[Brachial plexus tumors--neurosurgical treatment]

Tumours of the brachial plexus according to present classification are included to soft tissue tumours. Because of rare occurrence of these tumours diagnostic and operative experience is relatively small. There is also a few number of publications regarding tumours of the brachial plexus. Therefore the aim of the study was to present our experience in the surgical treatment of tumours of the brachial plexus basing on the material of 5 cases treated in the years 1997-2001. There were 4 males and 1 female, age from 17 to 58 years old. Four patients were under 27 years old. In 3 cases tumours of the brachial plexus invaded the spinal canal through the intervertebral foramen and caused spinal cord compression (type A). In 2 cases tumours involved only plexus elements (type B). In 2 cases tumours were associated with neurofibromatosis type II. Five cases of neural sheath tumours included 2 schwannomas, 2 neurofibromas and 1 schwannoma malignum. All patients underwent surgery. In case of schwannomas and neurofibromas the surgical removal was radical without impairment of brachial plexus function. In case of a giant schwannoma malignum tumor, which caused flaccid paresis and symptoms of insufficient blood, supply with severe pain in the upper limb radical extirpation was also possible. In type A tumours in the first stage intraspinal part of the tumor was removed. Follow up observation lasted from 3 months to 4 years. The result of treatment of benign tumours was very good with complete function recovery of the upper limb, pain disappearance and no symptoms of recurrence in the long postoperative period. In case of malignant schwannoma in the early postoperative period both pain and symptoms of blood supply disturbances completely disappeared. The patient died 12 months after the operation because of tumor dissemination. Benign tumours of the brachial plexus can be effectively surgically treated using microsurgical techniques and, if necessary, nerve grafting. In case of malignant tumours many authors also recommend surgery with optimal sparing of the brachial plexus function and subsequent radio and chemotherapy. Low number A few cases in our series makes impossible to draw any epidemiological conclusions.