title: Is surgery for brachial plexus schwannomas safe and effective?
abstract: BACKGROUND
  Schwannomas rarely are found in the brachial plexus, and although they are benign, they present significant challenges to surgical treatment. To our knowledge, there are few studies investigating the surgical outcomes of patients with brachial plexus tumors.
  
  
  OBJECTIVE
  We analyzed the outcomes of 19 patients with brachial plexus schwannomas and asked: (1) How do these patients present? (2) Where are the tumors located in the brachial plexus? (3) What are the complications and neurologic results of patients after excision of the tumor?
  
  
  METHODS
  From February 2002 to August 2012, one orthopaedic hand surgeon treated 19 patients with schwannomas of the brachial plexus. We retrospectively reviewed the medical records and MRI data of all patients. There were 11 women and eight men, with a mean age of 50.2 years (range, 32-63 years). The tumor was located on the right side in eight patients and on the left in 11 patients. We evaluated neurologic deficits preoperatively and neurologic deficits and local recurrence of tumors postoperatively. Minimum followup was 12 months (mean, 37.2 months; range, 12-90 months).
  
  
  RESULTS
  The most common initial presentation was a palpable mass. The masses were located at all levels along the brachial plexus, including the root, trunk, cord, and terminal branches. The smallest mass was 1.5 × 1.5 × 0.5 cm and the largest was 11 × 10 × 6 cm. Fourteen of the 19 patients did not have any postoperative neurologic deficits. All the removed masses were proven histologically to be schwannomas. Of the five patients who had postoperative neurologic deficits, three had transient sensory deficits, one had weakness of the flexor pollicis longus and second flexor digitorum profundus, and another had weakness of the extensor pollicis longus. No recurrence was observed during the followup period.
  
  
  CONCLUSIONS
  Schwannomas of the brachial plexus are a potentially curable lesion with an acceptable surgical risk of injury to neurovascular structures. With precise surgical techniques, these tumors can be removed to improve symptoms with minimal morbidity.
  
  
  METHODS
  Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
authors.forename: Hyuk Jin
authors.initials: HJ
authors.lastname: Lee
authors.forename: Jeong Hwan
authors.initials: JH
authors.lastname: Kim
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Rhee
authors.forename: Hyun Sik
authors.initials: HS
authors.lastname: Gong
authors.forename: Goo Hyun
authors.initials: GH
authors.lastname: Baek
mesh_terms: D000328:Adult; D001917:Brachial Plexus / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009442:Neurilemmoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D019637:Orthopedic Procedures / Q000009:adverse effects; D010524:Peripheral Nervous System Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome