title: Surgical outcome of schwannomas arising from major peripheral nerves in the lower limb.
abstract: OBJECTIVE
  The treatment of symptomatic Schwannoma is surgical excision. However, in the case of major peripheral nerves with motor function, there are concerns including neurological complications following surgery. This study was designed to evaluate the surgical outcome of Schwannomas originating from major peripheral nerves of the lower limb. Additionally, we sought to find out the predictable factors for permanent neurological deficits.
  
  
  METHODS
  Between 2004 and 2008, 30 consecutive Schwannomas underwent simple excision or enucleation. Surgical outcomes after excision were evaluated with an emphasis on neurological deficits and recurrence. Neurological complications were classified as major or minor neurological deficits and evaluated immediately after surgery and at final follow-up. Risk factors for development of neurological deficits were identified.
  
  
  RESULTS
  Twenty-three patients (23/30, 76.7 %) developed neurological deficits immediately after surgery. After a mean of 58.8 months (32-79 months), 19 patients (19/30, 63.3 %) showed no residual neurological deficits. Among the remaining 11 (11/30, 36.7 %), nine patients had tolerable symptoms and two patients had major neurological deficits including significant motor weakness and sensory impairments. Larger tumours tended to be at greater risk of neurological deficit after surgery. One recurrence of the tumour was seen two years after surgery. There were no cases of reoperation or malignant transformation
  
  
  CONCLUSIONS
  In the majority of cases, Schwannomas in the lower limb can be excised with acceptable risk for neurological deficits. However, meticulous dissection is required in large-sized Schwannomas because these tumours seem to have a higher frequency of fascicular injury during dissection.
authors.affiliation: Department of Orthopaedic Surgery, Yangsan Hospital, Pusan National University School of Medicine, Beomeo-ri, Mulgeum-eup, Yangsan, 626-770, Korea.
authors.forename: Sang-Min
authors.initials: SM
authors.lastname: Kim
authors.forename: Sung-Wook
authors.initials: SW
authors.lastname: Seo
authors.forename: Jun-Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Ki-Sun
authors.initials: KS
authors.lastname: Sung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D035002:Lower Extremity / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology; D009442:Neurilemmoma / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D010524:Peripheral Nervous System Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome