title: Brachial plexus reconstruction following resection of a malignant peripheral nerve sheath tumor: case report.
abstract: BACKGROUND
  The main therapeutic approach for malignant peripheral nerve sheath tumors (MPNSTs) of the brachial plexus is wide local excision. Sacrifice of some--occasionally all--elements of the brachial plexus often is required to obtain complete resection, and therefore can be associated with significant morbidity. While peripheral nerve repair is commonly used in the setting of traumatic nerve injury, little is known about its potential use in the treatment of MPNST.
  
  
  METHODS
  We present a patient with an enlarging right neck mass who was diagnosed with MPNST of the brachial plexus. The patient underwent gross total resection of the tumor, requiring sectioning of the upper trunk of the brachial plexus, as well as associated divisions. Following resection, sural nerve grafts were used to connect the C5 nerve root to the anterior division of the upper trunk and the spinal accessory nerve to the suprascapular nerve, whereas a triceps branch of the radial nerve was coapted directly to the anterior division of the axillary nerve.
  
  
  CONCLUSIONS
  By 20 months after surgery, the patient had regained significant strength in her upper trunk distribution and demonstrated no evidence of tumor recurrence. Brachial plexus reconstruction offers a potentially valuable surgical adjunct to MPNST treatment.
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spiliopoulos
authors.forename: Ziv
authors.initials: Z
authors.lastname: Williams
mesh_terms: D000328:Adult; D001917:Brachial Plexus / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D018317:Nerve Sheath Neoplasms / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D010524:Peripheral Nervous System Neoplasms / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*