A series of 146 peripheral non—neural sheath nerve tumors: 30-year experience at Louisiana State University Health Sciences Center

2005 ◽  
Vol 102 (2) ◽  
pp. 256-266 ◽  
Author(s):  
Daniel H. Kim ◽  
Judith A. Murovic ◽  
Robert L. Tiel ◽  
Gregory Moes ◽  
David G. Kline
Keyword(s):  
Brachial Plexus ◽  
Surgical Techniques ◽  
Health Sciences ◽  
Benign Tumors ◽  
State University ◽  
Pelvic Plexus ◽  
Content Type ◽  
Louisiana State University ◽  
Neural Sheath ◽  
Fine Print

Object. This is a retrospective review of 146 surgically treated benign and malignant peripheral non—neural sheath tumors (PNNSTs). Tumor classifications with patient numbers, locations of benign PNNSTs, and surgical techniques and adjunctive treatments are presented. The results of a literature review regarding tumor frequencies are presented. Methods. One hundred forty-six patients with 111 benign and 35 malignant PNNSTs were treated between 1969 and 1999 at the Louisiana State University Health Sciences Center (LSUHSC). The benign tumors included 33 ganglion cysts, 16 cases of localized hypertrophic neuropathy, 12 lipomas, 12 tumors of vascular origin, and 11 desmoid tumors. There were four each of lipofibrohamartomas, myositis ossificans, osteochondromas, and ganglioneuromas; two each of meningiomas, cystic hygromas, myoblastoma or granular cell tumors, triton tumors, and lymphangiomas; and one epidermoid cyst. The locations of benign PNNSTs were the following: 33 in the brachial plexus region, 39 in an upper extremity, one in the pelvic plexus, and 38 in a lower extremity. The malignant PNNSTs included 35 surgically treated carcinomas, 15 of which originated in the breast and nine in the lung. There were two melanomas metastatic to nerve and one tumor each that had metastasized from the bladder, rectum, skin, head and neck, and thyroid, and from a primary Ewing sarcoma. There was a single lymphoma that had metastasized to the radial nerve and one chordoma and one osteosarcoma, each of which had metastasized to the brachial plexus. Conclusions. There were more benign PNNSTs than malignant ones. Benign tumors were relatively equally distributed in the brachial plexus region and upper and lower extremities, with the exception of the pelvic plexus, which had only one tumor.

A series of 397 peripheral neural sheath tumors: 30-year experience at Louisiana State University Health Sciences Center

2005 ◽  
Vol 102 (2) ◽  
pp. 246-255 ◽  
Author(s):  
Daniel H. Kim ◽  
Judith A. Murovic ◽  
Robert L. Tiel ◽  
Gregory Moes ◽  
David G. Kline
Keyword(s):  
Brachial Plexus ◽  
Surgical Techniques ◽  
Neurofibromatosis Type ◽  
Health Sciences ◽  
High Morbidity ◽  
State University ◽  
Content Type ◽  
Louisiana State University ◽  
Neural Sheath ◽  
Fine Print

Object. This is a retrospective review of 397 benign and malignant peripheral neural sheath tumors (PNSTs) that were surgically treated between 1969 and 1999 at the Louisiana State University Health Sciences Center (LSUHSC). The surgical techniques and adjunctive treatments are presented, the tumors are classified with respect to type and prevalence at each neuroanatomical location, and the management of malignant PNSTs is reviewed. Methods. There were 361 benign PNSTs (91%). One hundred forty-one benign lesions were brachial plexus tumors: 54 schwannomas (38%) and 87 neurofibromas (62%), of which 55 (63%) were solitary neurofibromas and 32 (37%) were neurofibromatosis Type 1 (NF1)—associated neurofibromas. Among the brachial plexus lesions supraclavicular tumors predominated with 37 (69%) of 54 schwannomas; 34 (62%) of 55 solitary neurofibromas; and 19 (59%) of 32 NF1-associated neurofibromas. One hundred ten upper-extremity benign PNSTs consisted of 32 schwannomas (29%) and 78 neurofibromas (71%), of which 45 (58%) were sporadic neurofibromas and 33 (42%) were NF1-associated neurofibromas. Twenty-five benign PNSTs were removed from the pelvic plexus. Lower-extremity PNSTs included 32 schwannomas (38%) and 53 neurofibromas (62%), of which 31 were solitary neurofibromas and 22 were NF1-associated neurofibromas. There were 36 malignant PNSTs: 28 neurogenic sarcomas and eight other sarcomas (fibro-, spindle cell, synovial, and perineurial sarcomas). Conclusions. The majority of tumors were benign PNSTs from the brachial plexus region. Most of the benign PNSTs in all locations were neurofibromas, with sporadic neurofibromas predominating. Similar numbers of schwannomas were found in the upper and lower extremities, whereas neurofibromas were more prevalent in the upper extremities. Despite aggressive limb-ablation or limb-sparing surgery plus adjunctive therapy, malignant PNSTs continue to be associated with high morbidity and mortality rates.

Outcomes in a consecutive series of 111 surgically treated plexal tumors: a review of the experience at the Louisiana State University Health Sciences Center

2001 ◽  
Vol 95 (1) ◽  
pp. 51-60 ◽  
Author(s):  
Aruna Ganju ◽  
Norbert Roosen ◽  
David G. Kline ◽  
Robert L. Tiel
Keyword(s):  
Brachial Plexus ◽  
Health Sciences ◽  
Consecutive Series ◽  
State University ◽  
Palpable Mass ◽  
Content Type ◽  
Presenting Symptoms ◽  
Louisiana State University ◽  
Neural Sheath ◽  
Fine Print

Object. The authors conducted a retrospective study of 107 consecutive patients with 111 brachial plexus tumors surgically treated at the Louisiana State University Health Sciences Center (LSUHSC). Methods. During a 12-year period, from 1986 to 1998, 371 patients with lesions of the brachial plexus underwent surgery at LSUHSC. Among this group, 107 patients harbored 111 tumors of the brachial plexus. Neural sheath tumors were the most commonly found and included 33 neurofibromas (20 of which were associated with von Recklinghausen disease), 36 schwannomas, and 12 malignant neural sheath tumors. Of the non—neural sheath tumors, 13 were benign and 17 were malignant. Presenting symptoms included pain (59%), palpable mass (52%), paresthesias (30%), and paresis (29%). Anterior supraclavicular (82%) or posterior subscapular (18%) approaches were used to achieve gross-total (79%) or subtotal (21%) resection of tumor. The average follow-up period was 38.3 months or 3.2 years. Seventy percent of patients with benign neural sheath tumors became free from pain postoperatively or reported improvement in their preoperative pain status. Function remained intact or improved in 50% and remained stable postoperatively in another 20% of cases. Preservation of function was more likely in patients who presented intact and in those who had not undergone a previous attempted biopsy procedure or resection than in those in whom such manipulation had occurred. Conclusions. Resection of most plexal tumors is technically feasible and associated with acceptable morbidity and mortality rates.

Outcomes of surgery in 1019 brachial plexus lesions treated at Louisiana State University Health Sciences Center

2003 ◽  
Vol 98 (5) ◽  
pp. 1005-1016 ◽  
Author(s):  
Daniel H. Kim ◽  
Yong-Jun Cho ◽  
Robert L. Tiel ◽  
David G. Kline
Keyword(s):  
Brachial Plexus ◽  
Gunshot Wounds ◽  
Neurological Status ◽  
Health Sciences ◽  
State University ◽  
Content Type ◽  
Lower Trunk ◽  
Louisiana State University ◽  
Fine Print

Object. Outcomes of 1019 brachial plexus lesions in patients who underwent surgery at Louisiana State University Health Sciences Center during a 30-year period are reviewed in this paper to provide management guidelines. Methods. Causes of brachial plexus lesions included 509 stretches/contusions (50%), 161 plexus tumors (16%), 160 thoracic outlet syndromes (TOSs, 16%), 118 gunshot wounds (12%), and 71 lacerations (7%). Many features of clinical presentation, including prior treatment, patient's neurological status, results of electrophysiological studies, intraoperative findings, and postoperative level of function, were studied. The minimum follow-up period was 18 months and the mean follow-up period was 42 months. Repairs were best for injuries located at the C-5, C-6, and C-7 levels, the upper and middle trunk, the lateral cord to the musculocutaneous nerve, and the median and posterior cords to the axillary and radial nerves. Conversely, results were poor for injuries at the C-8 and T-1 levels, and for lower trunk and medial cord lesions, with the exception of injuries of the medial cord to the median nerve. Outcomes were most favorable when patients were carefully evaluated and selected for surgery, although variables such as lesion type, location, and severity, as well as time since injury also affected outcome. This was true also of TOSs and tumors arising from the plexus, especially if they had not been surgically treated previously. Conclusions. Surgical exploration and repair of brachial plexus lesions is technically feasible and favorable outcomes can be achieved if patients are thoroughly evaluated and appropriately selected.

Surgical interventions for traumatic lesions of the brachial plexus: a retrospective study of 134 cases

2005 ◽  
Vol 103 (4) ◽  
pp. 614-621 ◽  
Author(s):  
Julia A. Kandenwein ◽  
Thomas Kretschmer ◽  
Martin Engelhardt ◽  
Hans-Peter Richter ◽  
Gregor Antoniadis
Keyword(s):  
Brachial Plexus ◽  
Surgical Techniques ◽  
Functional Results ◽  
Content Type ◽  
Surgical Interventions ◽  
Louisiana State University ◽  
Surgical Measures ◽  
Grade 3 ◽  
Nerve Surgery ◽  
Fine Print

Object. Surgical therapy for traumatic brachial plexus lesions is still a great challenge in the field of peripheral nerve surgery. The aim of this study was to present the results of different surgical interventions in patients with this lesion type. Methods. One hundred thirty-four patients with traumatic brachial plexus lesions underwent surgery between January 1991 and September 1999. In more than 50% of the patients, injury was caused by a motorbike accident. Patients underwent surgery a mean of 6.3 months posttrauma. The following surgical techniques were applied: neurolysis for nerve lesions in continuity (27 cases), grafting for lesions in discontinuity (149 cases), and neurotization for root avulsions (67 cases). Sixty-five patients were evaluated for at least 30 months (mean follow up 42.1 months) after surgery. Function was graded using the Louisiana State University Health Sciences Center classification system. Only 2% of the patients had Grade 3 or better function preoperatively, increasing to 52% postoperatively. The effect of surgical measures on the functional results for different muscles were compared (supra- or infraspinatus, deltoid, biceps, and triceps muscles); the best results were obtained for biceps muscle function (57% of patients with Medical Research Council Grades M3–M5 function). Graft reconstruction yielded a better outcome than neurotization. Surgery within 5 months posttrauma clearly resulted in improved recovery of motor function compared with later interventions. Sural nerve grafts (monofascicular nerves) showed better results. Conclusions. The results of neurosurgical interventions for brachial plexus lesions are satisfactory, especially when the operation is performed between 3 and 6 months after trauma.

Tumors of the brachial plexus

2007 ◽  
Vol 22 (6) ◽  
pp. 1-6 ◽  
Author(s):  
Sunit Das ◽  
Aruna Ganju ◽  
Robert L. Tiel ◽  
David G. Kline
Keyword(s):  
Brachial Plexus ◽  
Surgical Approach ◽  
Health Sciences ◽  
State University ◽  
Louisiana State University ◽  
Clinical Challenge ◽  
Complex Anatomy

✓Tumors of the brachial plexus are relatively rare and present a clinical challenge for the neurosurgeon. The management of these tumors therefore requires not only an understanding of the complex anatomy of the brachial plexus but also an appreciation of the appropriate surgical approach to the various tumors that may be encountered. Over a 30-year period (1969–1999), 226 patients with brachial plexus tumors were evaluated and surgically treated by the senior authors (R.L.T., D.G.K.). In the present paper they review the most common benign and malignant brachial plexus tumors and discuss management and surgical principles established through their experience at the Louisiana State University Health Sciences Center.

Evaluation and treatment of atlas burst fractures (Jefferson fractures)

1991 ◽  
Vol 75 (2) ◽  
pp. 213-220 ◽  
Author(s):  
Lee Kesterson ◽  
Edward Benzel ◽  
William Orrison ◽  
James Coleman
Keyword(s):  
State University ◽  
Content Type ◽  
X Ray ◽  
Jefferson Fracture ◽  
Louisiana State University ◽  
Burst Fractures ◽  
Long Term Result ◽  
Atlas Fractures ◽  
Fine Print

✓ Although several large series of atlas fractures have been reported recently, none has concentrated on the evaluation and treatment of atlas burst fractures (Jefferson fractures). The treatment of this fracture is challenging. Its diagnosis may easily be missed due to concerns about associated trauma and absence of neurological signs. In addition, the open-mouth anteroposterior x-ray study, which is usually pathognomonic for the diagnosis, is often inadequate or not obtained. In order to clarify the diagnosis and treatment of this disorder, 17 cases of Jefferson fracture treated between 1982 and 1989 at the Louisiana State University Affiliated Hospitals are presented. The diagnosis was delayed in three patients because of a low index of suspicion and inadequate x-ray films. Four patients were noted to have unstable Jefferson fractures; all of these had an associated Type II odontoid fracture and were treated with occiput-C-2 wiring and fusion. The remainder of the patients had stable Jefferson fractures and were managed with Minerva jackets or rigid collar stabilization. No significant complications related to the treatment of the Jefferson fracture occurred in this series. One patient died from associated injuries: however, the remaining patients enjoyed an excellent long-term result with the acquisition of spinal stability and the resolution of subjective complaints.

Operative management of selected brachial plexus lesions

1983 ◽  
Vol 58 (5) ◽  
pp. 631-649 ◽  
Author(s):  
David G. Kline ◽  
Donald J. Judice
Keyword(s):  
Brachial Plexus ◽  
Operative Management ◽  
Significant Loss ◽  
Benign Tumors ◽  
Content Type ◽  
Lower Trunk ◽  
Large Size ◽  
Fine Print ◽  
Better Than

✓ A 12-year operative experience with 171 consecutive patients with severe brachial plexus lesions who had at least 1½ years of follow-up review is analyzed. Selection for and timing of operation was helped by categorization of each individual plexus element as “completely” or “incompletely” injured and as “in continuity” or “not in continuity.” Results for each element could be given a single grade by a system which defined that element's proximal and distal input. For most lesions in continuity, an operative delay of several months is advocated so that intraoperative electrical evaluation can be used. Thus, in 282 gunshot wounded and stretch-injured elements of which 210 were thought to be clinically complete, 63 were spared resection because of nerve action potentials (NAP's) found at intraoperative testing, and 57 recovered function with only neurolysis. Elements resected (120) were confirmed as neurotmetic both by intraoperative electrical and subsequent histological studies. Acceptable results were achieved in 16 of 24 sutures, in 43 of 89 grafts, and in each of seven split repairs. Upper trunk and lateral and posterior cord elements fared better than lower trunk and medial cord lesions unless the latter were shown, with evidence of NAP's, to be regenerating and could be spared resection. Some stretched elements could, however, not be repaired, even though an attempt was made to exclude such cases from operation. Lacerations to the brachial plexus where continuity is lost are best repaired primarily if the injury is sharp; in this series, 14 of 18 elements having such repair recovered, whereas in 37 elements with secondary repair, grafts were often necessary and only 50% recovered function. Although associated with skin lacerations, 17 elements with complete loss were in continuity, and six of these were shown to be regenerating and were not resected. Despite intraneural location, large size, and prior operation, many benign tumors (including neurofibromas) can be removed without significant loss by use of the surgical loupes or microscope and repetitive NAP recording. Surgery for selected brachial plexus lesions is worthwhile.

Pelvic plexus tumors

2007 ◽  
Vol 22 (6) ◽  
pp. 1-5 ◽  
Author(s):  
Kurtus Dafford ◽  
Daniel Kim ◽  
Natasha Reid ◽  
David Kline
Keyword(s):  
Clinical Presentation ◽  
Histopathological Examination ◽  
Neurofibromatosis Type ◽  
State University ◽  
Pelvic Plexus ◽  
Nerve Sheath Tumors ◽  
Louisiana State University ◽  
Neural Sheath

Object Pelvic plexus tumors are unusual entities. These lesions often reach significant size prior to clinical presentation due to vague lower extremity or other symptoms refractory to exhaustive workup and the potential space of the retroperitoneum. Methods The authors retrospectively reviewed the charts of 44 patients who presented to Louisiana State University Health Sciences Center with pelvic plexus tumors. All such patients were included in the present study if there was at least 12 months of follow-up. Clinical evaluations were examined, including typical clinical presentation, imaging studies, and other preoperative evaluations. These tumors include 38 peripheral neural sheath tumors (86%), two malignant neural sheath tumors (5%), and four nonneural sheath tumors (9%). The authors also examined the relation of pelvic neural sheath tumors to neurofibromatosis Type 1 (NF1). Results Histopathological examination confirmed 18 solitary neurofibromas (41%), 12 NF1-associated neurofibromas (27%), eight schwannomas (18%), two malignant nerve sheath tumors (5%), and four other nonneural sheath tumors (9%). The other nonneural sheath tumors consisted of one each of desmoid, ganglioma, lipoma, and an unspecified calcified mass. Conclusions The optimal treatment for retroperitoneal lesions remains operative excision with adjunctive therapy specific to the lesion encountered.

Intrapelvic and thigh-level femoral nerve lesions: management and outcomes in 119 surgically treated cases

2004 ◽  
Vol 100 (6) ◽  
pp. 989-996 ◽  
Author(s):  
Daniel H. Kim ◽  
Judith A. Murovic ◽  
Robert L. Tiel ◽  
David G. Kline
Keyword(s):  
Femoral Nerve ◽  
Gunshot Wounds ◽  
Nerve Lesion ◽  
Cystic Lesions ◽  
State University ◽  
Nerve Lesions ◽  
Content Type ◽  
Louisiana State University ◽  
Injury Mechanisms ◽  
Fine Print

Object. The authors present a retrospective analysis of 119 surgically treated femoral nerve lesions at intrapelvic and thigh levels seen at the Louisiana State University Health Sciences Center. Methods. Femoral nerve lesions treated between 1967 and 2000, (89 traumatic injuries and 30 tumors and cystic lesions) were evaluated for injury mechanisms, resulting lesions, surgical management, and postoperative functional outcomes by using retrospective chart reviews. The most common injury mechanism was iatrogenic (52 cases), which occurred after hernia and hip operations (10 each), followed by arterial bypass and gynecological procedures (eight each), angiography (seven), abdominal surgery (five), appendectomy (two), a laparoscopy, and a lumbar sympathectomy. Other injury mechanisms included hip or pelvic fractures (19), gunshot wounds (10), and lacerations (eight). The 30 femoral nerve tumors and cystic lesions consisted of neurofibromas (16), schwannomas (nine), ganglionic cysts (two), neurogenic sarcomas (two), and a leiomyosarcoma. Forty-four patients underwent neurolysis. Some had recordable nerve action potentials (NAPs) across their lesions in continuity, despite severe distal loss. Others with recordable NAPs had mild loss, but also experienced a pain problem, which was helped in some by neurolysis. In 36 patients, in whom repairs were performed using long sural grafts for mostly proximal pelvic-level injuries, recovery of useful function occurred. Eight of nine thigh-level suture repairs led to improvement to good functional levels. Most of the tumors and cystic lesions were resected, with preservation of preoperative function. Conclusions. The majority of femoral nerve injuries resulted in lesions in continuity, and intraoperative NAP recordings were essential in evaluating axonal regeneration across these lesions. Despite severe and frequently proximal injury levels requiring repairs with long grafts, femoral nerve lesion repairs resulted in good functional recovery.

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