Sá Ângelo, Nobre Azevedo Leandro, Cunha Luísa
Serviço de Cirurgia Plástica, Reconstrutiva e Maxilo-Facial. Hospital Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal.
Acta Med Port. 2016 Sep;29(9):519-524. doi: 10.20344/amp.6906. Epub 2016 Sep 30.
Schwannoma or neurilemmoma is a benign peripheric nerve tumor that usually presents as a slow growing single lesion; it has origin in Schwann cells proliferation. Although it represents a small percentage of the benign tumors of the upper arm, it is the most frequent of neural origin. We present a retrospective study of upper limb schwannomas; our aim is establish the appropriate preoperative approach, to recognise the efficiency of the treatment and the pos-operative follow-up.
Review of 17 patients treated between 2007 and 2014 with upper limb schwannoma and characterization as to age, gender, location in the upper limb, signs and symptoms, pre-operative studies, histologic diagnosis and postoperative surveillance.
In four of them the schwannoma was localized on the arm, three on the forearm, four on the wrist and 6 on the hand or fingers. We proceed to careful microsurgical dissection in a bloodless field to optimize the functional final result. The enucleation without fascicular lesion was achieved in 12 patients. In five patients we performed the excision of the fascicles involved by the mass. Nine patients developed paresthesias in the immediate postoperative period, with five of them improving in 12 months. One patient presented motor deficit of the radial nerve with partial recover at 12 monts.
Schwannomas are rare tumours with well circumscribed morphology. Occasionally it appears in upper limb. The preoperative diagnosis is rarely, so normally the diagnosis is established only after excision and histologic study.
Schwannoma should be considered as a diagnostic hypothesis when evaluating subcutaneous nodes associated with neurologic symptoms. It is important to query the presence of paresthesias and perform the Tinel sign, both typical of this condition. Imagiological exams have a scarce contribute in the diagnosis. To improve the final result, the preoperative study must be insightful, being advisable to consider the benefits of the surgery compared to the potential iatrogenic damage to the nerve.
施万细胞瘤或神经鞘瘤是一种良性周围神经肿瘤，通常表现为生长缓慢的单个病变；它起源于施万细胞的增殖。尽管它在上臂良性肿瘤中所占比例较小，但却是最常见的神经源性肿瘤。我们对上肢施万细胞瘤进行了一项回顾性研究；我们的目的是确定合适的术前方法，认识治疗的有效性和术后随访情况。
回顾2007年至2014年间接受治疗的17例上肢施万细胞瘤患者，并对其年龄、性别、上肢位置、体征和症状、术前检查、组织学诊断及术后监测进行特征描述。
其中4例施万细胞瘤位于上臂，3例位于前臂，4例位于腕部，6例位于手部或手指。我们在无血视野下进行仔细的显微手术解剖，以优化最终功能结果。12例患者实现了无束状病变的摘除。5例患者我们对肿块累及的束状结构进行了切除。9例患者在术后即刻出现感觉异常，其中5例在12个月内有所改善。1例患者出现桡神经运动功能障碍，12个月时部分恢复。
施万细胞瘤是形态边界清晰的罕见肿瘤。偶尔出现在上肢。术前诊断很少见，所以通常仅在切除和组织学研究后才能确诊。
在评估与神经症状相关的皮下结节时，应将施万细胞瘤视为一种诊断假设。询问是否存在感觉异常并进行Tinel征检查很重要，这两者都是这种疾病的典型表现。影像学检查对诊断的贡献不大。为了改善最终结果，术前研究必须有深刻见解，建议权衡手术益处与潜在的医源性神经损伤。
