Neurologic Deficits after Surgical Enucleation of Schwannoma in the Upper Extremity

Kang,  Jin Woo; Lee,  Yong Suk; Kim,  Chulkyu; Shin,  Seung Han; Chung,  Yang Guk

doi:2017.22.1.41

Arch Hand Microsurg > Volume 22(1); 2017 > Article

Original Article

Journal of the Korean Society for Surgery of the Hand 2017;22(1):41-48.
Published online March 31, 2017.
DOI: https://doi.org/10.12790/jkssh.2017.22.1.41

Neurologic Deficits after Surgical Enucleation of Schwannoma in the Upper Extremity

Jin Woo Kang, Yong Suk Lee, Chulkyu Kim, Seung Han Shin, Yang Guk Chung

Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. ygchung@catholic.ac.kr

Received: 10 November 2016 • Revised: 16 December 2016 • Accepted: 21 December 2016

Abstract

Purpose
Neurologic deficits after enucleation of schwannoma are not rare. To evaluate the neurologic deficits after surgical enucleation of schwannoma in the upper extremity, we performed a retrospective review of patients with surgically treated schwannoma over a 14-year period at a single institution.

Methods
Between March 2001 and September 2014, 103 patients underwent surgical enucleation for schwannomas; 36 patients of them had lesions in the upper extremity, and 2 out of 36 patients had multiple schwannomas. Each operation was performed by a single surgeon under loupe magnification. The postoperative neurological deficits were graded as major and minor in both immediate postoperatively and at last follow-up. The major deficit was defined as anesthesia or marked hypoesthesia, motor weakness of grade 3 or less and neuropathic pain. Minor deficit was defined as mild symptoms of mild hypoesthesia, paresthesia and motor weakness of grade 4 or more.

Results
There were 2 major (2 mixed nerve) and 12 minor (4 motor, 7 sensory, 1 mixed nerve) neurologic deficits after surgery. At the last follow-up, one major mixed neurologic deficit remained as major motor and minor sensory, and other major ones changed to mixed minor. And all minor deficits except 1 sensory deficit were recovered spontaneously.

Conclusion
Even though high incidence rate of neurologic deficit after enucleation of schwannoma in the upper extremity (38.9%), about three fourths of them were recovered spontaneously. There were 3 permanent neurologic deficits, and one of them was major one. In some cases, surgeon cannot avoid to encounter a neurological deficit. So we recommend more delicate microscopic surgical procedure and preoperative planning and counseling. And surgery is indicated for only symptomatic lesions.