Experience Of Surgical Management Of Brachial Plexus Region Tumors In 19 Patients

Objective: To present our experience in managing these lesions.This study retrospectively analyzed 19 cases of brachial plexus region tumors treated in our department for 7 years. Proposes a relatively simple surgical partitioning methods and gives advice for the corresponding operative approach to assess and summarize the efficacy of surgical treatment.Methods: Retrospective study was performed January 2008 to December 2014 after surgical treatment of brachial plexus region tumors of 19 cases in our department. The clinical manifestations, signs and imaging results of all patients were analysed. Magnetic resonance imaging(MRI) was performed to document tumour location and relationship with adjacent structures. According to the space relationship between tumour and brachial plexus,we proposed a relatively simple surgical partitioning methods and gives advice for the corresponding operative approach:(1) above the brachial plexux(Anterior supraclavicular),(2) internal brachial plexus(classic anterior clavicular),(3). Below the brachial plexus(utilitarian shoulder approach),(4) in front of the brachial plexus(clavicle osteotomy),(5) behind the brachial plexus(Posterior subscapular). Postoperative analysis pathological features, surgical complications, follow up to understand the extent of improvement in symptoms, relapse and mortality of the 19 cases.Results: 1.There were 16 patients(84.21%) have found growing mass as primary symptom history. Pain was a relevant complaint in 10(52.63%) patients. Six(31.58%)of our patients presented pre-operative motor deficit, 1(5.26%)of our patients presented pre-operative sensory loss. Thirteen patients adopted marginal resection.Six patients adopted intracapsular resection.Three patients have positive margins. One of our patients presented intraoperative nerve injury complications. 2. The surgical partition of the tumor pathology type :(1) above the brachial plexus for 3 patients(Ewing's Sarcoma diagnosed in 1 patient,lymphoma in 1 patient and follicle-like soft tissue sarcoma in 1 patient)(2) internal brachial plexus for 7 patients(schwannomas diagnosed in 5 patients, neurofibromatosis in 2 patients)(3) Below the brachial plexus for 4 patients(lymphatic vascular tumors diagnosed in 1 patient,lipoma in 1 patient,desmoid tumor in 1 patient and metastatic Squamous Cell Carcinoma in 1 patient)(4) in front of the brachial plexus for 3 patients(Ewing's Sarcoma diagnosed in 1 patient,osteosarcoma of the angiectatic in 1 patient,desmoid tumor in 1 patient)(5) behind the brachial plexus for 2 patients(desmoid tumor diagnosed in 1 patient,hemangioma in 1 patient). 3.The 19 patients were followed ranged from 8 to 49 months(average =24.1 months). All patients had acquired grade?healing.Two patients occured C8 and T1 nerve root symptoms in postoperative,one patient with the C8 nerve root symptoms had not significant improved during the follow-up of 29 months, the other patient with the T1 nerve root symptoms improved after 1 month. In patients who complained of pain at presentation, 8 became pain free, while pain severity was reduced after surgery in the remaining 2 patients. No patient developed pain after surgery. Three patients with paraesthesiae and numbness as initial symptoms reported remission after surgical treatment. Only one patients with sensory loss at initial presentation, reported postoperative remission of the symptom. New sensory deficits developed in 1 patients after surgery, who submitted to an en bloc resection, and neither recovered. After surgery, motor deficits improved in 4 patients and resolved in 2 patients. One patients presented new motor deficits postsurgery,who submitted toanen blocresection, did not improve. There was no recurrence of benign tumor during follow-up.Two patients diagnosed in desmoid have recurrence. One patient diagnosed in follicle-like soft tissue sarcoma died in lung cancer metastasis after 8 months, the others were alive.Conclusion: Based on the classic approach,surgical partitioning according to the tumor and the relationship between brachial plexus: above the brachial plexus,below the brachial plexus, internal brachial plexus,in front of the brachial plexus,behind the brachial plexus.This partition methods are simple and easy communication. Using this classification as a reference to select the appropriate surgical approach,good results can be obtained.