Arch Hand Microsurg 2019; 24(1): 87-95  
Outcome of Schwannoma Resection at Upper Extremity with Preservation of Nerve Fascicle
Jin Hee Choi, Tae Yeong Yang, Tae Kyung Lee, Sang Hyun Woo
W Institute for Hand and Reconstructive Microsurgery, W General Hospital, Daegu, Korea
Correspondence to: Sang Hyun Woo
W Institute for Hand and Reconstructive Microsurgery, W General Hospital, 1632 Dalgubeol-daero, Dalseo-gu, Daegu 42642, Korea
TEL: +82-53-550-5000, FAX: +82-53-552-4000, E-mail: handwoo@hotmail.com
Received: November 21, 2018; Revised: December 26, 2018; Accepted: December 28, 2018; Published online: March 1, 2019.
© Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Purpose: To analyze the risk factors and the rate of neurological complication occurring after micro-surgical enucleation of schwannoma, and the relationship between single fascicle resection and neurological deficiency.
Methods: From January 2010 through September 2018, a total of 65 patients underwent micro-surgical enucleation for schwannoma in the forearm and hand. The factors affecting new neurological deficiency after surgery were analyzed, and the differences in neurological incidence were compared between those that preserved the fascicle and those that were unavoidable to resect the fascicle at surgery.
Results: Immediately neurological complications were reported in 16 patients (24.6%) after the surgery, with 4 patients (6.2%) remaining in the final outcome. Neurological complication (50.0%) was higher in case of resection of fascicle at surgery (hazard ratio, HR=18.791, p<0.05). The preoperative misdiagnosis also increased the incidence of neurological complications (HR=10.693, p<0.05).
Conclusion: Accurate diagnosis before surgery and preservation of the nerve fascicle at surgery are important to reduce postoperative neurological complications in the treatment of schwannoma. For accurate diagnosis, detailed history taking, physical examination and magnetic resonance imaging should be actively done, and during surgery, efforts should be made to preserve the nerve fascicle as much as possible by using microscopic surgical techniques.
Keywords: Schwannoma, Upper extremity, Fascicle preservation, Neurilemmoma


This Article

e-submission

Archives of J Korean Soc Surg Hand

Archives of ARMS

Archives

Indexed/Covered by