Benign Peripheral Nerve Sheath Tumors: Recurrence Rates and Pain Outcomes Following Excision

Benign peripheral nerve sheath tumors (bPNSTs) present a surgical challenge due to their intimate relationship with functional neurons. This study aims to examine the anatomic distribution of bPNSTs and analyze recurrence rates and factors predictive of recurrence following surgical excision.

A retrospective analysis of patients who underwent resection of bPNST was conducted. The anatomic distribution was assessed, along with recurrence rates and pain outcomes. Exploratory bivariate analyses were conducted to assess factors associated with recurrence.

A total of 228 patients were included (follow-up: 1.02 years (IQR: 0.55-2.12)). BPNSTs were most commonly located in the upper extremity (45.2%) and lower extremity (44.3%), with fewer cases in the head and neck (6.6%), trunk (3.5%), and pelvis (0.4%). Schwannomas comprised 76.3% of cases, while neurofibromas accounted for 22.4%. The overall recurrence rate following excision was 7.0%, with neurofibromas exhibiting a higher recurrence rate (15.7% vs 4.6% for schwannomas, p=0.049). Patients with neurofibromatosis type 1 (NF1) demonstrated significantly higher recurrence rates (19.4% vs 5.1%, p=0.004). Recurrence was more frequent in patients with postoperative motor deficits (26.3% vs 5.3%, p<0.001), patients with psychiatric comorbidities (13.5% vs 3.9%, p=0.008), and younger patients (median age 38.5 (IQR:28.2-44.8) vs 50.2 years (IQR:39.3-60.3), p=0.001). Overall improvement was reported in 77.1% patients.

BPNSTs primarily affect the extremities, with schwannomas being the predominant histological subtype. Neurofibromas, NF1, postoperative motor deficits, psychiatric comorbidity, and younger age were associated with increased recurrence risk. Understanding these distribution patterns and recurrence factors is important for surgical planning and patient counseling.