A Case of Brachial Plexus Schwannoma Intrathoracic Extension Guided via Video-Assisted Thoracoscopic Surgery (VATS)

Schwannomas, arising from the brachial plexus, are rare nerve sheath tumors originating from Schwann cells, affecting peripheral nerves. Brachial plexus schwannomas present unique diagnostic and surgical challenges due to their rarity and intricate anatomy. This case report focuses on a significant case of a left brachial plexus schwannoma extending into the pleural cavity, emphasizing the complexities in diagnosis and the use of video-assisted thoracoscopic surgery (VATS) for intrathoracic extensions. A 71-year-old female with a two-year history of left arm pain and numbness presented, having undergone cervical disc herniation surgery without improvement. Imaging revealed a 23 mm cystic lesion extending into the thorax. VATS, supported by a multidisciplinary team, successfully excised the intrathoracic schwannoma originating from the brachial plexus lower trunk. Postoperative recovery was uneventful, confirming grade 1 schwannoma on histopathology. However, the patient reported left arm numbness during follow-up, leading to electromyography revealing axonal neuropathy and plexopathy. Rehabilitation and medication were initiated. Brachial plexus schwannomas, though benign, pose diagnostic challenges, often mimicking other conditions. Accurate diagnosis involves clinical evaluation, imaging, and sometimes biopsy. VATS, a less invasive alternative, proved effective in this case, shortening recovery time and improving patient satisfaction. The multidisciplinary approach, including chest surgery in intrathoracic cases, is crucial for optimal management. Surgical resection, while preserving nerves, is the primary treatment, although challenges may lead to postoperative complications. Intrathoracic brachial plexus schwannomas demand a comprehensive approach where VATS significantly enhances diagnostic accuracy and patient outcomes.