Operative steps in management of benign nerve sheath tumors

Benign peripheral nerve sheath tumors include the neurofibroma, schwannoma, and their plexiform variants. Operative management begins with an assessment of the relative risks associated with surgery compared with observation. The risks of observation include the risk of malignancy, the progression of symptoms, risk of delayed surgery, and ongoing patient suffering. The risks of surgery include anesthetic problems, wound complications, and neurological injury. New neurological deficits have been reported to occur in approximately 10 to 15% of surgically treated cases. In general, surgery is recommended for symptomatic or progressive lesions. Although the surgical approach will vary depending on the location, type, and extent of tumor, adherence to certain principles will facilitate success. Adequate visualization and successful removal will be achieved with detailed anatomical knowledge, an adequate extensile exposure to visualize the proximal and distal tumor extent, circumferential dissection of the tumor, microsurgical dissection under appropriate magnification, and meticulous hemostasis throughout the procedure.