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Arch Hand Microsurg > Volume 24(1); 2019 > Article
Archives of Hand and Microsurgery 2019;24(1):87-95.
Published online March 1, 2019.
DOI: https://doi.org/10.12790/ahm.2019.24.1.87   
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. handwoo@hotmail.com
Received: 21 November 2018   • Revised: 26 December 2018   • Accepted: 28 December 2018
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.
Key Words: Schwannoma, Upper extremity, Fascicle preservation, Neurilemmoma
 
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