Microsurgical Enucleation of Brachial Plexus Schwannoma

顯微鏡輔助手術下剝除臂叢神經鞘瘤

Yu-Yu Chou(周余諭) ； Dun-Wei Huang(黃惇暐) ； Ting-hsuan Liu(劉庭軒) ； Sheng-lin Tsai(蔡昇霖) ； Chien Wei Wu(吳建緯) ； Chih-Chun Hou(侯智鈞) ； Chun-Kai Chang(張鈞凱) ； Yuan-Sheng Tzeng(曾元生) ； Shyi-Gen Chen(陳錫根)

《臺灣整形外科醫學會雜誌》 31卷4期 (2022/12) Pp. 271-280

摘要

Background: Schwannoma is a benign neuroma composed of Schwann cells and is classified as a peripheral nerve sheath tumor. Schwannomas usually present as a local, slow-growing, yellow or gray mass, generally with a round shape and rarely oval or plexiform but may also show symptoms related to nerve compression. Schwannoma of the brachial plexus is relatively rare and complicated and presents a clinical challenge for plastic surgeons. Aim and Objectives: This study aimed to present and analyze the feasibility of using specific microsurgical techniques for removing brachial plexus schwannomas. Materials and Methods: We reviewed three patients with brachial plexus schwannomas who underwent total microsurgical enucleation at our hospital. Magnetic resonance imaging was performed to determine the tumor location and size. Intraoperatively, a microscope was used to assist in the procedure. Results: The three schwannomas were completely enucleated with microscope assistance to avoid damaging the trunks of the brachial plexus. No nerve function deficits or recurrence were observed in any of the patients after surgery within 100 months of follow-up (8-204 months). Conclusion: Considering the complexity of the brachial plexus, potential for surgical morbidity, and prevention of possible recurrence, microscopy is highly recommended for the identification and preservation of nerve function during surgery. All three cases of microscope-assisted enucleation of brachial plexus schwannoma had good outcomes with complete excision and without nerve function deficits and local recurrence.

關鍵字

brachial plexus ； schwannoma ； enucleation ； peripheral nerve tumor ； microscope

並列摘要

背景：神經鞘瘤是由神經中的神經鞘細胞組成的良性神經瘤，被歸類為周圍神經鞘瘤。神經鞘瘤通常為局部緩慢生長的黃色或灰色腫塊，通常呈圓形，很少呈橢圓形或叢狀，經常表現出神經壓迫相關之症狀，而臂叢神經鞘瘤發生率低且複雜，對整形外科醫師來說仍是個具有挑戰性的手術。目的及目標：這項研究的目的是介紹和分析使用特定顯微鏡外科技術協助醫師切除臂叢神經鞘瘤的可行性。材料及方法：我們回顧了三例在三軍總醫院進行顯微手術剝除的臂叢神經鞘瘤案例。手術前先進行磁共振成像以確認腫瘤的位置和大小；手術中使用顯微鏡輔助剝除臂叢神經鞘瘤。結果：三位患者在住院期間接受臂叢神經鞘瘤手術。臂叢神經鞘瘤在顯微鏡輔助下完全移除且同時避免對神經的損害。術後平均追蹤約八年（8-204個月），所有患者術後均無神經功能缺損且無復發情形。結論：臂叢神經腫瘤發生率低僅佔上肢所有腫瘤的5％。發生在頭部和頸部最常見，佔所有神經鞘瘤的25％，且僅約5％的神經鞘瘤為臂叢神經鞘瘤。考慮到臂叢神經的複雜性和術後併發症的可能性，建議在手術過程中使用顯微鏡來輔助識別神經，避免神經損傷，並完全移除以防止復發的可能。三例臂叢神經鞘瘤在顯微鏡輔助下手術均完全移除且無神經功能缺損和復發現象。