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Management of Brachial Plexus Tumors

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Diagnostic Assessment and Treatment of Peripheral Nerve Tumors

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Abstract

Tumors of the brachial plexus can be challenging from a diagnostic and management perspective. Once suspected based on history and physical exam, several imaging modalities such as MRI and high-resolution ultrasound can confirm the lesion and distinguish it from surrounding nerves. Surgery is offered to patients who meet indications with progression of neurologic symptoms, pain, or tumor size. Patients with neurofibromatosis-1 may be treated more aggressively due to the risk of malignancy. This chapter will discuss the preoperative management and decision-making, technical aspects of surgical resection, and adjuncts available to minimize complications.

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References

  1. Huang JH, Zaghloul K, Zager EL. Surgical management of brachial plexus region tumors. Surg Neurol. 2004;61:372–8.

    Article  PubMed  Google Scholar 

  2. Das S, Ganju A, Tiel RL, Kline DG. Tumors of the brachial plexus. Neurosurg Focus. 2007;22:1–6.

    Article  Google Scholar 

  3. Desai KI. Primary benign brachial plexus tumors: an experience of 115 operated cases. Neurosurgery. 2012;70:220–33.

    Article  PubMed  Google Scholar 

  4. Gachiani J, Kim D, Nelson A, Kline D. Surgical management of malignant peripheral nerve sheath tumors. Neurosurg Focus. 2007;22:1–8.

    Google Scholar 

  5. Kichari JR, Hussain SM, Den Hollander JC, Krestin GP. MR imaging of the brachial plexus: current imaging sequences, normal findings, and findings in a spectrum of focal lesions with MR-pathologic correlation. Curr Probl Diagn Radiol. 2003;32:88–101.

    Article  PubMed  Google Scholar 

  6. Siqueira MG, Martins RS, Teixeira MJ. Management of brachial plexus region tumours and tumour-like conditions: relevant diagnostic and surgical features in a consecutive series of eighteen patients. Acta Neurochir. 2009;151:1089–98.

    Article  CAS  PubMed  Google Scholar 

  7. Bowen BC, Pattany PM, Saraf-Lavi E, Maravilla KR. The brachial plexus: normal anatomy, pathology, and MR imaging. Neuroimaging Clin N Am. 2004;14:59–85.

    Article  PubMed  Google Scholar 

  8. Yuh EL, Jain Palrecha S, Lagemann GM, Kliot M, Weinstein PR, Barbaro NM, Chin CT. Diffusivity measurements differentiate benign from malignant lesions in patients with peripheral neuropathy or plexopathy. AJNR Am J Neuroradiol. 2015;36:202–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Schmidt M, Kasprian G, Amann G, Duscher D, Aszmann OC. Diffusion tensor tractography for the surgical management of peripheral nerve sheath tumors. Neurosurg Focus. 2015;39:1–6.

    Article  Google Scholar 

  10. Cage TA, Yuh EL, Hou SW, Birk H, Simon NG, Noss R, Rao A, Chin CT, Kliot M. Visualization of nerve fibers and their relationship to peripheral nerve tumors by diffusion tensor imaging. Neurosurg Focus. 2015;39:1–6.

    Article  Google Scholar 

  11. Kori SH, Foley KM, Posner JB. Brachial plexus lesions in patients with cancer: 100 cases. Neurology. 1981;31:45–50.

    Article  CAS  PubMed  Google Scholar 

  12. Kori SH. Diagnosis and management of brachial plexus lesions in cancer patients. Oncol Williston Park N. 1995;9:756–60; discussion 765

    CAS  Google Scholar 

  13. Ahmad A, Barrington S, Maisey M, Rubens RD. Use of positron emission tomography in evaluation of brachial plexopathy in breast cancer patients. Br J Cancer. 1999;79:478–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Filler AG, Kliot M, Howe FA, Hayes CE, Saunders DE, Goodkin R, Bell BA, Winn HR, Griffiths JR, Tsuruda JS. Application of magnetic resonance neurography in the evaluation of patients with peripheral nerve pathology. J Neurosurg. 1996;85:299–309.

    Article  CAS  PubMed  Google Scholar 

  15. Du R, Auguste KI, Chin CT, Engstrom JW, Weinstein PR. Magnetic resonance neurography for the evaluation of peripheral nerve, brachial plexus, and nerve root disorders. J Neurosurg. 2010;112:362–71.

    Article  PubMed  Google Scholar 

  16. Gupta R, Villablanca PJ, Jones NF. Evaluation of an acute nerve compression injury with magnetic resonance neurography. J Hand Surg. 2001;26:1093–9.

    Article  CAS  Google Scholar 

  17. Lapegue F, Faruch-Bilfeld M, Demondion X, Apredoaei C, Bayol MA, Artico H, Chiavassa-Gandois H, Railhac J-J, Sans N. Ultrasonography of the brachial plexus, normal appearance and practical applications. Diagn Interv Imaging. 2014;95:259–75.

    Article  CAS  PubMed  Google Scholar 

  18. Hung EHY, Griffith JF. Pitfalls in ultrasonography of soft tissue tumors. Semin Musculoskelet Radiol. 2014;18:79–85.

    Article  PubMed  Google Scholar 

  19. Griffith JF. Ultrasound of the brachial plexus. Semin Musculoskelet Radiol. 2018;22:323–33.

    Article  PubMed  Google Scholar 

  20. Lee FC, Singh H, Nazarian LN, Ratliff JK. High-resolution ultrasonography in the diagnosis and intraoperative management of peripheral nerve lesions. J Neurosurg. 2011;114:206–11.

    Article  PubMed  Google Scholar 

  21. Nason LK, Walker CM, McNeeley MF, Burivong W, Fligner CL, Godwin JD. Imaging of the diaphragm: anatomy and function. Radiographics. 2012;32:E51–70.

    Article  PubMed  Google Scholar 

  22. Zeidenberg J, Burks SS, Jose J, Subhawong TK, Levi AD. The utility of ultrasound in the assessment of traumatic peripheral nerve lesions: report of 4 cases. Neurosurg Focus. 2015;39:E3.

    Article  PubMed  Google Scholar 

  23. Haldeman CL, Baggott CD, Hanna AS. Intraoperative ultrasound-assisted peripheral nerve surgery. Neurosurg Focus. 2015;39:1–4.

    Article  Google Scholar 

  24. Simoni P, Ghassemi M, Le VD-M, Boitsios G. Ultrasound of the normal brachial plexus. J Belg Soc Radiol. 2017;101:1–6.

    Google Scholar 

  25. Mansukhani KA. Electrodiagnosis in traumatic brachial plexus injury. Ann Indian Acad Neurol. 2013;16:19–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Daube JR, Rubin DI. Nerve conduction studies. In: Aminoffs electrodiagnosis in clinical neurology. Elsevier; 2012. p. 289–325.

    Chapter  Google Scholar 

  27. Fisher MA. Electrophysiology of radiculopathies. Clin Neurophysiol. 2002;113:317–35.

    Article  PubMed  Google Scholar 

  28. Simmons Z. Electrodiagnosis of brachial plexopathies and proximal upper extremity neuropathies. Phys Med Rehabil Clin N Am. 2013;24:13–32.

    Article  PubMed  Google Scholar 

  29. Spinner RJ, Kline DG. Surgery for peripheral nerve and brachial plexus injuries or other nerve lesions. Muscle Nerve. 2000;23:680–95.

    Article  CAS  PubMed  Google Scholar 

  30. Russell SM, Kline DG. Complication avoidance in peripheral nerve surgery: injuries, entrapments, and tumors of the extremities—part 2. Neurosurgery. 2006;59:ONS449–57.

    PubMed  Google Scholar 

  31. Ball JR, Biggs MT. Operative steps in management of benign nerve sheath tumors. Neurosurg Focus. 2007;22:1–4.

    Article  Google Scholar 

  32. Ducatman BS, Scheithauer BW, Piepgras DG, Reiman HM, Ilstrup DM. Malignant peripheral nerve sheath tumors. A clinicopathologic study of 120 cases. Cancer. 1986;57:2006–21.

    Article  CAS  PubMed  Google Scholar 

  33. Evans DGR, Baser ME, McGaughran J, Sharif S, Howard E, Moran A. Malignant peripheral nerve sheath tumours in neurofibromatosis 1. J Med Genet. 2002;39:311–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Donner TR, Voorhies RM, Kline DG. Neural sheath tumors of major nerves. J Neurosurg. 1994;81:362–73.

    Article  CAS  PubMed  Google Scholar 

  35. Stone JJ, Spinner RJ. Go for the gold: a “plane” and simple technique for resecting benign peripheral nerve sheath tumors. Oper Neurosurg. 2020;18(1):60–8.

    Article  Google Scholar 

  36. Tender GC, Kline DG. Anterior supraclavicular approach to the brachial plexus. Neurosurgery. 2006;58:ONS360–5.

    Google Scholar 

  37. Jung I-H, Yoon K-W, Kim Y-J, Lee SK. Analysis according to characteristics of 18 cases of brachial plexus tumors: a review of surgical treatment experience. J Korean Neurosurg Soc. 2018;61:625–32.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Borchers AT, Gershwin ME. Complex regional pain syndrome: a comprehensive and critical review. Autoimmun Rev. 2014;13:242–65.

    Article  CAS  PubMed  Google Scholar 

  39. Chen E, Itkin M. Thoracic duct embolization for chylous leaks. Semin Interv Radiol. 2011;28:63–74.

    Article  CAS  Google Scholar 

  40. Biggs MT. Posterior subscapular approach for specific brachial plexus lesions. J Clin Neurosci. 2001;8:340–2.

    Article  CAS  PubMed  Google Scholar 

  41. Dubuisson AS, Kline DG, Weinshel SS. Posterior subscapular approach to the brachial plexus. Report of 102 patients. J Neurosurg. 1993;79:319–30.

    Article  CAS  PubMed  Google Scholar 

  42. Crutcher CL 2nd, Kline DG, Tender GC. A modified, less invasive posterior subscapular approach to the brachial plexus: case report and technical note. Neurosurg Focus. 2017;42:1–4.

    Article  Google Scholar 

  43. Tender GC, Kline DG. Posterior subscapular approach to the brachial plexus. Neurosurgery. 2005;57:377–81.

    PubMed  Google Scholar 

  44. Berger A, Schaller E, Mailänder P. Brachial plexus injuries: an integrated treatment concept. Ann Plast Surg. 1991;26:70–6.

    Article  CAS  PubMed  Google Scholar 

  45. Zadnik M, Eglseder WAJ, Shur VB. Transclavicular approach for brachial plexus reconstruction. Tech Hand Up Extrem Surg. 2008;12:126–30.

    Article  PubMed  Google Scholar 

  46. Birch R, Bonney G, Marshall RW. A surgical approach to the cervicothoracic spine. J Bone Joint Surg Br. 1990;72:904–7.

    Article  CAS  PubMed  Google Scholar 

  47. Nomori H, Abe M, Sugimura H, Takeshi A. Twenty-five years’ experience with a trap-door thoracotomy modified with disconnection of the first rib for tumors invading the anterior superior sulcus. Ann Thorac Surg. 2014;97:1946–9.

    Article  PubMed  Google Scholar 

  48. Goertz O, Langer S, Uthoff D, Ring A, Stricker I, Tannapfel A, Steinau H-U. Diagnosis, treatment and survival of 65 patients with malignant peripheral nerve sheath tumors. Anticancer Res. 2014;34:777–83.

    PubMed  Google Scholar 

  49. Perrin RG, Guha A. Malignant peripheral nerve sheath tumors. Neurosurg Clin N Am. 2004;15:203–16.

    Article  PubMed  Google Scholar 

  50. Kretschmer T, Antoniadis G, Heinen C, Borm W, Scheller C, Richter H-P, Koenig RW. Nerve sheath tumor surgery: case-guided discussion of ambiguous findings, appropriateness of removal, repeated surgery, and nerve repairs. Neurosurg Focus. 2007;22:1–9.

    Article  Google Scholar 

  51. Gofeld M, Bristow SJ, Chiu S, Kliot M. Preoperative ultrasound-guided mapping of peripheral nerves. J Neurosurg. 2013;119:709–13.

    Article  PubMed  Google Scholar 

  52. Wu G, Belzberg A, Nance J, Gutierrez-Hernandez S, Ritzl EK, Ringkamp M (2019) Solutions to the technical challenges embedded in the current methods for intraoperative peripheral nerve action potential recordings. J Neurosurg:1–10.

    Google Scholar 

  53. Kwok K, Davis B, Kliot M. Resection of a benign brachial plexus nerve sheath tumor using intraoperative electrophysiological monitoring. Neurosurgery. 2007;60:316–21.

    PubMed  Google Scholar 

  54. Alon M, Rochkind S. Pre-, intra-, and postoperative electrophysiologic analysis of the recovery of old injuries of the peripheral nerve and brachial plexus after microsurgical management. J Reconstr Microsurg. 2002;18:77–82.

    Article  PubMed  Google Scholar 

  55. Selch MT, Lin K, Agazaryan N, Tenn S, Gorgulho A, DeMarco JJ, DeSalles AAF. Initial clinical experience with image-guided linear accelerator-based spinal radiosurgery for treatment of benign nerve sheath tumors. Surg Neurol. 2009;72:668–75.

    Article  PubMed  Google Scholar 

  56. Bhatnagar AK, Gerszten PC, Ozhasaglu C, Vogel WJ, Kalnicki S, Welch WC, Burton SA. CyberKnife frameless radiosurgery for the treatment of extracranial benign tumors. Technol Cancer Res Treat. 2005;4:571–6.

    Article  PubMed  Google Scholar 

  57. Shin D-W, Sohn M-J, Kim H-S, Lee D-J, Jeon SR, Hwang YJ, Jho E-H. Clinical analysis of spinal stereotactic radiosurgery in the treatment of neurogenic tumors. J Neurosurg Spine. 2015;23:429–37.

    Article  PubMed  Google Scholar 

  58. Gerszten PC, Quader M, Novotny J, Flickinger JC. Radiosurgery for benign tumors of the spine: clinical experience and current trends. Technol Cancer Res Treat. 2012;11:133–9.

    Article  PubMed  Google Scholar 

  59. Chaudhary N, Iyer A, Chang SD. Radiosurgery for benign spine tumors and vascular malformations. In: Youmans and Winn neurological surgery. 7th ed. Elsevier. p. 272, 2250–2254.e1.

    Google Scholar 

  60. Wong WW, Hirose T, Scheithauer BW, Schild SE, Gunderson LL. Malignant peripheral nerve sheath tumor: analysis of treatment outcome. Int J Radiat Oncol Biol Phys. 1998;42:351–60.

    Article  CAS  PubMed  Google Scholar 

  61. Chou D, Bilsky MH, Luzzati A, et al. Malignant peripheral nerve sheath tumors of the spine: results of surgical management from a multicenter study. J Neurosurg Spine. 2017;26:291–8.

    Article  PubMed  Google Scholar 

  62. Davis GA, Knight S. Pancoast tumor resection with preservation of brachial plexus and hand function. Neurosurg Focus. 2007;22:1–8.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Sophie Y. Su & Eric L. Zager

  2. Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands

    Martijn J. A. Malessy

  3. Department of Neurosurgery, University of California at San Francisco, San Francisco, CA, USA

    Line G. Jacques

Authors
  1. Sophie Y. Su
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  2. Martijn J. A. Malessy
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  3. Line G. Jacques
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  4. Eric L. Zager
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Corresponding author

Correspondence to Eric L. Zager .

Editor information

Editors and Affiliations

  1. WFNS Peripheral Nerve Surgery Committee Division of Neurosurgery, Department of Surgery, Gaffrée e Guinle University Hospital (HUGG) School of Medicine Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Rio de Janeiro, Brazil

    Fernando Guedes

  2. WFNS Peripheral Nerve Surgery Committee Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA

    Eric L. Zager

  3. WFNS Peripheral Nerve Surgery Committee Department of Neurosurgery, Mediclinic Parkview Hospital, Dubai, United Arab Emirates

    Debora Garozzo

  4. WFNS Peripheral Nerve Surgery Committee, Faculty of Medicine University of Belgrade, Clinic for Neurosurgery, University Clinical Center of Serbia, Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Belgrade, Serbia

    Lukas Rasulic

  5. WFNS Peripheral Nerve Surgery Committee Peripheral Nerve & Brachial Plexus Surgery Program Department of Neurosurgery, University of Buenos Aires School of Medicine, Buenos Aires, Argentina

    Mariano Socolovsky

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Su, S.Y., Malessy, M.J.A., Jacques, L.G., Zager, E.L. (2021). Management of Brachial Plexus Tumors. In: Guedes, F., Zager, E.L., Garozzo, D., Rasulic, L., Socolovsky, M. (eds) Diagnostic Assessment and Treatment of Peripheral Nerve Tumors. Springer, Cham. https://doi.org/10.1007/978-3-030-77633-6_20

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