Clavicular window for brachial plexus schwannoma removal

Area of Science:

• Neurosurgery
• Oncology

Background:

• Schwannomas are benign nerve sheath tumors, often associated with neurofibromatosis type 2 (NF2).
• Brachial plexus (BP) schwannomas with supra- and infraclavicular components pose surgical resection challenges.
• Limited reports exist on clavicular osteotomies for BP exposure, with no prior use of a clavicular window for schwannoma resection.

Observation:

• A case of a large brachial plexus schwannoma spanning roots to cords in an NF2 patient with a history of subtotal resection and tumor regrowth.
• The schwannoma predominantly involved the retroclavicular inferior trunk.
• A clavicular window was created by removing a 2 cm mid-clavicular segment, allowing for 6 cm of exposure.

Findings:

• The clavicular window provided extensive exposure of the BP trunks and divisions.
• This facilitated a gross total resection of the brachial plexus schwannoma.
• The resected clavicular segment was refixed with a plate post-resection.

Implications:

• The clavicular window technique offers a valuable approach for optimizing surgical exposure of brachial plexus lesions.
• This method may be beneficial for resecting large or complex schwannomas that are obscured by the clavicle.
• Enhanced visualization through the clavicular window can improve the completeness of tumor resection.