Abstract
Simple SummaryPeripheral nerve sheath tumors are associated with significant morbidity. Clinical presentation, tumor location, and therapeutic strategies are variable. We aim to provide high-quality data concerning the results of interdisciplinary operative approaches for surgical resection of schwannomas. Understanding the anatomical and functional challenges of surgical interventions in the peripheral nervous system can help to enhance the outcomes of these therapies. We aim to highlight the need for interdisciplinarity and provide evidence for both excellent functional outcomes, as well as improved quality of life for patients undergoing sporadic schwannoma surgery.Most sporadic peripheral nerve sheath tumors in adults are schwannomas. These tumors usually present with significant pain but can also cause neurological deficits. Symptomatology is diverse, and successful surgical interventions demand interdisciplinarity. We retrospectively reviewed 414 patients treated between 2006 and 2017 for peripheral nerve sheath tumors. We analyzed clinical signs, symptoms, histology, and neurological function in the cohort of adult patients with schwannomas without a neurocutaneous syndrome. In 144 patients, 147 surgical interventions were performed. Mean follow-up was 3.1 years. The indication for surgery was pain (66.0%), neurological deficits (23.8%), significant tumor growth (8.8%), and suspected malignancy (1.4%). Complete tumor resection was achieved on 136/147 occasions (92.5%). The most common location of the tumors was intraspinal (49.0%), within the cervical neurovascular bundles (19.7%), and lower extremities (10.9%). Pain and neurological deficits improved significantly (p ≤ 0.003) after 131/147 interventions (89.1%). One patient had a persistent decrease in motor function after surgery. Complete resection was possible in 67% of recurrent tumors, compared to 94% of primary tumors. There was a significantly lower chance of complete resection for schwannomas of the cervical neurovascular bundle as compared to other locations. The surgical outcome of sporadic schwannoma surgery within the peripheral nervous system is very favorable in experienced peripheral nerve surgery centers. Surgery is safe and effective and needs a multidisciplinary setting. Early surgical resection in adult patients with peripheral nerve sheath tumors with significant growth, pain, neurological deficit, or suspected malignancy is thus recommended.
Highlights
Peripheral nerve sheath tumors are not usually a daily occurrence
The inclusion criteria were not met by 766 patients with 2388 cases
This article aims at providing an overview of the surgical outcome and considerations for treatment, since the most favorable outcomes of peripheral schwannoma surgery shown by this study demonstrate the opportunity surgery offers to
Summary
Peripheral nerve sheath tumors are not usually a daily occurrence. These tumors comprise a heterogenous group, consisting mostly of benign tumors (such as neurofibromas and schwannomas) as well as malignant neoplasms (malignant peripheral nerve sheath tumor, MPNST). Peripheral nerve sheath tumors can have significant morbidity, especially due to local complications [1]. In the remaining cases, there is mostly an association with. Benign nerve sheath tumors in NF1 are usually neurofibromas. They can grow diffusely as plexiform neurofibromas (PNF) with local infiltration of the surrounding tissue and organs, or as solitary neurofibromas related to a defined peripheral nerve. Plexiform neurofibromas are a specific manifestation, typical of and confined to NF1, and 50% of patients are affected [3]
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