Outcomes in a consecutive series of 111 surgically treated plexal tumors: a review of the experience at the Louisiana State University Health Sciences Center

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Object. The authors conducted a retrospective study of 107 consecutive patients with 111 brachial plexus tumors surgically treated at the Louisiana State University Health Sciences Center (LSUHSC).

Methods. During a 12-year period, from 1986 to 1998, 371 patients with lesions of the brachial plexus underwent surgery at LSUHSC. Among this group, 107 patients harbored 111 tumors of the brachial plexus. Neural sheath tumors were the most commonly found and included 33 neurofibromas (20 of which were associated with von Recklinghausen disease), 36 schwannomas, and 12 malignant neural sheath tumors. Of the non—neural sheath tumors, 13 were benign and 17 were malignant. Presenting symptoms included pain (59%), palpable mass (52%), paresthesias (30%), and paresis (29%).

Anterior supraclavicular (82%) or posterior subscapular (18%) approaches were used to achieve gross-total (79%) or subtotal (21%) resection of tumor. The average follow-up period was 38.3 months or 3.2 years.

Seventy percent of patients with benign neural sheath tumors became free from pain postoperatively or reported improvement in their preoperative pain status. Function remained intact or improved in 50% and remained stable postoperatively in another 20% of cases.

Preservation of function was more likely in patients who presented intact and in those who had not undergone a previous attempted biopsy procedure or resection than in those in whom such manipulation had occurred.

Conclusions. Resection of most plexal tumors is technically feasible and associated with acceptable morbidity and mortality rates.

Article Information

Address reprint requests to: David G. Kline, M.D., Louisiana State University Health Sciences Center, 1542 Tulane Avenue, Box T7–3, New Orleans, Louisiana 70112–2822.

© AANS, except where prohibited by US copyright law.

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Figures

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    Coronal T1-weighted MR image revealing a neurofibroma (arrows) arising from the C-6 nerve on the right side.

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    Intraoperative photograph showing a neurofibroma involving the C-6 nerve and root, which was approached via the posterior subscapular route. The arrow points to the tumor in the proximal C-6 nerve. A plastic loop curves around a long thoracic nerve. The patient had no neurological deficit postoperatively but did require meningocele repair 18 months later.

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    Intraoperative photograph showing a neurogenic sarcoma arising from the middle trunk of the plexus. The clavicle (single arrow) is encircled by a sponge and is seen in the lower-right corner. The upper trunk (double arrows) is adherent to the superior surface of the tumor. A Penrose drain can be observed around the C-5 nerve, whereas C-6 can be seen behind it.

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    Intraoperative photograph of a neurofibroma arising from the right C-8 and T-1 nerves, which was approached via the posterior subscapular approach. The ribbon retractor is on the apical pleura. The T-1 and C-8 nerves distal to the tumor are labeled. The patient had undergone a previous procedure in which a biopsy specimen was obtained. Symptoms included paresthesias of the little and ring fingers and mild but definite interosseous hand weakness.

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    Intraoperative photograph demonstrating splitting of fascicles away from a schwannoma (arrow) arising from the lower trunk. The upper and middle trunks are encircled by Penrose drains after neurolysis, so that they can be displaced laterally. The phrenic nerve is elevated and moved medially with the aid of a Penrose drain.

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    Intraoperative photograph showing a moderately large infraclavicular neurogenic sarcoma arising from the lateral cord and encircling the axillary artery and a portion of the axillary vein. These vessels were isolated both proximal and distal to the tumor, encircled by drains, and then skeletonized from any remaining tumor around them. The tumor could then be dissected out of the lateral cord, by splitting away uninvolved fascicles from its surface and at both poles of the lesion.

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    Axial MR image revealing a right paramedian desmoid tumor (arrow) at the level of C7—T1. The tumor is adherent to the vertebral body at this level. Venous flow in the left jugular vein provides the appearance of a tumor. J = jugular vein; T = trachea.

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