title: Hemangiomas of the brachial plexus: a case series.
abstract: OBJECTIVE
  Hemangiomas of the brachial plexus are very rare, and there has not been a collection of multiple cases published in the literature to date. Extraneural brachial plexus hemangiomas typically present with similar signs and symptoms as nerve sheath tumors, including pain, paresthesia, and occasionally weakness, in addition to nonspecific imaging findings, making their diagnosis difficult. Exploratory surgery can lead to significant bleeding and nerve injury when a hemangioma or an associated aneurysm is encountered intraoperatively. We present 5 cases of extraneural hemangiomas causing brachial plexopathy, including pre-, intra-, and postoperative decision making, with an emphasis on diagnostic and management issues as well as outcomes.
  
  
  METHODS
  A retrospective review was performed of 5 patients who underwent surgery at a university teaching hospital between 1995 and 2007 for exploration of brachial plexus lesions that were confirmed to be hemangiomas at pathological examination.
  
  
  RESULTS
  All 5 patients presented with findings on history, physical examination, imaging, and electromyography suggesting a diagnosis of nerve sheath tumor. Two patients had biopsies (1 needle, 1 open), both of which were nondiagnostic. Three patients underwent digital subtraction angiography with successful preoperative embolization. Each patient had a complete or a radical subtotal tumor resection, and all were intact neurologically after surgical resection. Pathological evaluation identified 3 venous hemangiomas, 1 hemangioma with arteriovenous malformation features, and 1 Masson hemangioma associated with a large aneurysm.
  
  
  CONCLUSIONS
  Extraneural hemangiomas of the brachial plexus are very rare, but a high index of suspicion and appropriate preoperative evaluation, including angiography with the option for embolization, can result in decreased intraoperative hemorrhage and better patient outcomes.
authors.affiliation: Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. nathan.ranalli@uphs.upenn.edu
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: Ranalli
authors.forename: Jason H
authors.initials: JH
authors.lastname: Huang
authors.forename: Edward B
authors.initials: EB
authors.lastname: Lee
authors.forename: Paul J L
authors.initials: PJ
authors.lastname: Zhang
authors.forename: Evan S
authors.initials: ES
authors.lastname: Siegelman
authors.forename: Eric L
authors.initials: EL
authors.lastname: Zager
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D001706:Biopsy; D001917:Brachial Plexus / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D020516:Brachial Plexus Neuropathies / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D004576:Electromyography; D004621:Embolization, Therapeutic; D005260:Female; D006391:Hemangioma / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D018317:Nerve Sheath Neoplasms / Q000175:diagnosis; D019635:Neurosurgical Procedures / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult