All-Endoscopic Resection of an Infraclavicular Brachial Plexus Schwannoma: Surgical Technique

Endoscopic En-Bloc Resection of Neurilemmoma of the Foot Dorsum

Neurilemmoma (schwannoma) is a benign, slow-growing, encapsulated tumor originating from the Schwann cells of the peripheral nerve sheath. The purpose of this technical note is to describe the technique of endoscopic en-bloc resection of neurilemmoma of the foot dorsum. This has the advantage of better cosmetic result and less postoperative perineural fibrosis.

Endoscopy-Assisted Resection of Neurilemmoma of the Tibial Nerve at the Distal Leg

Neurilemmoma of the tibial nerve at the distal leg is a deep-seated tumor, and diagnosis can be delayed for several years. The purpose of this Technical Note is to describe the technique of endoscopy-assisted resection of neurilemmoma of the tibial nerve at the distal leg. This minimally invasive approach can minimize soft-tissue dissection and may reduce the risk of postoperative perineural fibrosis.

Endoscopic brachial plexus neurolysis in the management of infraclavicular nerve injuries due to glenohumeral dislocation

INTRODUCTION

Infraclavicular brachial plexus (BP) injury secondary to glenohumeral joint (GHJ) dislocation is a rather common complication, which may be accountable for long-lasting deficits. The purpose of this study was to assess the potential benefits of BP neurolysis in such presentation, using an endoscopic approach.

MATERIALS AND METHODS

All patients who underwent endoscopic BP neurolysis in the setting of infraclavicular BP palsy due to GHJ dislocation were included. Preoperative physical examination was conducted to classify the observed motor and sensitive deficits into nerves and/or cord lesions. Six weeks after the trauma, examination was repeated and endoscopic BP neurolysis was elected if no significant improvements were observed. If nerve ruptures and/or severe damages were identified during surgery, nerve reconstructions were conducted within a month; in other cases, follow-up examinations were conducted at 6 weeks, 3 and 6 months to assess the course of postoperative recovery.

RESULTS

Eleven patients were included, including 6 men and 5 women, with a mean age of 43 ± 23 years (16;73). Six patients had at least one cord involved, four patients had isolated axillary nerve palsy, and one patient had a complete BP palsy. In 7 patients with cord lesions and/or isolated axillary nerve palsy, at least grade-3 strength, according to the British Medical Research Council grading system, was noted in all affected muscles within 6 weeks following the neurolysis; after 3 months of follow-up, grade-4 strength was observed in all muscles, and all but patients but one had fully recovered within 6 months. In 3 patients with isolated axillary nerve palsy, complete nerve ruptures (n=2) and severe damages (n=1) were identified under scopic magnification; secondary nerve transfers were conducted to reanimate the axillary nerve, and all patients fully recovered within a year. In one patient with complete BP palsy, improvements started after 6 months of follow-up, and full recovery was yielded after 2 years. No intra- and/or postoperative complications were noted.

CONCLUSIONS

At the cost of minimal additional morbidity, endoscopic BP neurolysis appears to be a safe and reliable procedure to shorten recovery delays in most patients presenting with BP palsy due to GHJ dislocation.

Nerve-Preserving Endoscopically Assisted Resection of Schwannoma of the Radial Nerve

Schwannomas are the most common peripheral nerve tumors; they can present as painful masses or paresthesia. The aim of surgical treatment of a symptomatic schwannoma is total to gross total excision of the tumor along with preservation of the affected nerve and its function, particularly in patients with conserved functionality of a major nerve trunk. This Technical Note describes the technical details of nerve-preserving endoscopically assisted resection of a schwannoma of the radial nerve. This is an intracapsular resection of the tumor, and the risk of nerve injury is minimized.