Abstract
Schwannoma is the most common benign tumor of peripheral nerve. Only 7% of schwannomas arise from the median nerve, and its localization in the motor branch is extremely rare. A 57-year old right-handed female presented with a carpal tunnel syndrome symptoms associated to a little painful thenar swelling in the left hand with no motor or sensory deficit. An electromyogram confirmed the clinical diagnosis of carpal tunnel syndrome. Ultrasonography (US), performed to study the thenar swelling, revealed an infracentimetric avascular well-limited intramuscular mass. Surgical resection of the mass was performed satisfactorily with preservation of nerve fascicles. Histopathology concluded to a benign schwannoma of the motor branch of the median nerve. In the literature reviewed by us, this is the third case of motor branch of the median nerve schwannoma.
Highlights
Schwannoma, called neurilemmoma, is the most frequent benign tumor of the peripheral nerves
We report a case of schwannoma developing in the motor branch of the median nerve associated to a carpal tunnel syndrome
Dissection was performed under the radial bank of this incision and intramuscular dissection found a well encapsulated tumor which was intimately associated to the motor branch of the median nerve (Figure 2)
Summary
Schwannoma, called neurilemmoma, is the most frequent benign tumor of the peripheral nerves. We report a case of schwannoma developing in the motor branch of the median nerve associated to a carpal tunnel syndrome. Ultrasonography (US) (Figure 1), performed to study the thenar swelling, revealed an avascular well-limited intramuscular mass, communicating to the carpal tunnel by a fistula. Dissection was performed under the radial bank of this incision and intramuscular dissection found a well encapsulated tumor which was intimately associated to the motor branch of the median nerve (Figure 2). The patient is a 57-year old right-handed woman, with no relevant family or personal history She presented with a 2year history of numbness and tingling of both hands, especially noted at night, with a recent weakness of the right hand and pain in the thenar eminence of the left one without motor weakness in the movement of thumb. In the first case reported by Squarzina et al, this plane of cleavage was not identifiable and the resection sacrificed the motor branch [4]
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