Brachial plexus tumours: Diagnosis, treatment, surgical approach, and outcomes in a series of 47 patients

Abstract

Introduction

Brachial plexus tumours are uncommon, with a prevalence of less than 5% of upper extremity tumours, and their surgical resection represents a major challenge due to the anatomical complexity of the region. The aim of this retrospective study is to analyze, in a large patient series, the clinical, radiological, and surgical characteristics of brachial plexus tumours, as well as to evaluate the different surgical approaches used according to tumour location and characteristics.

Material and methods

A retrospective study was conducted of all patients operated on for brachial plexus tumours between 2000 and 2025 at a tertiary center. Clinical, radiological, histological, surgical, and follow-up variables were collected. Approaches were classified as supraclavicular, infraclavicular, supra-infraclavicular, and posterior. Mild and severe neurological deficits were defined. Descriptive statistics and χ² tests were used to analyze the relationship between tumour size and malignancy.

Results

Forty-seven patients were included (mean age: 48.5 years; 55.3% women). The most common symptom was pain (72.3%). The tumours were: schwannomas 29.8%, neurofibromas 27.7%, malignant 25.5%, metastases 4.3%, and miscellaneous 12.8%. Complete resection was achieved in 53.2%, being more frequent in schwannomas. The most frequent locations were the posterior cord and the inferior trunk. The size-malignancy relationship showed a non-significant trend towards higher malignancy in tumours >50 mm (p = 0.072). After surgery, 46.8% were left without sequelae; new motor deficit was more common in patients without prior deficits. Recurrences were recorded in 23.4% and progression of residual tumour in 14.9%.

Conclusions

Surgical resection of brachial plexus tumours depends on histological type, size, and their relationship with neurovascular structures. Schwannomas allowed a higher rate of total resection, unlike neurofibromas and malignant tumours, which were limited by infiltration and size. We highlight the usefulness of surgery for functional improvement, as most patients improved in this aspect, aided by intraoperative neurophysiological monitoring.