Skip to main content

Advertisement

SpringerLink
Log in

Perineural spread to the brachial plexus: a focused review of proposed mechanisms and described pathologies

  • Review Article - Peripheral Nerves
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Perineural spread (PNS) is an emerging mechanism for progressive, non-traumatic brachial plexopathy. We aim to summarize the pathologies (tumor and infection) shown to have spread along or to the brachial plexus, and identify the proposed mechanisms of perineural spread.

Methods

A focused review of the literature was performed pertaining to pathologies with identified perineural spread to the brachial plexus.

Results

We summarized pathologies currently reported to have PNS in the brachial plexus and offer a structure for understanding and describing these pathologies with respect to their interaction with the peripheral nervous system.

Conclusions

Perineural spread is an underrepresented entity in the literature, especially regarding the brachial plexus. It can occur via a primary or secondary mechanism based on the anatomy, and understanding this mechanism helps to support biopsies of sacrificial nerve contributions, leading to more effective and timely treatment plans for patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Alsarraf LA, Shah KB, Hessel AC, Williams MD, Ginsberg LE (2016) Perineural spread along the intermediate branch of the supraclavicular nerve: a case report. Neurographics 6:16–19. https://doi.org/10.3174/ng.1160138

    Article  Google Scholar 

  2. Balink H, de Visscher JG, van der Meij EH (2014) Recurrent head and neck desmoplastic melanoma with perineural spread along the nervus mandibularis revealed by 18F-FDG PET/CT. Int J Oral Maxillofac Surg 43:941–943. https://doi.org/10.1016/j.ijom.2014.04.004

    Article  CAS  Google Scholar 

  3. Bansal M, Martin SR, Rudnicki SA, Hiatt KM, Mireles-Cabodevila E (2011) A rapidly progressing Pancoast syndrome due to pulmonary mucormycosis: a case report. J Med Case Rep 5:388. https://doi.org/10.1186/1752-1947-5-388

    Article  Google Scholar 

  4. Barnett SL, Wells MJ, Mickey B, Hatanpaa KJ (2011) Perineural extension of cutaneous desmoplastic melanoma mimicking an intracranial malignant peripheral nerve sheath tumor. Case report. J Neurosurg 115:273–277. https://doi.org/10.3171/2011.4.JNS10913

    Article  Google Scholar 

  5. Behnke NK, Crosby SN, Stutz CM, Holt GE (2013) Periscapular amputation as treatment for brachial plexopathy secondary to recurrent breast carcinoma: a case series and review of the literature. Eur J Surg Oncol 39:1325–1331. https://doi.org/10.1016/j.ejso.2013.10.005

    Article  CAS  Google Scholar 

  6. Binder DK, Smith JS, Barbaro NM (2004) Primary brachial plexus tumors: imaging, surgical, and pathological findings in 25 patients. Neurosurg Focus 16:E11. https://doi.org/10.3171/foc.2004.16.5.12

    Article  Google Scholar 

  7. Bourque PR, Warman Chardon J, Bryanton M, Toupin M, Burns BF, Torres C (2018) Neurolymphomatosis of the brachial plexus and its branches: case series and literature review. Can J Neurol Sci 45:137–143. https://doi.org/10.1017/cjn.2017.282

    Article  Google Scholar 

  8. Briani C, Visentin A, Campagnolo M, Salvalaggio A, Ferrari S, Cavallaro T, Manara R, Gasparotti R, Piazza F (2019) Peripheral nervous system involvement in lymphomas. J Peripher Nerv Syst 24:5–18. https://doi.org/10.1111/jns.12295

    Article  Google Scholar 

  9. Calabek B, Meng S, Pollanz S, Klepetko W, Hoetzenecker K, Oberndorfer F, Grisold W (2015) A case of Pancoast tumor with unusual presentation. J Brachial Plex Peripher Nerve Inj 10:e53–e56. https://doi.org/10.1055/s-0035-1551654

    Article  Google Scholar 

  10. Capek S, Amrami KK, Howe BM, Salomao DR, Dyck PJ, Spinner RJ (2015) Perineural spread of squamous cell carcinoma: from skin to skin through the brachial plexus. Clin Neurol Neurosurg 128:90–93. https://doi.org/10.1016/j.clineuro.2014.11.004

    Article  Google Scholar 

  11. Capek S, Amrami KK, Spinner RJ (2016) Gastroesophageal junction carcinoma and brachial plexopathy: An anatomic explanation via perineural spread. Clin Anat 29:800–803. https://doi.org/10.1002/ca.22708

    Article  Google Scholar 

  12. Chan YJ, Chen SL (2009) Nerve invasion by epithelial cells in benign breast diseases. J Chin Med Assoc 72:150–152. https://doi.org/10.1016/S1726-4901(09)70041-3

    Article  Google Scholar 

  13. Chang PC, Fischbein NJ, McCalmont TH, Kashani-Sabet M, Zettersten EM, Liu AY, Weissman JL (2004) Perineural spread of malignant melanoma of the head and neck: clinical and imaging features. AJNR Am J Neuroradiol 25:5–11

    Google Scholar 

  14. Choi JY, Kang CH, Kim BJ, Park KW, Yu SW (2009) Brachial plexopathy following herpes zoster infection: two cases with MRI findings. J Neurol Sci 285:224–226. https://doi.org/10.1016/j.jns.2009.05.016

    Article  Google Scholar 

  15. Cooper D (1974) Malignant mesothelioma invading the spinal canal. Postgrad Med J 50:718–723. https://doi.org/10.1136/pgmj.50.589.718

    Article  CAS  Google Scholar 

  16. Dastur DK (1983) Pathology and pathogenesis of predilective sites of nerve damage in leprous neuritis. Nerves in the arm and the face. Neurosurg Rev 6:139–152. https://doi.org/10.1007/bf01742765

    Article  CAS  Google Scholar 

  17. Davis GA, Knight S (2007) Pancoast tumor resection with preservation of brachial plexus and hand function. Neurosurg Focus 22:E15

    Google Scholar 

  18. Duraker N, Caynak ZC, Turkoz K (2006) Perineural invasion has no prognostic value in patients with invasive breast carcinoma. Breast 15:629–634. https://doi.org/10.1016/j.breast.2005.12.003

    Article  CAS  Google Scholar 

  19. El-Barrany WG, Marei AG, Vallee B (1999) Anatomic basis of vascularised nerve grafts: the blood supply of peripheral nerves. Surg Radiol Anat 21:95–102. https://doi.org/10.1007/s00276-999-0095-9

    Article  CAS  Google Scholar 

  20. Expert Panel on Neurologic I, Bykowski J, Aulino JM, Berger KL, Cassidy RC, Choudhri AF, Kendi AT, CFE K, Luttrull MD, Sharma A, Shetty VS, Than K, Winfree CJ, Cornelius RS (2017) ACR Appropriateness Criteria((R)) Plexopathy. J Am Coll Radiol 14:S225–S233. https://doi.org/10.1016/j.jacr.2017.02.002

    Article  Google Scholar 

  21. Fabian VA, Wood B, Crowley P, Kakulas BA (1997) Herpes zoster brachial plexus neuritis. Clin Neuropathol 16:61–64

    CAS  Google Scholar 

  22. Ferner RE, Gutmann DH (2002) International consensus statement on malignant peripheral nerve sheath tumors in neurofibromatosis. Cancer Res 62:1573–1577

    CAS  Google Scholar 

  23. Frey I, Le Breton C, Lefkopoulos A, Perrot N, Khalil A, Chopier J, Le Blanche A, Bigot JM (1998) Intradural extramedullary spinal canal secondary neoplasms: MR findings in 30 patients. Eur Radiol 8:1187–1192. https://doi.org/10.1007/s003300050532

    Article  CAS  Google Scholar 

  24. Frydenlund N, Leone DA, Mitchell B, Yang S, Deng A, Hoang MP, Mahalingam M (2015) Neurotrophin receptors and perineural invasion in desmoplastic melanoma. J Am Acad Dermatol 72:851–858. https://doi.org/10.1016/j.jaad.2015.01.026

    Article  CAS  Google Scholar 

  25. Ghia D, Gadkari R, Nayak C (2012) Complex regional pain syndrome secondary to leprosy. Pain Med 13:1067–1071. https://doi.org/10.1111/j.1526-4637.2012.01426.x

    Article  Google Scholar 

  26. Gilder HE, Puffer RC, Bydon M, Spinner RJ (2018) The implications of intradural extension in paraspinal malignant peripheral nerve sheath tumors: effects on central nervous system metastases and overall survival. J Neurosurg Spine 29:725–728. https://doi.org/10.3171/2018.5.SPINE18445

    Article  Google Scholar 

  27. Gwathmey KG (2018) Plexus and peripheral nerve metastasis. Handb Clin Neurol 149:257–279. https://doi.org/10.1016/B978-0-12-811161-1.00017-7

    Article  Google Scholar 

  28. Hebert-Blouin MN, Amrami KK, Loukas M, Spinner RJ (2011) A proposed anatomical explanation for perineural spread of breast adenocarcinoma to the brachial plexus. Clin Anat 24:101–105. https://doi.org/10.1002/ca.21079

    Article  Google Scholar 

  29. Ismail A, Rao DG, Sharrack B (2009) Pure motor Herpes Zoster induced brachial plexopathy. J Neurol 256:1343–1345. https://doi.org/10.1007/s00415-009-5149-8

    Article  CAS  Google Scholar 

  30. Iwamoto S, Odland PB, Piepkorn M, Bothwell M (1996) Evidence that the p75 neurotrophin receptor mediates perineural spread of desmoplastic melanoma. J Am Acad Dermatol 35:725–731. https://doi.org/10.1016/s0190-9622(96)90728-8

    Article  CAS  Google Scholar 

  31. Jack AS, Shah V, Ramey WL, Bowman C, Huie CJ, Jacques LG (2020) Brachial plexus mucormycosis secondary to perineurial spread: literature review and case report of a rare mode of infectious spread. Interdiscip Neurosurg 20. https://doi.org/10.1016/j.inat.2020.100687

  32. James AW, Shurell E, Singh A, Dry SM, Eilber FC (2016) Malignant peripheral nerve sheath tumor. Surg Oncol Clin N Am 25:789–802. https://doi.org/10.1016/j.soc.2016.05.009

    Article  Google Scholar 

  33. Jayakumar N, Ismail H, Athar S, Ashwood N (2020) Perineural invasion in intramedullary spinal cord metastasis. Ann R Coll Surg Engl:e1–e3. https://doi.org/10.1308/rcsann.2020.0009

  34. Jones LK Jr, Reda H, Watson JC (2014) Clinical, electrophysiologic, and imaging features of zoster-associated limb paresis. Muscle Nerve 50:177–185. https://doi.org/10.1002/mus.24141

    Article  Google Scholar 

  35. Kalfas F, Scudieri C (2020) Intramedullary metastasis to the cervical spinal cord from malignant pleural mesothelioma: review of the literature and case reports. Asian J Neurosurg 15:70–75. https://doi.org/10.4103/ajns.AJNS_234_18

    Article  Google Scholar 

  36. Karak SG, Quatrano N, Buckley J, Ricci A Jr (2010) Prevalence and significance of perineural invasion in invasive breast carcinoma. Conn Med 74:17–21

    Google Scholar 

  37. Kim JG, Chung SG (2016) Herpetic brachial plexopathy: application of brachial plexus magnetic resonance imaging and ultrasound-guided corticosteroid injection. Am J Phys Med Rehabil 95:e67–e71. https://doi.org/10.1097/PHM.0000000000000445

    Article  Google Scholar 

  38. 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. https://doi.org/10.3171/jns.2005.102.2.0246

    Article  Google Scholar 

  39. Kim J, Jeon JY, Choi YJ, Choi JK, Kim SB, Jung KH, Ahn JH, Kim JE, Seo S (2020) Characteristics of metastatic brachial plexopathy in patients with breast cancer. Support Care Cancer 28:1913–1918. https://doi.org/10.1007/s00520-019-04997-6

    Article  Google Scholar 

  40. Kolokythas A, Cox DP, Dekker N, Schmidt BL (2010) Nerve growth factor and tyrosine kinase A receptor in oral squamous cell carcinoma: is there an association with perineural invasion? J Oral Maxillofac Surg 68:1290–1295. https://doi.org/10.1016/j.joms.2010.01.006

    Article  Google Scholar 

  41. Kotoulas C, Psathakis K, Tsintiris K, Sampaziotis D, Karnesis L, Laoutidis G (2006) Pulmonary mucormycosis presenting as Horner’s syndrome. Asian Cardiovasc Thorac Ann 14:86–87. https://doi.org/10.1177/021849230601400123

    Article  Google Scholar 

  42. Lederman RJ, Wilbourn AJ (1984) Brachial plexopathy: recurrent cancer or radiation? Neurology 34:1331–1335. https://doi.org/10.1212/wnl.34.10.1331

    Article  CAS  Google Scholar 

  43. Levy H, Sacho H, Feldman C, Naude GE, Peskin J, Stead KJ, Kallenbach JM (1986) Pulmonary mucormycosis presenting with Horner’s syndrome. Report of a medical cure. S Afr Med J 70:363–365

    CAS  Google Scholar 

  44. Marek T, Howe BM, Amrami KK, Spinner RJ (2018) Perineural spread of nonmelanoma skin cancer to the brachial plexus: identifying anatomic pathway(s). World Neurosurg 114:e818–e823. https://doi.org/10.1016/j.wneu.2018.03.092

    Article  Google Scholar 

  45. Marek T, Laughlin RS, Howe BM, Spinner RJ (2018) Perineural spread of melanoma to the brachial plexus: identifying the anatomic pathway(s). World Neurosurg 111:e921–e926. https://doi.org/10.1016/j.wneu.2018.01.031

    Article  Google Scholar 

  46. Mizuma A, Kijima C, Nagata E, Takizawa S (2016) A case of suspected breast cancer metastasis to brachial plexus detected by magnetic resonance neurography. Case Rep Oncol 9:395–399. https://doi.org/10.1159/000447054

    Article  CAS  Google Scholar 

  47. Nalini A, Singh RJ, Saini J, Prasad C, Mahadevan A (2015) Magnetic resonance neurography identifies involvement of plexuses in leprous neuropathy. Neurol India 63:624–626. https://doi.org/10.4103/0028-3886.162102

    Article  Google Scholar 

  48. Newlin HE, Morris CG, Amdur RJ, Mendenhall WM (2005) Neurotropic melanoma of the head and neck with clinical perineural invasion. Am J Clin Oncol 28:399–402. https://doi.org/10.1097/01.coc.0000144853.76112.3d

    Article  Google Scholar 

  49. Omar AT 2nd, Villaruel AR, Khu KJO (2020) Tuberculoma of the peripheral nerve: illustrative case and systematic review of the literature. World Neurosurg 137:e547–e553. https://doi.org/10.1016/j.wneu.2020.02.031

    Article  Google Scholar 

  50. Omar AT 2nd, Villaruel AR, Khu KJO (2020) Tuberculoma of the peripheral nerve: illustrative case and systematic review of the literature. World Neurosurg. https://doi.org/10.1016/j.wneu.2020.02.031

  51. Panagopoulos N, Leivaditis V, Koletsis E, Prokakis C, Alexopoulos P, Baltayiannis N, Hatzimichalis A, Tsakiridis K, Zarogoulidis P, Zarogoulidis K, Katsikogiannis N, Kougioumtzi I, Machairiotis N, Tsiouda T, Kesisis G, Siminelakis S, Madesis A, Dougenis D (2014) Pancoast tumors: characteristics and preoperative assessment. J Thorac Dis 6(Suppl 1):S108–S115. https://doi.org/10.3978/j.issn.2072-1439.2013.12.29

    Article  Google Scholar 

  52. Paraf F, Flejou JF, Pignon JP, Fekete F, Potet F (1995) Surgical pathology of adenocarcinoma arising in Barrett’s esophagus. Analysis of 67 cases. Am J Surg Pathol 19:183–191. https://doi.org/10.1097/00000478-199502000-00007

    Article  CAS  Google Scholar 

  53. Payne R, Baccon J, Dossett J, Scollard D, Byler D, Patel A, Harbaugh K (2015) Pure neuritic leprosy presenting as ulnar nerve neuropathy: a case report of electrodiagnostic, radiographic, and histopathological findings. J Neurosurg 123:1238–1243. https://doi.org/10.3171/2014.9.JNS142210

    Article  Google Scholar 

  54. Puffer RC, Marek T, Stone JJ, Raghunathan A, Howe BM, Spinner RJ (2018) Extensive perineural spread of an intrapelvic sciatic malignant peripheral nerve sheath tumor: a case report. Acta Neurochir 160:1833–1836. https://doi.org/10.1007/s00701-018-3619-4

    Article  Google Scholar 

  55. Restrepo CE, Spinner RJ, Howe BM, Jentoft ME, Markovic SN, Lachance DH (2015) Perineural spread of malignant melanoma from the mandible to the brachial plexus: case report. J Neurosurg 122:784–790. https://doi.org/10.3171/2014.12.JNS14852

    Article  Google Scholar 

  56. Roh J, Muelleman T, Tawfik O, Thomas SM (2015) Perineural growth in head and neck squamous cell carcinoma: a review. Oral Oncol 51:16–23. https://doi.org/10.1016/j.oraloncology.2014.10.004

    Article  Google Scholar 

  57. Shamji FM, Leduc JR, Bormanis J, Sachs HJ (1988) Acute Pancoast’s syndrome caused by fungal infection. Can J Surg 31:441–443

    CAS  Google Scholar 

  58. Shibuya K, Misawa S, Hirano S, Kuwabara S (2013) Acute brachial plexopathy caused by Burkitt’s lymphoma infiltration. Intern Med 52:931. https://doi.org/10.2169/internalmedicine.52.9156

    Article  Google Scholar 

  59. Song M, Sun X, Sun R, Liu T, Li G, Liu S, Lu M, Qu W (2016) Ulnar nerve tuberculoma: a case report and literature review. J Clin Neurosci 32:130–133. https://doi.org/10.1016/j.jocn.2015.12.047

    Article  Google Scholar 

  60. Stark AM, Mehdorn HM (2013) Leptomeningeal metastasis of an intradural malignant peripheral nerve sheath tumor. J Clin Neurosci 20:1181–1183. https://doi.org/10.1016/j.jocn.2012.09.039

    Article  Google Scholar 

  61. Stark AM, Buhl R, Hugo HH, Mehdorn HM (2001) Malignant peripheral nerve sheath tumours--report of 8 cases and review of the literature. Acta Neurochir 143:357–363; discussion 363-354. https://doi.org/10.1007/s007010170090

    Article  CAS  Google Scholar 

  62. Stubblefield MD (2017) Neuromuscular complications of radiation therapy. Muscle Nerve 56:1031–1040. https://doi.org/10.1002/mus.25778

    Article  Google Scholar 

  63. Visser LH, Jain S, Lokesh B, Suneetha S, Subbanna J (2012) Morphological changes of the epineurium in leprosy: a new finding detected by high-resolution sonography. Muscle Nerve 46:38–41. https://doi.org/10.1002/mus.23269

    Article  Google Scholar 

  64. Warwar RE, Bullock JD (1998) Rhino-orbital-cerebral mucormycosis: a review. Orbit 17:237–245. https://doi.org/10.1076/orbi.17.4.237.2742

    Article  Google Scholar 

  65. White HD, White BA, Boethel C, Arroliga AC (2011) Pancoast’s syndrome secondary to infectious etiologies: a not so uncommon occurrence. Am J Med Sci 341:333–336. https://doi.org/10.1097/MAJ.0b013e3181fa2e2d

    Article  Google Scholar 

  66. Laothamatas J, Hemachudha T, Mitrabhakdi E, Wannakrairot P, Tulayadaechanont S (2003) MR imaging in human rabies. AJNR Am J Neuroradiol 24:1102–1109

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Mayo Clinic, 200 First St. SW, Gonda 8-214, Rochester, MN, 55905, USA

    Nikhil K. Murthy & Robert J. Spinner

  2. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Kimberly K. Amrami

Authors
  1. Nikhil K. Murthy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kimberly K. Amrami
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert J. Spinner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert J. Spinner.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Peripheral Nerves

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Murthy, N.K., Amrami, K.K. & Spinner, R.J. Perineural spread to the brachial plexus: a focused review of proposed mechanisms and described pathologies. Acta Neurochir 162, 3179–3187 (2020). https://doi.org/10.1007/s00701-020-04466-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-020-04466-8

Keywords

Search

Navigation