Open resection of rare and big Schwannoma of brachial plexus branches

Emir Begagić, University of Zenica, Faculty of Medicine, Zenica, Bosnia and Herzegovina
Lejla Čejvan, University of Zenica, Faculty of Medicine, Zenica, Bosnia and Herzegovina
Hakija Bečulić, Cantonal Hospital Zenica, Department of Neurosurgery, Bosnia and
Herzegovina

Introduction: Schwannomas are encapsulated tumors that originate from Schwann cells and
develop slowly. Tumors can develop in any nerve, but tumors of the brachial plexus are the most
uncommon, accounting for less than 5% of all schwannomas.

Case description: A 29-year-old woman presented with a mass on the left upper arm's
posteromedial side. It's a localized mass, solid to the touch, of the upper arm which causes distal
paresthesia. An Magnetic Resonance Imaging scan revealed a mass along with the medial head
of the triceps brachial muscle. This tumor affects the ulnar, radial, and musculocutaneous nerves
on radiography. The brachial artery and vein were first removed from the tumor, during
resection. The ulnar nerve and the musculocutaneous nerve are isolated. A simple origin
infiltrates the radial nerve, and preserved fibers were successfully dissected. Since more than half
of the radial nerve is preserved, there is no need for a sural graft. The patient's left dorsiflexion
was reduced after surgery. The patient made a full recovery after physical therapy.

Discussion: The first treatment option was open surgery due to the tumor's size and presence in
surrounding structures. The prompt therapy aided in the avoidance of neurological deficits. The
benign nature of the tumor was confirmed by pathohistological analysis, which revealed
dominant Antoni A areas and a less myxoid hypocellular portion (Antoni B areas). Because of
the minimal dorsiflexion of the left hand, the recovery phase included physical therapy.

Conclusion: Separation of non-infiltrated nerve fibers and rehabilitation process represents a

safe protocol that results in a positive outcome.

Keywords: Schwannoma, Neoplasms, Brachial Plexus, Neurosurgical Procedures