Skip to main content

Advertisement

SpringerLink
Log in

Brachial plexus tumors extending into the cervicothoracic spine: a review with operative nuances and outcomes

  • Review Article
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Background

The rarity and anatomical complexity of brachial plexus tumors (BPTs) impose many challenges onto surgeons performing surgical resections, especially when these tumors invade the cervicothoracic spine. Treatment choices and surgery outcomes heavily depend on anatomical location and tumor type.

Methods

The authors performed an extensive review of the published literature (PubMed) focusing on “brachial plexus tumors” that identified invasion of the cervicothoracic spine.

Results

The search yielded 2774 articles pertaining to “brachial plexus tumors”. Articles not in the English language or involving cervicothoracic spinal invasion were excluded.

Conclusions

Recent research has shown that the most common method used to resect tumors of the proximal roots is the dorsal subscapular approach. Despite its association with high morbidity rate, this technique offers excellent exposure to the spinal roots and intraforaminal portion of the spinal nerve. The dorsal approach is used to resect recurrent lower trunk tumors and dumbbell-shaped neurofibromas, yet it is also the least common overall approach used in brachial plexus tumor resections. The ventral or anterior technique is commonly used to resect tumors at the cord to division level, and root to trunk level. Motor complications, transient nerve palsy, and bleeding are among the most common complications of the anterior supraclavicular approach. Further controlled studies are needed to fully determine the optimal surgical approach used to obtain the best outcomes and least complications for each type of brachial plexus tumor.

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

Similar content being viewed by others

References

  1. Binder DK, Smith JS, Barbaro NM. Primary brachial plexus tumors: imaging, surgical, and pathological findings in 25 patients. Neurosurg Focus. 2004;16:1–6. https://doi.org/10.3171/foc.2004.16.5.12.

    Article  Google Scholar 

  2. 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:E7. https://doi.org/10.3171/2016.12.FOCUS16470.

    Article  PubMed  Google Scholar 

  3. Das S, Ganju A, Tiel RL, Kline DG. Tumors of the brachial plexus. Neurosurg Focus. 2007;22:1–6. https://doi.org/10.3171/foc.2007.22.6.27.

    Article  Google Scholar 

  4. Desai KI. Primary benign brachial plexus tumors. Neurosurgery. 2012;70:220–33. https://doi.org/10.1227/NEU.0b013e31822d276a.

    Article  PubMed  Google Scholar 

  5. Dubuisson AS, Kline DG, Weinshel SS. Posterior subscapular approach to the brachial plexus. J Neurosurg. 1993;79:319–30. https://doi.org/10.3171/jns.1993.79.3.0319.

    Article  CAS  PubMed  Google Scholar 

  6. Ganju A, Roosen N, Kline DG, Tiel RL. Outcomes in a consecutive series of 111 surgically treated plexal tumors: a review of the experience at the Louisiana State University Health Sciences Center. J Neurosurg. 2001;95:51–60. https://doi.org/10.3171/jns.2001.95.1.0051.

    Article  CAS  PubMed  Google Scholar 

  7. Garcia CA, Kline DG, Lusk MD. Tumors of the brachial plexus. Neurosurgery. 1987;21:439–53. https://doi.org/10.1227/00006123-198710000-00001.

    Article  PubMed  Google Scholar 

  8. Go MH, Kim SH, Cho KH. Brachial plexus tumors in a consecutive series of twenty one patients. J Korean Neurosurg Soc. 2012. https://doi.org/10.3340/jkns.2012.52.2.138.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Graf A, Yang K, King D, Dzwierzynski W, Sanger J, Hettinger P. Lipomas of the brachial plexus: a case series and review of the literature. Hand. 2017;14:333–8. https://doi.org/10.1177/1558944717735946.

    Article  PubMed  Google Scholar 

  10. Gwathmey KG. Plexus and peripheral nerve metastasis. Handbook of clinical neurology, vol. 149. Amsterdam: Elsevier; 2018. https://doi.org/10.1016/B978-0-12-811161-1.00017-7.

    Book  Google Scholar 

  11. Huang JH, Samadani U, Zager EL. Brachial plexus region tumors: a review of their history, classification, surgical management, and outcomes. Neurosurg Q. 2003;13:151–61. https://doi.org/10.1097/00013414-200309000-00001.

    Article  Google Scholar 

  12. Huang JH, Zaghloul K, Zager EL. Surgical management of brachial plexus region tumors. Surg Neurol. 2004;61:372–8. https://doi.org/10.1016/j.surneu.2003.08.006.

    Article  PubMed  Google Scholar 

  13. Jaeckle KA. Nerve plexus metastases. Neurol Clin. 1991;9:857–66.

    Article  CAS  Google Scholar 

  14. Jaeckle KA. Neurologic manifestations of neoplastic and radiation-induced plexopathies. Semin Neurol. 2010. https://doi.org/10.1055/s-0030-1255219.

    Article  PubMed  Google Scholar 

  15. Jia X, Yang J, Chen L, Yu C, Kondo T. Primary brachial plexus tumors: clinical experiences of 143 cases. Clin Neurol Neurosurg. 2016;148:91–5. https://doi.org/10.1016/j.clineuro.2016.07.009.

    Article  PubMed  Google Scholar 

  16. Jung IH, Yoon KW, Kim YJ, 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. https://doi.org/10.3340/jkns.2018.0045.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kim DH, Cho Y-J, Tiel RL, Kline DG. Outcomes of surgery in 1019 brachial plexus lesions treated at Louisiana State University Health Sciences Center. J Neurosurg. 2003;98:1005–16. https://doi.org/10.3171/jns.2003.98.5.1005.

    Article  PubMed  Google Scholar 

  18. Kim DH, Murovic JA, Tiel RL, Moes G, Kline DG. A series of 397 peripheral neural sheath tumors: 30-year experience at Louisiana State University Health Sciences Center. J Neurosurg. 2005;102:246–55. https://doi.org/10.3171/jns.2005.102.2.0246.

    Article  PubMed  Google Scholar 

  19. Kimura M, Kamata Y, Matsumoto K, Takaya H. Electron microscopical study on the tumor of von Recklinghausen’s neurofibromatosis. Acta Pathol Jpn. 1974;24:79–91. https://doi.org/10.1111/j.1440-1827.1974.tb00809.x.

    Article  CAS  PubMed  Google Scholar 

  20. Kindl RP, Patel K, Trivedi RA. Supraclavicular brachial plexus approach for excision of C8 nerve root schwannoma: 3-dimensional operative video. Oper Neurosurg (Hagerstown). 2019;16:634–5. https://doi.org/10.1093/ons/opy209.

    Article  Google Scholar 

  21. Kindl RP, Patel K, Trivedi RA. Supraclavicular brachial plexus approach for excision of C8 nerve root schwannoma: 3-dimensional operative video. Oper Neurosurg. 2019;16:634–5. https://doi.org/10.1093/ons/opy209.

    Article  Google Scholar 

  22. Kline D, Hudson A, Tiel R, Guha A. Management of peripheral nerve tumors. In: Winn H, Winn H, editors. Youmans neurological surgery, 4-volume set. 6th ed. Philadelphia: Saunders; 2011. p. 4960.

    Google Scholar 

  23. Kline DG, Donner TR, Happel L, Smith B, Richter HP. Intraforaminal repair of plexus spinal nerves by a posterior approach: an experimental study. J Neurosurg. 1992;76:459–70. https://doi.org/10.3171/jns.1992.76.3.0459.

    Article  CAS  PubMed  Google Scholar 

  24. Kline DG, Judice DJ. Operative management of selected brachial plexus lesions. J Neurosurg. 1983;58:631–49. https://doi.org/10.3171/jns.1983.58.5.0631.

    Article  CAS  PubMed  Google Scholar 

  25. Koga T, Iwasaki H, Ishiguro M, Matsuzaki A, Kikuchi M. Frequent genomic imbalances in chromosomes 17, 19, and 22q in peripheral nerve sheath tumours detected by comparative genomic hybridization analysis. J Pathol. 2002;197:98–107. https://doi.org/10.1002/path.1101.

    Article  CAS  PubMed  Google Scholar 

  26. Kori SH, Foley KM, Posner JB. Brachial plexus lesions in patients with cancer: 100 cases. Neurology. 1981;31:45–50. https://doi.org/10.1212/wnl.31.1.45.

    Article  CAS  PubMed  Google Scholar 

  27. Lee HJ, Kim JH, Rhee SH, Gong HS, Baek GH. Is surgery for brachial plexus schwannomas safe and effective? Clin Orthop Relat Res. 2014;472:1893–8. https://doi.org/10.1007/s11999-014-3525-x.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Lee HJ, Kim JH, Rhee SH, Gong HS, Baek GH. Is surgery for brachial plexus schwannomas safe and effective? Clin Orthop Relat Res®. 2014;472:1893–8. https://doi.org/10.1007/s11999-014-3525-x.

    Article  Google Scholar 

  29. Lee MH, Park HK, Park HR, Park SQ, Chang JC, Cho SJ. Brachial plexus neurofibroma: a case report. Nerve. 2020;6:12–4. https://doi.org/10.21129/nerve.2020.6.1.12.

    Article  Google Scholar 

  30. Lutz AM, Gold G, Beaulieu C. MR imaging of the brachial plexus. Neuroimaging Clin N Am. 2014;24:91–108. https://doi.org/10.1016/j.nic.2013.03.024.

    Article  PubMed  Google Scholar 

  31. Lwu S, Midha R. Clinical examination of brachial and pelvic plexus tumors. Neurosurg Focus. 2007;22:E5. https://doi.org/10.3171/foc.2007.22.6.6.

    Article  PubMed  Google Scholar 

  32. Murovic JA, Charles Cho S, Park J. Surgical strategies for managing foraminal nerve sheath tumors: the emerging role of CyberKnife ablation. Eur Spine J. 2010;19:242–56. https://doi.org/10.1007/s00586-009-1160-0.

    Article  PubMed  Google Scholar 

  33. Richardson RR, Siqueira EB, Oi S, Nunez C. Neurogenic tumors of the brachial plexus. Neurosurgery. 1979;4:66–70. https://doi.org/10.1227/00006123-197901000-00014.

    Article  CAS  PubMed  Google Scholar 

  34. Rosario MS, Yamamoto N, Hayashi K, Takeuchi A, Miwa S, Inatani H, Higuchi T, Tsuchiya H. A case of infected schwannoma mimicking malignant tumor. World J Surg Oncol. 2016. https://doi.org/10.1186/s12957-016-1058-3.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Saifuddin A. Imaging tumours of the brachial plexus. Skelet Radiol. 2003;32:375–87. https://doi.org/10.1007/s00256-003-0618-0.

    Article  Google Scholar 

  36. 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. https://doi.org/10.1007/s00701-009-0380-8.

    Article  CAS  PubMed  Google Scholar 

  37. Tender GC, Kline DG. Anterior supraclavicular approach to the brachial plexus. Neurosurgery. 2006. https://doi.org/10.1227/01.NEU.0000209027.52848.A3 ((discussion ONS-364–365)).

    Article  PubMed  Google Scholar 

  38. Tschoe C, Holsapple JW, Binello E. Resection of primary brachial plexus tumor via a modified supraclavicular approach. J Neurol Surg Rep. 2014;75:133–5. https://doi.org/10.1055/s-0034-1376423.

    Article  Google Scholar 

  39. Vucemilo L, Lajtman Z, Mihalj J, Plascak J, Mahovic Lakusic D, Muzinic D. Brachial plexus schwannoma—case report and literature review. Acta Clin Croat. 2018;57:366–71. https://doi.org/10.20471/acc.2018.57.02.19.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

The authors have not received any funding for this work from any organization.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Desert Regional Medical Center, 1150 N. Indian Canyon Drive, Palm Springs, CA, 92262, USA

    B. Fiani

  2. University of California Riverside School of Medicine, 92521 Ucr Botanic Gardens Rd, Riverside, CA, 92507, USA

    M. H. El-Farra, A. Dahan, P. Endres, T. Taka & L. Delgado

Authors
  1. B. Fiani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. H. El-Farra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Dahan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Endres
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. Taka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L. Delgado
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Fiani.

Ethics declarations

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Additional information

Publisher's Note

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fiani, B., El-Farra, M.H., Dahan, A. et al. Brachial plexus tumors extending into the cervicothoracic spine: a review with operative nuances and outcomes. Clin Transl Oncol 23, 1263–1271 (2021). https://doi.org/10.1007/s12094-020-02549-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12094-020-02549-7

Keywords

Search

Navigation