Neurologic Deficits after Surgical Enucleation of Schwannoma in the Upper Extremity.
10.12790/jkssh.2017.22.1.41
- Author:
Jin Woo KANG
1
;
Yong Suk LEE
;
Chulkyu KIM
;
Seung Han SHIN
;
Yang Guk CHUNG
Author Information
1. Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. ygchung@catholic.ac.kr
- Publication Type:Original Article
- Keywords:
Schwannoma;
Neurologic deficit;
Enucleation;
Upper extremity
- MeSH:
Anesthesia;
Counseling;
Follow-Up Studies;
Humans;
Hypesthesia;
Incidence;
Neuralgia;
Neurilemmoma*;
Neurologic Manifestations*;
Paresthesia;
Retrospective Studies;
Upper Extremity*
- From:Journal of the Korean Society for Surgery of the Hand
2017;22(1):41-48
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Neurologic deficits after enucleation of schwannoma are not rare. To evaluate the neurologic deficits after surgical enucleation of schwannoma in the upper extremity, we performed a retrospective review of patients with surgically treated schwannoma over a 14-year period at a single institution. METHODS: Between March 2001 and September 2014, 103 patients underwent surgical enucleation for schwannomas; 36 patients of them had lesions in the upper extremity, and 2 out of 36 patients had multiple schwannomas. Each operation was performed by a single surgeon under loupe magnification. The postoperative neurological deficits were graded as major and minor in both immediate postoperatively and at last follow-up. The major deficit was defined as anesthesia or marked hypoesthesia, motor weakness of grade 3 or less and neuropathic pain. Minor deficit was defined as mild symptoms of mild hypoesthesia, paresthesia and motor weakness of grade 4 or more. RESULTS: There were 2 major (2 mixed nerve) and 12 minor (4 motor, 7 sensory, 1 mixed nerve) neurologic deficits after surgery. At the last follow-up, one major mixed neurologic deficit remained as major motor and minor sensory, and other major ones changed to mixed minor. And all minor deficits except 1 sensory deficit were recovered spontaneously. CONCLUSION: Even though high incidence rate of neurologic deficit after enucleation of schwannoma in the upper extremity (38.9%), about three fourths of them were recovered spontaneously. There were 3 permanent neurologic deficits, and one of them was major one. In some cases, surgeon cannot avoid to encounter a neurological deficit. So we recommend more delicate microscopic surgical procedure and preoperative planning and counseling. And surgery is indicated for only symptomatic lesions.
