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周围神经肿瘤:66 例回顾性研究。

Peripheral nerve tumours: A 66-case retrospective study.

机构信息

Servicio de Neurocirugía, Hospital de Clínicas, Montevideo, Uruguay.

Servicio de Neurocirugía, Hospital Regional Universitario de Málaga, Málaga, España.

出版信息

Neurocirugia (Astur : Engl Ed). 2020 May-Jun;31(3):105-111. doi: 10.1016/j.neucir.2019.09.002. Epub 2019 Oct 31.

Abstract

BACKGROUND/OBJECTIVES: Peripheral nerve tumours (PNT) are rare lesions that are generally categorised as soft tissue tumours, so they are usually managed by a range of surgical disciplines such as plastic, orthopaedic and trauma surgery, dermatology, general surgery and neurosurgery. Appropriate knowledge of the therapeutic indication and surgical management are essential in order to avoid neurological deficit.

MATERIALS AND METHODS

This is a retrospective study of 66 tumour lesions in 64 patients, acquired from the joint experience of 2surgical teams specialised in peripheral nerve surgery.

RESULTS

The most common location was the lower limb and upper limb with 48 tumour lesions. The most common pathological diagnosis was Schwannoma, accounting for 51.5%. Complete tumour resection was achieved in 81.8% of the lesions and always with neurophysiological stimulation and/or monitoring. The most common postsurgical complication was neuropathic pain and/or a transient sensory disorder in 15% of surgeries, with only one persistent motor deficit appearing in 2cases that required nerve graft reconstruction.

CONCLUSIONS

Although the therapeutic management of benign tumours such as Schwannomas can be considered to be relatively simple thanks to the application of the basic concepts of peripheral nerve microsurgery, malignant tumors, despite being very rare, require multidisciplinary management. The option of pre-surgical biopsy remains a controversial issue and no consensus has been reached among the different authors. In our opinion, percutaneous biopsy is not necessary in most cases.

摘要

背景/目的:周围神经肿瘤(PNT)是罕见的病变,通常归类为软组织肿瘤,因此通常由多个外科学科管理,如整形外科、骨科和创伤外科、皮肤科、普通外科和神经外科。为了避免神经功能缺损,适当了解治疗适应症和手术管理至关重要。

材料和方法

这是一项对 64 名患者的 66 个肿瘤病变的回顾性研究,来自 2 个专门从事周围神经外科的外科团队的联合经验。

结果

最常见的部位是下肢和上肢,有 48 个肿瘤病变。最常见的病理诊断是神经鞘瘤,占 51.5%。81.8%的病变完全切除肿瘤,始终进行神经生理刺激和/或监测。最常见的术后并发症是 15%的手术出现神经性疼痛和/或短暂感觉障碍,只有 2 例出现持续运动功能障碍,需要神经移植重建。

结论

尽管由于应用周围神经微创手术的基本概念,良性肿瘤(如神经鞘瘤)的治疗管理可以被认为相对简单,但恶性肿瘤尽管非常罕见,仍需要多学科管理。术前活检的选择仍然是一个有争议的问题,不同作者之间没有达成共识。在我们看来,在大多数情况下,经皮活检不是必需的。

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