Neurosurgical Perspectives on Management of Peripheral Nerve Tumors
Bunpot Sitthinamsuwan MD, MSc*, Sawanee Pumseenil RN**
Affiliation : * Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Neurosurgical Unit, Division of Perioperative Nursing, Department of Nursing, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Most of peripheral nerve tumors are benign. Surgical removal is still the standard treatment and should be
considered in patients with symptoms.
Objective : The operation endeavors to excise tumors concomitant with preservation of neural function.
Material and Method: The authors reviewed medical literatures in terms of peripheral nerve tumor classification, clinical
manifestation, diagnosis, intraoperative neurophysiological monitoring and surgical treatment.
Results : The most common peripheral nerve tumor is schwannoma. Malignant peripheral nerve sheath tumor (MPNST) is
a rare entity and often associated with neurofibromatosis type 1. Patients with peripheral nerve tumors can present with
palpable mass, pain, neurological deficits and pressure symptoms. Magnetic resonance imaging (MRI) is the gold standard
method for diagnosis. Ultrasonography, diffusion tensor imaging (DTI) with tractography and electrophysiological studies
are optional presurgical investigations. Operation complications can be avoided by using intraoperative neurophysiological
monitoring. Surgery aims to remove the tumors totally. Functional nerve fascicles must be preserved. Radical resection is
necessary in MPNST to improve survival outcomes.
Conclusion : Most of peripheral nerve tumors can be resected totally and have good prognosis. Diagnosis of the tumors is
based on clinical examination and imaging studies. Malignant tumors must be treated aggressively to prolong survival rate.
Keywords : peripheral nerve tumor, schwannoma, neurofibroma, malignant peripheral nerve sheath tumor, surgical treat- ment
