Schwannoma in the extremity: clinical features and microscopic intra-capsular enucleation

Keiichi MURAMATSU; Yasuhiro TANI; Tetsuya SETO; Ryuta IWANAGA; Atsushi MIHARA; Koichiro IHARA; Takashi SAKAI

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Schwannoma in the extremity: clinical features and microscopic intra-capsular enucleation

VernacularTitle:Schwannoma in the extremity: clinical features and microscopic intra-capsular enucleation
Author: Keiichi MURAMATSU ¹ ; Yasuhiro TANI ² ; Tetsuya SETO ¹ ; Ryuta IWANAGA ¹ ; Atsushi MIHARA ² ; Koichiro IHARA ² ; Takashi SAKAI ³
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1. Department of Hand and Microsurgery, Nagato General Hospital, Japan
2. Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Japan
3. Department of Orthopedic Surgery, Kanmon Medical Center, Japan
Keywords: Schwannoma; peripheral nerve; extremity; enucleation; microsurgery
From:Journal of Rural Medicine 2021;16(4):184-190
CountryJapan
Language:English
Abstract: Objective: Schwannomas are the most common type of neoplasm of the peripheral nerves. Enucleation is a standard surgical procedure; however, it occasionally results in iatrogenic nerve injury, even with atraumatic procedures. Herein, we present the clinical characteristics of schwannoma arising in the extremities and discuss the clinical outcomes of extra- and intra-capsular enucleation.Patients and Methods: We reviewed 122 schwannomas treated at our institute. Schwannomas arising from the minor nerve (n=30) or intramuscularly (n=15) were operated using the extra-capsular technique. Of the 77 major nerve schwannomas, 62 schwannomas were treated using the intra-capsular technique and 15 schwannomas using the extra-capsular technique.Results: Neurological deficits following enucleation were significantly lower using the intra-capsular technique than with the extra-capsular technique. The patient age, duration of symptoms, maximum tumor diameter, and site of occurrence were not associated with subsequent neurological deficits. With both techniques, no tumor recurrence was observed at the final follow-up.Conclusion: These results support the use of intra-capsular micro-enucleation as a safe and reliable treatment for every type of schwannoma. To minimize the risk of nerve injury, en bloc resection should not be used because the main purpose of schwannoma surgery is the relief of symptoms, not tumor resection.