Tumors of Extremity Nerve Trunks

Orlov ., Kokin G.

Polenov Research Neurosurgical Institute, Saint Petersburg, Russia

 

The research goal was development of optimum methods of diagnosis and surgical tactics, as well as determination of indications for operations.

Material and Methods. There were 214 cases with this pathology, treated at the Polenov Research Neurosurgical Institute in 1960-2005. Their age varied from 11 up to 74 years. The methods, used by us, comprised neurological and ultrasonic examination, electromyography, electrodiagnosis, MRI. There were tumors of brachial and cervical plexuses (58 cases; 27.1%), tumors of nerves of upper (86 cases; 40.2%) and lower (70 cases; 32.7%) extremities.

Results and Discussion. The disease duration was 4.5 years on the average. A tumor was an accidental finding in 1 patient. Pain was the first symptom, which appeared during neoplasm palpation or physical loads. It was of a shooting or irradiating character. Syndrome of partially or totally impaired conductivity of a nerve trunk was diagnosed in 90% of cases. Cases with tumors of extremity nerve trunks were subjected to ultrasonic examination; MRI was used in patients with neoplasms of brachial or cervical plexuses. The patients underwent interventions with applying a surgical microscope and microsurgical technique. Intratrunk enucleation of a tumor with removal of its capsule was performed in cases with lesions of brachial or cervical plexuses or of a functionally eloquent nerve. Estimation of remote results showed, that 84.3% of cases restored their health and returned to their former labor activity; tumor removal and presence of other diseases became a cause of disability in 15 patients (7%). There were 12 cases (5.6%) with relapses and repeated operations; an extremity amputation was made in 3 patients (1.4%).

Conclusion. Indications for surgical treatment were as follows:
1. Marked pain syndrome.
2. Completely or partially impaired conductivity.
3. Compression of a neurovascular bundle.
4. Frequent relapses of neoplasm.