Brachial Plexus Schwannoma: Case Report

Abstract

Introduction: Brachial plexus schwannomas is a rare entity, only about 5% arise from the brachial plexus. The diagnosis can be a challenge to surgeons. we provide a case report of a brachial plexus schwannoma and we highlight the clinical aspects of these tumors, the role of imaging in the diagnosis, the surgical treatment, and its outcomes.. Case Report: A 62-year-old male patient, presented with a slowly growing neck mass that had been noted for more than 20 years, associated with slowly evolving weakness of the left upper limb. clinically a 4 x 5 cm mass located in the left supraclavicular region was found. (CT) showed a well- encapsulated, low-density mass near the cervical spinal root. The mass was excised through a supraclavicular incision. The histopathology of the tumor was consistent with Schwannoma. A neurological deficit of the left arm was found immediately after the operation. The patient received sessions of rehabilitation therapy only. Six months later, the motor neurological functions had partially recovered. Discussion: Schwannomas are indolent tumors but may present with symptoms secondary to nerve compression. Clinically, the most common presenting symptoms are palpable mass, pain paresthesia/numbness, and weakness. Contrast-enhanced CT and magnetic resonance images (MRI) are helpful in the pre-operative diagnosis. MR imaging is the study of choice to delineate the margins of the tumor from surrounding tissues with the greatest contrast. The choice of surgical approach is important and can be selected according to the tumor size, tumor site, and relationship with adjacent organs. A variety of surgical approaches are used. Recently, intracapsular enucleation has been introduced to preserve the neurological functions, it is possible to open the capsule and shell out the tumor, thereby leaving the capsular nerve undisturbed and possibly avoiding functional deficits [1]. Despite the extrafascicular characterization of the tumor, it is almost always possible to find a small fascicle entering and exiting the proximal and distal poles of the tumors, such as in our reported case. This fascicle does not transmit nerve action potential and can be sectioned so that the tumor can be.