Clin Exp Otorhinolaryngol.  2020 May;13(2):203-208. 10.21053/ceo.2019.01207.

Feasibility of Brachial Plexus Schwannoma Enucleation With Intraoperative Neuromonitoring

• Lee DY
• Chi JY
• Seok J
• Han S
• Lee MH
• Jeong WJ
• Jung YH

• KMID: 2500294
• DOI: http://doi.org/10.21053/ceo.2019.01207

Abstract

Objectives
. To evaluate the feasibility of brachial plexus schwannoma enucleation under intraoperative neuromonitoring.
Methods
. Five patients who were treated for brachial plexus schwannoma under intraoperative neuromonitoring from 2008 to 2018 were included in this retrospective review. Neuromonitoring was performed with a 100-μV event threshold of the neuromonitoring system (NIM-2 or 3) at the deltoid, biceps brachii, triceps brachii, and brachioradialis muscles. Patient characteristics, tumor size and location, intraoperative neuromonitoring findings, and postoperative function were evaluated.
Results
. The intraoperative neuromonitoring findings were in accordance with the preoperative assessment of the included nerve root. Three patients had no postoperative morbidity, one patient had temporary paresthesia of the forearm for 2 months, and one patient mild loss of grip strength for 1 month.
Conclusion
. Intraoperative neuromonitoring of the arm and forearm muscles during enucleation of brachial plexus schwannoma promoted confident and successful surgery with minimal postoperative morbidity.

Keyword

Brachial Plexus; Schwannoma; Neurilemmoma; Enucleation; Neuromonitoring; Feasibility Study

Figure

• 

  Fig. 1. Schematic diagram of the muscles to be monitored, their innervation, and the locations of the tumor in five cases. The table describes the innervation of the arm and the muscles controlled by each of the nerves.

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  Fig. 2. Surgical technique. Exposure of the shoulder and arm is essential because muscle twitching can be observed during nerve stimulation (A). Neuromonitoring was performed with a two-channel (one case) or four-channel (four cases) nerve integrity monitor (NIM-2 or -3, Medtronic, Memphis, TN, USA) and a unipolar stimulating probe was used to stimulate the tumor or the nerves before identification and enucleation of the mass (B, C). After enucleation of the tumor, stimulation of the nerve was performed to confirm neural integrity (D).

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