only in 25% of cases. At final follow-up, 82.1% of patients was symptom-free. Numbness, local tenderness and hypertrophic scar were reported in 7.1%, 7.1% and 3.6% of patients, respectively. No recurrence and no wound complications were noted. No reoperation was necessary. Multiple lesions and a positive Tinel's sign were associated with less satisfactory outcome and increased risk of postoperative complications as shown by the statistical analysis. ConclusionNeurilemmoma should be one of the differential diagnoses when dealing with hand masses. Tinel's sign should be done routinely on examination to facilitate correct preoperative diagnosis. Loupe magnification should be used during operation for optimal surgical outcome.