A precise excision technique for schwannomas

Abstract

Schwannomas (or neurilemmomas) are the most common primary neural tumours occurring in the hand and wrist, arising from cells of the Schwann sheath. Th ey are benign and slow-growing, but nerve compression symptoms may arise if diagnosis is delayed and tumour growth progresses unchecked. The tumour is typically enclosed by a well-defined epineural capsule, which arises in close proximity to adjacent nerve structures. Treatment of choice is surgical excision. The current technique, primary extra-capsular excision, puts nerve fibres at great risk of damage, making patients prone to post-operative sensory and motor deficits. The senior author describes a simple technique that significantly reduces the risk of nerve injury, whilst still achieving complete resection, with excellent recovery and no residual long-term neurological sequelae. The case revolves around a 40-year-old male, right-hand dominant truck driver who presents following a 12-month history of increasing painless mass on the volar aspect of his right hand. The outcome following this simple technique was that the patient made an excellent recovery with no residual long-term neurological sequelae. Our aim is to raise awareness and discussion regarding this novel, simple technique as a serious alternative to the extra-capsular approach, which is currently the most preferred method.