An innovative resection of giant neurofibromas

Abstract

Background

Plexiform neurofibromas (PNF) are highly vascular tumors with the potential for significant growth. Surgical removal of giant PNF is often challenging because of intraoperative hemorrhage. This study proposed and evaluated an innovative surgical approach involving FENCY ligation and the role of preoperative embolization in the resection of giant PNF.

Methods

This was a retrospective, interventional, and sequential case series conducted in a plastic and reconstructive surgery unit. We summarized all patients with PNF who underwent resection at our center between 2019 and 2024. Surgical case notes from 11 patients with giant PNF who underwent FENCY ligation were reviewed, including three patients who received preoperative embolization. All patients participated in structured telephone interviews. Patient demographics, surgical safety, postoperative recovery, and patient satisfaction were evaluated.

Results

Among 456 patients with 494 PNF who underwent surgical resection, we categorized the procedures into median, large, and giant PNF subgroups. To illustrate comprehensive perioperative and surgical approaches, we analyzed seven female and four male patients with giant PNF. The median maximum tumor diameter at the time of surgery was 30.4 ​cm (range, 11.5–55.6 ​cm). Most PNF were located on the face (63.6%), followed by the back (18.2%), buttocks (18.2%), upper limbs (9.1%), and neck (9.1%). The median intraoperative hemorrhage volume was 366 ​mL (range, 10–2 034 ​mL), And the median hospital stay was 17 days (range, 14–33 days). The mean follow-up duration was 2.5 years (range, 0.4–5.5 years). No severe complications were observed, except for one case of infection.

Conclusion

PNF resection, particularly giant PNF resection, is a high-risk treatment option. Comprehensive evaluation, perioperative preparation, and surgical techniques are required to ensure efficacy and safety. FENCY ligation and preoperative embolization can be used to resect giant PNF in multiple complex regions with satisfactory outcomes.