Diagnostic steps, imaging, and electrophysiology.
The patient with a peripheral nerve tumor can present with a variety of signs and symptoms, including pain, motor weakness, sensory deficit, a palpable mass, and even as an asymptomatic incidental finding. Although most tumors that arise from nerve are solitary tumors associated with a single nerve, they may also be associated with global diseases, such as neurofibromatosis type I (von Recklinghausen's), in which case, there maybe multiple masses involving several nerves. Most peripheral nerve tumors are histologically benign; however, they may experience malignant degeneration, especially in the setting of neurofibromatosis. Treatment in the form of gross total surgical removal is therefore indicated in most nerve tumors for histologic diagnosis as well as for relief of symptoms. The goals of the initial diagnostic steps, imaging and electrophysiology, are to determine baseline clinical neurologic function, define anatomic location and extent of the tumor, and record baseline electromyographic parameters. Once these elements are defined, the surgeon may proceed to the operating room with a level of confidence as to how to approach the lesion and remove it safely. Biopsy of peripheral nerve tumors is to be discouraged over gross total removal, and this can be avoided by proper preoperative diagnostic workup.
Maniker
Allen H
AH
Department of Neurosurgery, New Jersey Medical School, Doctors Office Center, 90 Bergen Street, 8th Floor, Newark, NJ 07103, USA. maniker@umdnj.edu
D004576:Electromyography; D006801:Humans; D008279:Magnetic Resonance Imaging; D010524:Peripheral Nervous System Neoplasms / Q000473:pathology* / Q000503:physiopathology*