• Multiple schwannomas
• Multiple schwannomas scattered on a single peripheral nerve
• Segmental schwannomatosis
• Selective enucleation
• Treatment strategy

• Humans
• Neurilemmoma/surgery
• Neurilemmoma/pathology
• Male
• Female
• Middle Aged
• Peripheral Nervous System Neoplasms/surgery
• Peripheral Nervous System Neoplasms/pathology
• Retrospective Studies
• Adult
• Aged
• Treatment Outcome

• medication
• neuromodulation
• pain
• schwannomatosis
• surgery

• complications
• diagnostic imaging
• intraneural fibrosis
• long-term follow-up
• recurrence factors
• recurrent schwannoma
• surgical difficulties
• surgical excision
• ulnar nerve

• Intraneural dissection
• Narrow-band imaging (NBI)
• Pseudocapsule
• Schwannoma
• True capsule

• Humans
• Neurilemmoma/surgery
• Neurilemmoma/diagnostic imaging
• Middle Aged
• Narrow Band Imaging/methods
• Retrospective Studies
• Female
• Male
• Adult
• Head and Neck Neoplasms/surgery
• Head and Neck Neoplasms/diagnostic imaging
• Head and Neck Neoplasms/pathology
• Aged
• Dissection/methods

• benign
• forearm
• median nerve
• peripheral nervous tumour
• schwannoma

• antoni a and antoni b areas
• benign peripheral nerve sheath tumor
• cerebellopontine angle tumours
• painless nodule
• peripheral schwannoma

• diagnostics
• lower extremity
• medial sural cutaneous nerve
• sural schwannoma
• treatment

• foot
• nerve sheath neoplasms
• peroneal nerve
• schwannoma

• Enucleation
• Fascicular resection
• Nerve tumor
• Schwannoma

• Humans
• Neurilemmoma/surgery
• Male
• Female
• Retrospective Studies
• Middle Aged
• Adult
• Postoperative Complications/etiology
• Postoperative Complications/epidemiology
• Risk Factors
• Aged
• Young Adult

• Humans
• Soft Tissue Neoplasms/diagnostic imaging
• Diagnosis, Differential
• Knee/diagnostic imaging
• Magnetic Resonance Imaging/methods
• Knee Joint/diagnostic imaging
• Knee Joint/pathology

• common peroneal nerve
• neurological deficit
• schwannoma

• hoffman tinel sign
• neurilemmoma
• neurofibroma
• peripheral nerve sheath tumors
• schwannoma

• neurilemmoma
• neurinoma
• peroneal nerve schwannoma
• schwannomatosis
• verocay body

• Benign tumor
• Digital nerve tumor
• Hand tumor
• Neurilemmoma
• Schwannoma

• Schwannomatosis
• neurofibromatosis
• peripheral nerve sheath tumors
• sciatic nerve

• diagnosis
• extremity
• microsurgery
• prognosis
• retrospective study
• schwannoma

• Schwannoma
• case report
• delayed diagnosis
• enucleation
• radial nerve

• Functionality
• Lower Limb
• Neurinoma
• Peroneal nerves
• Schwannoma

• C5 palsy
• cervical
• nerve sheath tumor
• neurofibroma
• oncology
• schwannoma
• surgical outcomes

Objective: Schwannomas are the most common type of neoplasm of the peripheral nerves. Enucleation is a standard surgical procedure; however, it occasionally results in iatrogenic nerve injury, even with atraumatic procedures. Herein, we present the clinical characteristics of schwannoma arising in the extremities and discuss the clinical outcomes of extra- and intra-capsular enucleation.

Patients and Methods: We reviewed 122 schwannomas treated at our institute. Schwannomas arising from the minor nerve (n=30) or intramuscularly (n=15) were operated using the extra-capsular technique. Of the 77 major nerve schwannomas, 62 schwannomas were treated using the intra-capsular technique and 15 schwannomas using the extra-capsular technique.

Results: Neurological deficits following enucleation were significantly lower using the intra-capsular technique than with the extra-capsular technique. The patient age, duration of symptoms, maximum tumor diameter, and site of occurrence were not associated with subsequent neurological deficits. With both techniques, no tumor recurrence was observed at the final follow-up.

Conclusion: These results support the use of intra-capsular micro-enucleation as a safe and reliable treatment for every type of schwannoma. To minimize the risk of nerve injury, en bloc resection should not be used because the main purpose of schwannoma surgery is the relief of symptoms, not tumor resection.

• Schwannoma
• enucleation
• extremity
• microsurgery
• peripheral nerve

Schwannoma is a benign, encapsulated and slowly growing tumor originating from Schwann cells and is rarely seen in the peripheral nerve system. Typical symptoms are soreness, radiating pain and sensory loss combined with a soft tissue mass.

To evaluate pre- and postoperative symptoms in patients operated for schwannomas in the extremities and investigate the rate of malignant transformation.

In this single center retrospective study design, all patients who had surgery for a benign schwannoma in the extremities from May 1997 to January 2018 were included. The location of the tumor in the extremities was divided into five groups; forearm, arm, shoulder, thigh and leg including foot. The locations of the tumor in the nerves were also categorized as either; proximal, distal, minor or major nerve. During the pre- and postoperative clinical evaluation, symptoms were classified as paresthesia, local pain, radiating pain, swelling, impairment of mobility/strength and asymptomatic tumors that were found incidentally (with magnetic resonance imaging). The patients were evaluated after surgery using the following categories: Asymptomatic or symptomatic patients (radiating and/or local pain) and those with complications. The follow up period was from the time of surgery until last examination of the particular physician. Multivariate logistic regression analysis was performed to identify independent prognostic factors for postoperative significant symptoms at follow-up.

We identified 858 cases from the institutional pathology register. We excluded cases with duplicate diagnoses (n = 407), pathology not including schwannomas (n = 157), lesions involving the torso, spine and neck (n = 150) leaving 144 patients for further analysis. In this group 99 patients underwent surgery and there were five complications recorded: 2 infections (treated with antibiotics) and 3 nerve palsies (2 involving the radial nerve and one involving the median nerve) that recovered spontaneously. At the end of follow-up, 1.4 mo (range 0.5-76) postoperatively, we recorded a post-operative decrease in clinical symptoms: Local pain 76% (6/25), radiating pain 97% (2/45), swelling 20% (8/10). Symptoms of paresthesia increased by 2.8% (37/36) and there was no change in motor weakness before and after surgery 1% (1/1). Multivariate analysis showed that tumors located within minor nerves had a significantly higher prevalence of postoperative symptoms compared with tumors in major nerves (odds ratio: 2.63; confidence intervals: 1.22-6.42, P = 0.029). One patient with schwannoma diagnosed by needle biopsy was diagnosed to have malignant transformation diagnosed in the surgically removed tumor. No local recurrences were reported.

Surgery of schwannomas can be conducted with low risk of postoperative complications, acceptable decrease in clinical symptoms and risk of malignant transformation is low.

• Schwannoma
• Extremities
• Surgery
• Removal
• Symptoms
• Outcome

• Breast neoplasms
• brachial plexus
• diagnosis
• differential
• neurilemmoma
• scwannoma

• Malignant peripheral nerve sheath tumor
• NF1
• NF2
• Neural crest
• Neurofibroma
• Schwann cell
• Schwannoma

• Female
• Humans
• Middle Aged
• Neurilemmoma/diagnosis
• Neurilemmoma/surgery
• Pain
• Peripheral Nerves
• Peroneal Nerve/surgery

•

Plexiform schwannomas are exceedingly rare in paediatric populations.

Schwannomas are benign, slow-growing nerve sheath tumors of neoplastic Schwann cells. They are the most common peripheral nerve tumors in adults and are typically discovered incidentally due to their asymptomatic presentation. Despite the fact that most schwannomas are unassociated with a syndrome, their etiology is thought to be related to alterations or loss of the neurofibromatosis type two tumor suppressor gene.

We present the case of a fifteen-year-old female who presented with a recurrent lower back/upper buttocks 9 cm mass with imaging suspicious for schwannoma. Needle biopsy revealed an S100 positive cellular schwannoma with patchy Ki-67. During surgical dissection down to the sacrum, no nerve of origin was identified.

Schwannomas have no pathognomonic findings on MRI and may occur at any location that Schwann cells are present; therefore, confirming a diagnosis relies on histopathology. Plexiform schwannomas are defined by a “network-like” intraneural growth pattern and are exceedingly rare in paediatric populations. A location distinct from the spinal canal is also very rare as schwannomas typically originate from the head and neck region.

Paediatric plexiform schwannomas have been rarely reported. Surgical planning relies on multiple factors such as tumor size, tumor location, pathologic features and symptomatic burden. The distinctive features of this case including an unknown nerve origin and a location outside the spinal canal provide a unique opportunity to discuss the diagnosis and management of paraspinal schwannomas and the impact on operative planning when a nerve of origin is not identified.

• Paediatric
• Paraspinal
• Plexiform
• Schwannoma

• Nerve
• Neurofibromatosis
• Schwannoma
• Sural
• Tumour

Schwannomas and neurofibromas are rare benign tumors originating from the peripheral nerve sheath. Tumors in neurofibromatosis are mostly neurofibromas and often appear in the soft tissue of peripheral nerves. In this report, a patient presented with two large adjacent soft tissue tumors in the right wrist and distal forearm which originated from a common nerve. A schwannoma had formed beside a neurofibroma from the ulnar nerve and induced numbness and paresthesia in the little and ring fingers. Although the patient had café au lait spots on the skin, neurofibromatosis was not suspected due to lack of symptoms. The patient was referred to the current research clinic suffering from two soft tissue masses in the wrist and ulnar nerve dysfunction. In neurofibromatosis patients, two tumors of a different nature originating from a common nerve close together have rarely been described in the literature. The patient was treated by en bloc excision of the mass while protecting the nerve fascicles. The follow-up results indicated no neurological symptoms and complete restoration of ulnar nerve function.

• neurofibroma
• neurofibromatosis
• schwannoma

• Female
• Foot
• Foot Diseases
• Humans
• Middle Aged
• Neurilemmoma/diagnosis
• Neurilemmoma/surgery
• Sural Nerve

Objective  To analyze the epidemiological profile and evolution of 20 patients diagnosed with upper- and lower-limb schwannomas.

Methods  A group of patients was defined for a retrospective evaluation comprising the period between February 2002 and June 2018, in which we studied and evaluated 20 medical records of patients undergoing surgery due to schwannoma; the diagnosis was confirmed by an anatomopathological examination.

Results  Male and female patients were equally affected. The average age was 50.85 years, ranging from 12 to 77 years. There was a predominance of the upper limb and of the flexor face. The most affected nerve was the ulnar nerve. In total, 6 (30%) patients had transient postoperative complications. No cases of tumor recurrence were identified.

Conclusion  Schwannoma is a rare and difficult-to-diagnose lesion. It should always be considered as a hypothesis when facing a soft-tissue tumor affecting the limbs. The Tinel sign should be regarded, given its higher correlation with complications. The patients should be informed of the possible postoperative complications, which are frequent but usually transient.

• neoplasia
• neurilemmoma
• peripheral nerves

Schwannoma, which is also known as neurilemmoma, is a type of tumor that arises from the peripheral nerve sheaths. Cases of schwannomas located in different regions have been reported. Some schwannomas present as asymptomatic masses, while others cause discomfort, such as pain and numbness. Magnetic resonance imaging (MRI) is a valuable diagnostic tool. A 23-year-old woman presented to our hospital with a mass in the left axilla that was misdiagnosed as mammae erraticae. The patient also considered the condition to be mammae erraticae for approximately 14 months because of a lack of symptoms. MRI was recommended by a surgeon from the galactophore department. A giant schwannoma was found. The mass was surgically excised, while preserving the continuity of the long thoracic nerve. Routine histopathological analysis confirmed the presence of a benign schwannoma. Schwannomas located in the axilla are rare and may be easily misdiagnosed as mammae erraticae or enlarged lymph nodes. Early investigation is necessary to make the diagnosis, and surgical excision is usually curative.

• Schwannoma
• axilla
• enucleation
• long thoracic nerve
• lymph node
• mammae erraticae
• neurilemmoma
• surgical excision

• NF2
• Peripheral nerve sheath tumors
• Schwannoma
• Sodium fluorescein

We report the case of a 61-year-old man with sharp pain, tender mass at the left lower one-third posterior tibial region. The patient has a 10-year history of multiple myeloma and related chemotherapy. A positron emission tomography computed tomography and magnetic resonance imaging indicated the suspect of a posterior tibial nerve tumor. En bloc resection of the tumor was performed under guidance of nerve stimulator without resecting nerve trunk. Active nerve was reserved without any neuropathic pain. Histology revealed the presence of a peripheral schwannoma. In conclusion, the tibial nerve schwannoma appeared to be a whole nerve mass, but meticulous dissection showed that this tibial nerve schwannoma was a well-encapsulated tumor and can be separated from the nerve trunk with active nerve fibers reserved. Removal of the tumor made patient free of pain and asymptomatic after surgery. The level of clinical evidence is 4.

• Surgery
• neurology
• orthopedics/rehabilitation/occupational therapy

Schwannomas are well-encapsulated, benign neoplasms, and enucleation is a standard operation procedure. The incidence of neurological complications after surgical treatment for schwannomas of the extremities varies, and there is no consensus concerning predictive factors for complications. The aim of this study was to elucidate predictive factors for complications after surgical treatment of schwannomas that develop in the major nerves of the extremities.

A total of 139 patients with 141 schwannomas arising in major nerves were retrospectively analyzed. Data regarding preoperative clinical features, the postoperative neurological complications, and clinical course of complications, with a median follow-up period of 2 months (range, 0.5–96), were obtained. Predictive factors for complications were statistically analyzed.

Postoperative complications occurred in 49 lesions (34.8%), including 42 with sensory disturbance and 8 with motor weakness. In univariate analysis, older age, tumors originating from the upper extremity, and major motor nerve involvement were associated with a higher complication rate (p = 0.03, p = 0.003, and p = 0.001, respectively). In multivariate analysis, major motor nerve involvement was an independent predictive factor for postoperative complications (p = 0.03). Almost all complications gradually improved, but 6 out of 8 patients with motor weakness did not show full recovery at the final follow-up.

Schwannomas originating from major motor nerves can lead to a higher risk for postoperative complications.

• Complication
• Enucleation
• Extremities
• Peripheral nerve
• Schwannoma

• musculoskeletal oncology
• intra-articular
• tumor
• review
• orthopaedics

• Diagnostic techniques, neurological
• Diffusion magnetic resonance imaging
• Diffusion tensor imaging
• Nerve sheath neoplasms
• Peripheral nerves

• peripheral nerve tumor
• saphenous nerve
• schwannoma
• superficial femoral artery
• vascular claudication

• Benign peripheral nerve sheath tumor
• Pseudocapsule
• Schwannoma
• True capsule

• Adult
• Aged
• Aged, 80 and over
• Female
• Humans
• Male
• Middle Aged
• Neurilemmoma/diagnostic imaging
• Neurilemmoma/pathology
• Neurilemmoma/surgery
• Peripheral Nervous System Neoplasms/diagnostic imaging
• Peripheral Nervous System Neoplasms/pathology
• Peripheral Nervous System Neoplasms/surgery
• Retrospective Studies
• Young Adult

• Benign retroperitoneal schwannoma
• S100 protein
• encapsulated mass
• histological examination
• lower back pain
• magnetic resonance imaging
• tumour

• Chronic Pain/etiology
• Chronic Pain/surgery
• Female
• Humans
• Low Back Pain/etiology
• Low Back Pain/surgery
• Magnetic Resonance Imaging
• Middle Aged
• Neurilemmoma/complications
• Neurilemmoma/diagnostic imaging
• Neurilemmoma/surgery
• Retroperitoneal Neoplasms/complications
• Retroperitoneal Neoplasms/diagnostic imaging
• Retroperitoneal Neoplasms/surgery

Schwannoma is a benign, noninvasive tumour of the peripheral nerve sheath with rare occurrence in the extremities. We present a case of a schwannoma in the posterior tibial nerve which presented with symptoms suggestive of tarsal tunnel syndrome. The patient was managed with surgical excision of the tumour under microscope, and the diagnosis was confirmed by histopathology. Such a presentation is rare, and our case report adds light regarding the management of such cases.