[Schwannomas of the peripheral nerve in the hand and the upper limb: Analysis of 14 cases].
The Schwannomas are usually considered as enucleable lesions of which the excision under microscope doesn't entail a post-operative deficit. Having frequently observed the inclusion of fascicle in the tumor, we wanted to verify the absence of deficit in a retrospective survey. Our survey is composed of 14 patients operated of schwannoma of the superior member and whose mean age is 53 years old. All patients presented an average of nine months old palpable mass; the pain was present in four cases; paresthesiae in seven cases; irritatif syndrome in ten cases. A preoperative sensory deficit was present in two patients but without any case of preoperative motor deficit. The schwannoma was localized in eight cases in the hand, one case in the forearm, two cases in the elbow, two cases in the arm and one case in the armpit. The affected nerves were the digital ones in six cases, the main trunk of the median nerve in four cases, the trunk of the ulnaire nerve in three cases and the sensory branch of the radial nerve in one case. All tumors have been operated under a microscope. The enucleation was possible without fascicle lesion in six cases. In the eight other cases we have proceeded to a resection of indissociable fascicles. The diagnosis is confirmed by the histologycal examination in all cases. In postoperative, the two patients that presented a preoperative sensory deficit no longer presented it. On the contrary, three patients that didn't have any preoperative deficit presented each a post-operative sensory deficit with in addition a motor trouble in one of cases. We conclude from this survey that there is a risk of peroperative fascicle lesion even when using the microscope. This information is important to consider in the setting of deciding how to proceed before the excision of this benign lesion.
Akambi Sanoussi
K
K
Service de chirurgie du membre supérieure, clinique la Francilienne, 16, avenue de Hôtel de ville, 77340 Pontault-Combhault, France. a.a.kassoum@caramail.com
Dubert
T
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm; D005260:Female; D006225:Hand; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000473:pathology; D008853:Microscopy; D008875:Middle Aged; D009442:Neurilemmoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D010524:Peripheral Nervous System Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications; D011826:Radial Nerve / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014459:Ulnar Nerve / Q000473:pathology