Abstract
Background
Schwannomas are the most common benign tumours developing in peripheral nerves. They usually present as a slow-growing mass, sometimes associated with pain and paraesthesia. The aim of this study is to define the correct preoperative diagnosis, to review the surgical treatment employed and to evaluate short- and long-term neurological deficits.
Methods
Thirty-four patients affected by schwannoma in the upper limbs were treated in the period 1995–2011. In 15 patients the tumour was located on the ulnar nerve, in 8 on the median nerve, in 2 on the radial nerve, in 1 on the anterior interosseous nerve, in 1 on the muscle-cutaneous nerve, and in the remaining 7 on the digital nerves. All patients were surgically treated using a microsurgical approach.
Results
The enucleation of the mass was possible without fascicle lesion in 12 cases. In 22 cases resection of the indissociable fascicles was performed. Postoperative paraesthesia was present in 28 out of 34 treated patients; this clinical sign regressed in a mean period of 12 months in 27 patients.
Conclusions
When approaching a palpable mass in the upper limbs, the possibility of a peripheral nerve tumour should always be considered. It is important to look for typical signs of schwannomas, such as a positive Tinel sign and peripheral paraesthesia. Imaging assessment with magnetic resonance imaging (MRI) and ultrasonography enables the determination of where the tumour takes its origin and from which nerve. Microsurgical techniques and know-how are recommended in approaching the resection in order to respect as many nerve fibres as possible.
References
Adani R, Baccarani A, Guidi E, Tarallo L (2008) Schwannomas of the upper extremity: diagnosis and treatment. Chir Organi Mov 92:85–88
Akambi Sanoussi K, Dubert T (2006) Schwannomas of the peripheral nerve in the hand and the upper limb: analysis of 14 cases. Chir Main 25:131–135
Beaman FD, Kransdorf MJ, Menke DM (2004) Schwannoma: radiologic-pathologic correlation. Radiographics 24:1477–1481
Donner TR, Voorhies RM, Kline DG (1994) Neural sheath tumors of major nerves. J Neurosurg 81:362–373
Forthman CL, Blazar PE (2004) Nerve tumors of the hand and upper extremity. Hand Clin 20:233–242
Hems TEJ, Burge PD, Wilson DJ (1997) The role of magnetic resonance imaging in the management of peripheral nerve tumors. J Hand Surg [Br] 22:57–60
Hoglund M, Muren C, Engkvist O (1997) Ultrasound characteristics of five common soft-tissue tumors in the hand and forearm. Acta Radiol 38:348–354
Holdsworth BJ (1985) Nerve tumors in the upper limb-a clinical review. J Hand Surg [Br] 10:236–238
Ichikawa J, Sato E, Haro H, Anayama S, Ando T, Hamada Y (2008) Posterior interosseous nerve palsy due to schwannoma: case report. J Hand Surg [Am] 33:1525–1528
Isobe K, Tominaga S, Tsutomu A, Hiroyuki K (2004) Imaging of ancient schwannoma. Am J Radiol 183:331–336
Kang HJ, Shin SJ, Kang ES (2000) Schwannomas of the upper extremity. J Hand Surg [Br] 25:604–607
Kehoe NJ, Reid RP, Semple JC (1995) Solitary benign peripheral-nerve tumours. Review of 32 years’ experience. J Bone Joint Surg [Br] 77:497–500
Kim DH, Murovic JA, Tiel RL, Moes G, Kline DG (2005) A series of 397 peripheral neural sheath tumors: 30-year experience at Louisiana State University Health Sciences Center. J Neurosurg 102:246–255
Kransdorf MJ (1995) Benign soft-tissue tumors in a large referral population: distribution of specific diagnoses by age, sex, and location. AJR Am J Roentgenol 164:395–402
Kuo YL, Yao WJ, Chiu HY (2005) Role of sonography in the preoperative assessment of neurilemmoma. J Clin Ultrasound 33:87–89
Kuo YL, Chiu HY, Yao WJ, Shieh SJ (2009) Ultrasound for schwannoma in the upper extremity. J Hand Surg [Eu] 34:697–698
Oberle J, Kahamba J, Richter HP (1997) Peripheral nerve schwannomas-an analysis of 16 patients. Acta Neurochir (Wein) 139:949–953
Ozdemir O, Ozsoy MH, Kurt C, Coskunol E, Calli I (2005) Schwannomas of the hand and wrist: long-term results and review of the literature. J Orthop Surg (Hong Kong) 13:267–272
Park MJ, Seo KN, Kang HJ (2009) Neurological deficit after surgical enucleation of schwannomasof the upper limb. J Bone Joint Surg Br 91:1482–1486
Patel MR, Mody K, Moradia VJ (1996) Multiple schwannomas of the ulnar nerve: a case report. J Hand Surg [Am] 21:875–876
Phalen GS (1976) Neurilemmomas of the forearm and hand. Clin Orthop Relat Res 114:219–222
Saito S, Suzuki Y (2010) Schwannomatosis affecting all three major nerves in the same upper extremity. J Hand Surg [Eu] 35:592–594
Sandberg K, Nilsson J, Søe Nielsen N, Dahlin LB (2009) Tumours of peripheral nerves in the upper extremity: a 22-year epidemiological study. Scand J Plast Reconstr Surg Hand Surg 43:43–49
Sawada T, Sano M, Ogihara H, Omura T, Miura K, Nagano A (2006) The relationship between pre-operative symptoms, operative findings and postoperative complications in schwannomas. J Hand Surg [Br] 31:629–634
Strickland JW, Steichen JB (1977) Nerve tumors of the hand and forearm. J Hand Surg [Am] 2:285–291
Rockwell GM, Thoma A, Salama S (2003) Schwannoma of the hand and wrist. Plast Reconstr Surg 3:1227–1232
Takase K, Yamamoto K, Imakiire A (2004) Clinical pathology and therapeutic results of neurilemmoma in the upper extremity. J Orthop Surg 12:222–225
Tanabe K, Tada K, Ninomiya H (1997) Multiple schwannomas in the radial nerve. J Hand Surg [Br] 22:664–668
Tang JB, Ishii S, Usui M, Naito T (1990) Multifocal neurilemomas in different nerves of the same upper extremity. J Hand Surg [Am] 15:788–792
Vlychou MI, Dailiana ZH (2011) Ancient schwannoma of the hand. J Hand Surg [Am] 36:2030–2033
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Adani, R., Tarallo, L., Mugnai, R. et al. Schwannomas of the upper extremity: analysis of 34 cases. Acta Neurochir 156, 2325–2330 (2014). https://doi.org/10.1007/s00701-014-2218-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-014-2218-2