Supraclavicular Brachial Plexus Approach for Excision of C8 Nerve Root Schwannoma: 3-Dimensional Operative Video.

Abstract

Brachial plexus tumors are uncommon lesions in young adults. The majority of these are benign peripheral sheath tumors. In this 3-dimensional video, we present a case of a 19-yr-old female who presented to the neurosurgical outpatients with an anterior neck lump. It has been present for months, causing occasional numbness and paraesthesia in the distribution of the left ring finger. There was no objective weakness in finger flexion with normal long flexors reflexes. The cervical spine and supraclavicular brachial plexus were investigated with a magnetic resonance imaging (Gadolinium) scan (Figure1). It demonstrated 30×20×20 mm lesion adjacent to the C8 nerve arising from the neural foramen, however, mostly occupying the space lateral to it. The patient was consented for resection of the tumor. This was done via the supraclavicular brachial plexus approach. The brachial plexus nerves were macroscopically demonstrated lateral to the anterior scalene muscle. The intraoperative electrophysiology was used to directly stimulate the nerves, which aided in accurate tracking during the dissection. The tumor was exposed after tracing the C8 nerve deep and medial to the anterior scalene muscle. It was resected down to the foramen, reaching the level of the epidural venous plexus, while C8 was spared. The patient recovered with no neurological deficit. The histopathology confirmed grade 1 schwannoma. Subsequently, there was no radiological follow-up performed. This case demonstrates the surgical dissection of supraclavicular brachial plexus in 3-dimensions while describing the unusual dissection medial to scalenus anterior muscle.