Schwannomas of the brachial plexus--diagnostic and surgical problems

This paper reports four cases of schwannomas of the brachial plexus operated upon with good outcome and discusses the CT and MRI findings and the best surgical treatment of these lesions.

All patients had large schwannomas (more than 4 cm in diameter) presenting as painless masses in the supraclavear region, explored by CT and MRI. A homogeneous mass, hypo-isointense in T1- and hyperintense in T2-weighted images, with well-defined margins, is in favor of a schwannoma. The nerve of origin, external to the tumor mass, may be defined on MRI.

All patients have been operated upon using microsurgical technique: enucleation of the tumor content, piecemal removal of the capsule, identification and preservation of the neural elements were the main goals of the operation in all cases.

Postoperatively, one patient experienced transient deficit of the deltoid muscle (two weeks). Actually, all four patients are symptom-free with no tumor recurrence, 6 months to 7 years after the operation.

A correct preoperative diagnosis of schwannoma of the brachial plexus may be obtained by MRI, which shows a rather typical aspect; on the other hand, needle aspiration histology and open biopsies should be avoided. The microsurgical treatment with preservation of the neural structures, as for schwannomas of the cranial and spinal nerves, results in good outcome without recurrences.