J Korean Neurosurg Soc.  2012 Aug;52(2):138-143. 10.3340/jkns.2012.52.2.138.

Brachial Plexus Tumors in a Consecutive Series of Twenty One Patients

• Go MH
• Kim SH
• Cho KH

• KMID: 2190553
• DOI: http://doi.org/10.3340/jkns.2012.52.2.138

Abstract

OBJECTIVE
This is a retrospective review of 22 surgically treated benign and malignant tumors of brachial plexus region to describe clinical presentation, the characteristics of brachial plexus tumor and clinical outcomes with a literature review.
METHODS
Twenty-one patients with consecutive 22 surgeries for primary brachial plexus tumors were enrolled between February 2002 and November 2011 were included in this study. The medical records of all patients were reviewed.
RESULTS
Eleven male and 10 female patients were enrolled. Mean age was 39 years. Three patients had brachial plexus tumor associated with neurofibromatosis (13.6%). Presenting signs and symptoms included parenthesis and numbness (54.5%), radiating pain (22.7%), direct tenderness and pain (27.2%), palpable mass (77.3%). Twelve patients presented preoperative sensory deficit (54.5%) and 9 patients presented preoperative motor deficit (40.9%). Twenty tumors (90.9%) were benign and 2 tumors (9.1%) were malignant. Benign tumors included 15 schwannomas (68.2%), 4 neurofibromas (18.2%) and 1 granular cell tumor (4.5%). There were 1 malignant peripheral nerve sheath tumor (MPNST) and 1 malignant granular cell tumor. Gross total resection was achieved in 16 patients (72.7%), including all schwannomas, 1 neurofibroma. Subtotal resection was performed in 6 tumors (27.3%), including 3 neurofibromatosis associated with brachial plexus neurofibromas, 1 MPNST and 2 granular cell tumor in one patient.
CONCLUSION
Resection of tumor is the choice of tumor in the most of benign and malignant brachial plexus tumors. Postoperative outcomes are related to grade of resection at surgery and pathological features of tumor.

Keyword

Brachial plexus tumor; Nerve sheath tumor; Schwannoma; Neurofibroma; Granular cell tumor

MeSH Terms

Brachial Plexus
Female
Granular Cell Tumor
Humans
Hypesthesia
Male
Medical Records
Nerve Sheath Neoplasms
Neurilemmoma
Neurofibroma
Neurofibromatoses
Peripheral Nerves
Retrospective Studies

Figure

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  Fig. 1 Coronal T1-weighted SE image showing a small schwannoma arising from a trunk of the left brachial plexus. The lesion is isointense to muscle.

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  Fig. 2 Axial T2-weighted FSE image showing a large schwannoma arising from the left brachial plexus in a patient with schwannoma. The lesion is hyperintense and displays the typical "target sign" that characterizes a benign nerve sheath tumor.

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  Fig. 3 Axial T1-weighted SE image of a patient with a schwannoma arising from the left brachial plexus. Pre-contrast image (A) shows the lesion to be homogeneous and isointense to muscle. Following gadolinium administration (B), the tumor shows inhomogeneous enhancement.

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  Fig. 4 A 44-year-old female patient presented with left shoulder pain and weakness of left arm. Initial MRI (A and B) revealed brachial plexus tumor on left side which was oval and well delineated. Pathology had been a benign granular cell tumor at the first surgery and was transformed into malignant granular cell tumor (C and D) in 17 months later after surgery.

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