SURGICAL EXCISION WITH PRESERVATION OF PARENT NERVE IN BENIGN SOLITARY LIMB SCHWANNOMAS – REPORT OF OUTCOME OF 16 CASES

Abstract

Introduction: Limb schwannomas are benign nerve sheath tumours. They typically present with a cystic swelling or palpable lump. They may also present with symptoms relating to the affected nerve. If the lesion is solitary there is no malignant potential. Clinically the lump will be freely mobile except in the plane of the longitudinal course of the nerve and may have a positive Tinnel’s test. Magnetic resonance imaging or ultrasound scanning are key adjuncts to diagnosis. Treatment is excision of the lump by incising the epineurium, “shelling out” the lesion and preserving unaffected nerve fascicles. We present a case series from a regional soft tissue tumour centre that shows the excellent outcome that can be achieved with these methods.

Methods: We retrospectively analysed the case notes of 16 cases of schwannoma who had surgical excision and preservation of the parent nerve. Our outcome measures were resolution of symptoms, post-operative neurological function and recurrence.

Results: Of 16 patients, 12 had no neurological deficit. 1 had motor weakness (foot drop) and 1 had residual par-aesthesia post-operatively. 2 patients declined surgery. In addition, 2 patients had persistent pain post-operatively, but at reduced levels to their pre-operative pain. There were no cases of recurrence.

Discussion: The diagnosis of schwannoma should be considered in patients with a lump associated with neurological symptoms. Following confirmation of diagnosis with appropriate radiology, surgical excision should be carried out as detailed above to minimise morbidity. This should be performed by a surgeon skilled in dealing with soft tissue tumours.