Nerve Tumors
The entire benign space-occupying lesions – either extra- or intraneurally located – are described here. The list of tumors consist of schwannomas (neurinomas), neurofibromas, plexiform neurofibromas, perineurioma, nerve sheath myxoma (neurothekeoma), hae
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Nerve Tumors Götz Penkert
13.1
Types, Symptoms, and Diagnosis
Most types of nerve tumor are characterized by the same slowly proceeding symptoms that we consider as typical of all the other previously mentioned focal neuropathies. Therefore, it normally takes several months to find the correct diagnosis and to differentiate from alternative neuropathies. Either the patient notices a focal swelling in his extremity not on a particular day, or eventually increasing symptoms give reason for imaging examination which leads to finding a tumor. In the following, we restrict ourselves to benign spaceoccupying lesions either located extra- or intraneurally for which a revised overview was recently published in literature [1]. In all of these cases, the slowly increasing space-occupying effect on nerve axons causes the typical electric-current like paresthesias, in other words, the typical Tinel sign, which characterizes all kinds of focal neuropathies with partial or complete loss of axon continuity (see Sect. 4.1). The point where these sensations are felt most strongly indicates the location of degenerating and
G. Penkert et al., Focal Peripheral Neuropathies, DOI 10.1007/978-3-642-54780-5_13, © Springer-Verlag Berlin Heidelberg 2015
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Nerve Tumors
regenerating neuronal sprouts. First, patients repeatedly notice the location of their sensation, and then they sometimes observe something like a tumor mass which is movable transverse to the nerve course. Later, it becomes more and more sensitive. Neurological deficits occur rather late. Unfortunately, electrodiagnostic testing is of subordinate value to find the diagnosis because it cannot reveal the correct pathology (see Chap. 5). However, imaging either as high resolution ultrasound or as magnetic resonance imaging is of superior value, and it should therefore be arranged in any case (see Sects. 6.1.7 and 6.2.7).
13.2
Surgical Considerations and Prognosis
The introduction of microsurgery has extended our surgical horizons in tumor cases. Results have massively improved so that it seems increasingly difficult to justify cases where the involved nerve is completely sacrificed. As to be expected, secondary nerve repair after nerve sacrifice achieves a lower functional level than a microsurgical primary procedure with preservation of unaffected nerve fibers (Fig. 13.1). Therefore, surgery seems mandatory in all kinds of benign histology and solitary manifestation. In most of all cases, imaging findings are sufficient to define the entity as a benign one what will facilitate to decide to operate on. The question about solitary or multiple tumor occurrences in a limb can be solved more easily by means of ultrasound because MRI is technically restricted for certain limb segments. Because most nerve tumors are revealed as solitary, they have to be assessed as easily and primarily accessible; thus we should not hesitate to apply our microsurgical experience and remove the pathology completely. As a principle, the exposure of all kind of benign tumor first re
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