Jerzy Gosk

Results of Surgical Treatment of Schwannomas Arising from Extremities

Schwannomas are benign neoplasms derived from Schwann cells. In this work, we present our experience in operative management of schwannomas and analyse results of treatment. Clinical material consisted of 34 patients, in whom 44 schwannomas located in extremities were excised between 1985 and 2013. Thirty-five tumours originated from major peripheral nerves and 9 from small nerve branches. Postoperatively, in the first group of tumours, pain resolved in 100%, paresthesias in 83.3%, and Hoffmann-Tinel sign in 91.6% of the patients. Improvement in motor function was noted in 28.5% of the cases, in sensory function: complete in 70%, and partial in 15%. The most frequently affected major peripheral nerves were the ulnar (11 tumours) and median (5 tumours) nerves. Schwannomas originating from small nerve branches were removed without identification of the site of origin. After their resection, definitive healing was achieved. Conclusions. (1) Schwannomas located in extremities arise predominantly from major peripheral nerves, most commonly the ulnar and median nerves. (2) Gradual tumour growth causes exacerbation of compression neuropathy, creating an indication for surgery. (3) In most cases, improvement in peripheral nerve function after excision of schwannoma is achieved. (4) The risk of new permanent postoperative neurological deficits is low.

Assessment of the usefulness of X-ray myelography and magnetic resonance myelography, performed with an open low-field device, in diagnosing perinatal preganglionic injuries of the brachial plexus.

Introduction The goal is to assess the usefulness of diagnostic imaging in diagnosing perinatal preganglionic injuries of the brachial plexus. Material and methods The clinical material included 40 children of both genders, aged 2 to 35 months. The authors analysed the results of diagnostic imaging examinations (myelography in 20 cases and magnetic resonance [MR] myelography in 20 cases), intraoperative view and clinical course. Results In 13 out of 40 (32.5%) examined children, no evidence of avulsion of the roots of the spinal nerves was found either by diagnostic imaging or during the surgery. In 3 cases (7.5%) with avulsed roots of the spinal nerves, the diagnostic imaging and intraoperative appearance were in agreement. Total agreement of the diagnostic imaging and intraoperative view was found in 40% of cases. In 9 patients (22.5%) suspected avulsion of roots of the spinal nerves was not confirmed during the surgery. However, the further clinical course of the disease in these cases indicated high probability of avulsion of roots without their pull-out from the intervertebral foramens. In the remaining cases, the findings were as follows: false positive results – 7 (17.5%), false negative results – 1 (2.5%), results underestimating injury – 3 (7.5%), results overestimating injury – 2 (5%). Conclusions It was determined that the usefulness of pre-operative diagnostic imaging is limited. Due to the risk of occurrence of false positive and false negative results, final decisions concerning selection of the surgical technique must be based on the analysis of the intraoperative view and preoperative clinical symptoms.

Schwannoma of the medial cutaneous nerve of the arm: a rare location with concomitant compression neuropathy of the ulnar nerve

The objective of this paper is to present a case of rare location of schwannoma in the medial cutaneous nerve of the arm at the level of the axilla. Preliminary diagnostic examination of the tumour was carried out in another hospital by means of open biopsy. In the preoperative period symptoms of ulnar nerve dysfunction (paraesthesias, positive Hoffmann-Tinel sign) dominated the clinical picture. After having performed imaging studies and electromyographic (EMG) examination, the patient was scheduled for an operation. The tumour, measuring 3.5 × 3.0 × 1.5 cm, was resected without damage to the fascicular structure. Presence of paraesthesias in the distribution of the medial cutaneous nerve of the arm, which was first noted in the postoperative period, persists in moderate severity until now. As a result of the performed operative treatment, such symptoms as palpable tumour mass, pain, paraesthesias in the ulnar nerve distribution and positive Hoffmann-Tinel sign resolved. On the basis of histopathological examination results the final diagnosis of classical schwannoma was established.