Hand and Microsurgery Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
Department of Orthopedic Surgery, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
J Hand Surg Asian Pac Vol. 2021 Mar;26(1):17-23. doi: 10.1142/S2424835521500028.
Previous reports on schwannomas of the upper extremities have mainly focused on proximal involvement. This study aimed to evaluate pre- and peri-operative findings in schwannomas of the distal upper extremities and assess the accuracy of diagnosis and surgical outcome. We identified 24 patients with isolated tumors. Seven patients had schwannomas located in the forearm, eleven in the hand, and six in the digits. We collected the following data: preoperative clinical and magnetic resonance imaging findings, provisional diagnosis, surgical findings and procedures, tumor volume, and postoperative clinical findings. Data were compared between tumors of different locations. The mean age of our cohort at the time of surgery was 48.0 years and the mean follow-up period was 10.6 months. All patients with forearm schwannomas were diagnosed preoperatively by the presence of the Tinel-like sign and suggestive magnetic resonance imaging findings. In contrast, schwannomas in the hands and digits often lacked these diagnostic features; only five patients with hand schwannomas and one with digit schwannoma were correctly diagnosed. Microsurgical enucleation was the most common treatment. Ten patients reported newly acquired paresthesia after operation, which resolved within the follow-up period in nine patients. Three of the four patients with preoperative paresthesia and one patient who underwent enucleation with surgical loupes still had paresthesia at the final follow-up. In schwannomas of the distal upper extremities, a more distal location is associated with a lower occurrence of the Tinel-like sign and fewer suggestive magnetic resonance imaging findings, resulting in lower diagnostic accuracy. However, intra-operative diagnosis is usually straightforward and microsurgical enucleation does not cause iatrogenic nerve deficit. When treating soft tissue tumors in the hand and digits that present without specific or suggestive findings, the possibility of schwannoma should be considered.
先前关于上肢神经鞘瘤的报告主要集中在近端受累。本研究旨在评估远端上肢神经鞘瘤的术前和围手术期发现，并评估诊断和手术结果的准确性。我们共确定了 24 例孤立性肿瘤患者。7 例患者的神经鞘瘤位于前臂，11 例位于手部，6 例位于手指。我们收集了以下数据：术前临床和磁共振成像发现、暂定诊断、手术发现和程序、肿瘤体积以及术后临床发现。我们比较了不同部位肿瘤的数据。我们队列中患者的平均手术年龄为 48.0 岁，平均随访时间为 10.6 个月。所有前臂神经鞘瘤患者均通过 Tinel 样征和提示性磁共振成像表现术前诊断。相比之下，手部和手指的神经鞘瘤往往缺乏这些诊断特征；仅 5 例手部神经鞘瘤和 1 例手指神经鞘瘤患者被正确诊断。显微镜下剜除术是最常见的治疗方法。10 例患者术后报告新出现感觉异常，9 例患者在随访期间消失。4 例术前有感觉异常的患者中有 3 例和接受手术放大镜下剜除术的患者中有 1 例在最终随访时仍有感觉异常。在远端上肢神经鞘瘤中，位置越远，Tinel 样征的发生率越低，提示性磁共振成像表现越少，导致诊断准确性降低。然而，术中诊断通常很直接，显微镜下剜除术不会造成医源性神经缺损。在手和手指等无特定或提示性表现的软组织肿瘤的治疗中，应考虑神经鞘瘤的可能性。
