Abstract
Aim: To review a series of 30 tumours affecting the Brachial plexus for the purposes of analysing the presentation, pathology, indication, surgical approach and outcome of these tumours. We describe a modification of an approach to such tumours.
Method: A personal series of 30 cases of tumours affecting the Brachial Plexus were identified, and their notes reviewed. 30 patients with a slight predominance of females, and an average age of 43 were reviewed. The presenting complaints (in order of decreasing frequency) were mass, pain, motor dysfunction, sensory dysfunction and Horner’s syndrome. Previous operation was common. There was significant past history of neurofibromatosis, radiotherapy and other malignancy.
The supra-clavicular approach was most commonly used, however infra-clavicular, trans-clavicular, trans-manubrial, trans-thoracic, axillary and combined approaches were all used when necessary. A modification of the trans-manubrial approach is described preserving the continuity of the clavicle.
The histology of the tumours was extremely varied, with half being benign and half malignant. The incidence of marginal and incomplete excision was higher then other tumour sites, due presumably to the proximity of vital structures.
Post-operatively there was good resolution of pain and recovery of motor dysfunction, but poor recovery of sensory loss and Horner’s syndrome. At follow up most were alive, 5 had lung metastases, 3 local recurrence, 4 metastases else where and 5 dead of their disease.
Conclusion: Tumours affecting the Brachial plexus are rare. Only 3 previous series have been published. The adjacent structures and the morbidity complicate tumour clearance, however, outcomes suggest that excision is worthwhile.
Correspondence should be addressed to BOOS at the Royal College of Surgeons, 35 - 43 Lincoln’s Inn Fields, London WC2A 3PN
