Over a 17-year period, 56 patients with 57
tumors involving the brachial plexus were operated upon. The 40 neural sheath
tumors included 26
neurofibromas, 8
schwannomas, 4 malignant neural sheath
tumors, 1
fibrosarcoma, and 1
meningioma. Nine of the
neurofibromas were associated with
von Recklinghausen's disease (VRD), and 2 others were what was termed regionalized
neurofibromatosis characterized by involvement of one limb with extension along the course of one or more plexus elements. Seventeen
tumors were not of neural sheath origin; 7 were benign and 10 were metastatic malignant
tumors compressing or invading the plexus. Benign
neurofibromas and malignant sheath
tumors almost always presented with
pain or functional neural deficit, whereas
schwannomas often presented with a palpable mass as their only initial symptom. Patients with solitary
neurofibromas were significantly older, often female, and more likely to have
tumor on the right side than patients with
schwannomas, malignant neural sheath
tumors, or
neurofibromas associated with VRD. Solitary
neurofibromas could often be totally resected without added deficit by sacrificing fascicles entering and leaving
tumor that were determined to be "nonfunctional" by intraoperative nerve action potential recordings. Resection of
neurofibromas associated with VRD sometimes but not always resulted in significant loss. Operation is nonetheless recommended, especially when
malignancy is suspected because of rapidly increasing size, when severe
pain or neural deficit is present, or when compression of adjacent plexus
elements is a concern.
Schwannomas and benign non-neural sheath
tumors can usually be extirpated without damage to plexus elements. Forequarter
amputation is advised for malignant intrinsic
tumors involving distal plexus elements even though gross total resection seems feasible.