Maciej Urban

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.

Our experience with surgical treatment of perinatal brachial plexus palsy--results in different types of lesions.

INTRODUCTION Perinatal brachial plexus palsies can be divided into upper (C5-C6), upper-middle (C5-C6-C7) and total injuries (C5-Th1). The study aimed to evaluate the results of surgical repair in the different types of palsies. MATERIAL AND METHODS The patient population comprised 80 children who underwent primary repair of the brachial plexus (external neurolysis, internal neurolysis, direct neurorrhaphy, nerve grafts, extraanatomical intraplexus reconstruction, extraanatomical extraplexus reconstruction). 31 patients were additionally subjected to 39 tenomioplasty procedures. Widely recognised assessment scales were used to evaluate the outcome of surgical treatment of different types of palsies in 70 patients. RESULTS Good and very good post-operative function of the glenohumeral and elbow joints was demonstrated in all patients with upper palsy. In the group of upper-middle injuries, 61.5% of patients presented good and very good function of the shoulder joint and 76.9% had good function of the elbow. In subjects with total brachial plexus palsy, good function of the glenohumeral was demonstrated by 51.2%, good function of the elbow by 61% and 53.6% presented with a functionally useful hand. CONCLUSIONS 1. While surgical repair may be indicated in brachial plexus injuries at all levels, it is usually inevitable in total and upper-middle palsies. 2. The surgical outcome depends on the extent of baseline damage to the brachial plexus, with the best prognosis in insolated upper palsies.

Preganglionic injuries in perinatal brachial plexus palsies – results of surgical treatment

BACKGROUND AND PURPOSE The authors report their experience in surgical treatment of preganglionic injuries in perinatal brachial plexus palsies. MATERIAL AND METHODS Clinical material consisted of 16 children, of both sexes, aged from 2.5 to 33 months (mean 6.2 months), treated surgically between 1994 and 2006. The clinical view of the injury and location of preganglionic lesions was analysed and the description of the performed microsurgical techniques is provided. Control clinical examinations included a group of 14 children. The shortest postoperative observation period was 3 years. The currently accepted scales of evaluation of function of particular joints of the upper limb were used. RESULTS The following outcome was noted after surgical treatment of perinatal brachial plexus palsies with signs of pre- and postganglionic injuries: good shoulder function in 6 cases, and average in 2 others; good elbow function in 4 cases, and average in 7 patients; functional position of the forearm in 9 cases, and good range of pronation and supination in 1 patient; useful function of wrist (flexion/extension) in 4 cases; good motor hand function in 3 cases, and fair in 6 patients. CONCLUSIONS In preganglionic perinatal brachial plexus injuries located in the upper-middle part, spinal nerve C7 roots avulsion is the most frequently observed, and in the lower part of the brachial plexus, spinal nerve C8 roots avulsion is the most frequently observed. In preganglionic injuries of the brachial plexus, the number of avulsed spinal nerves has an influence on technical possibilities of performing reconstruction procedures, and then the results of the surgical treatment.

Rare triphalangeal thumb polydactyly: A case report

A 3-month-old boy was seen for evaluation of a congenital left upper limb anomaly. He was born at 40 weeks gestation by caesarean section. There was no family history of congenital anomalies or musculoskeletal deformities. During gestation (at 2 months) the mother had had labial herpes. There were no other anomalies besides that of the the left upper extremity. Growth and development were normal. The left shoulder had a normal appearance and a full range of motion. The left elbow showed a lack of skin creases and was held in full extension. The forearm was broadened in the proximal part and lay supine. Active flexion of the elbow was absent. Passive flexion of the elbow was impossible when supine, but a few degrees of flexion was obtained after pronation of the forearm. The wrist was held in slight palmar flexion, but could be actively extended to neutral. There was a slight tendency to radial deviation of the wrist. The hand had eight digits. The ulnar four digits appeared normal, each with active flexion and extension. The radial four digits were grouped in some opposition to the remaining fingers and had a nearly normal range of motion. The two most radial digits showed partial syndactyly of the soft tissue (Figure. 1). An accentuated web space was observed between the two groups of digits. Additional examinations included X-ray, 3D-CT of the left elbow, and MR of both arms and forearms. X-ray examination of the left upper limb revealed a slight deformation of the left clavicle. The glenohumeral joint and humerus were normal. The radiological evaluation of the forearm showed the ulna and a short, hypoplastic radius. The ulna had wellformed, but with a dislocated olecranon. The wrist had duplication of the carpal bones. The four ulnar four digits were triphalangeal. The most radial and most ulnar digits of the radial group of four digits were biphalangeal. The hand had six well-developed metacarpals, one hypoplastic (complementing the most radial digit), and also a small ossification center (complementing the most ulnar of the radial group of digits) (Figure. 2). MR imaging showed no differences in shape and musculature of the arms. The left forearm had a more triangular shape and increased anteroposterior dimension. The muscular mass of the flexors was particularly developed with additional muscles to the radial