NEURAL SHEATH TUMORS OF MAJOR NERVES

Over a 22-year period, operations were performed on 263 patients for 2 88 primary benign tumors of major peripheral nerves. The tumors includ ed 85 schwannomas, 197 neurofibromas, and six plexiform neurofibromas. Total removal was achieved in 83 of the 85 schwannomas, and 76 of the se patients were available for follow-up evaluation. Motor function ei ther improved or was unchanged in 87% of these patients and 85% of tho se with pain in the distribution of the involved nerve had either tota l or partial resolution of their symptoms. Of the neurofibromas, 123 o ccurred in 121 patients without von Recklinghausen's disease. All tumo rs within this group were completely excised using a fascicular approa ch to the tumor. Of the 99 patients available for follow-up evaluation , 90% had either improved or unchanged motor function and 88% had part ial or complete resolution of pain syndromes. Fifty-nine patients with von Recklinghausen's disease had 80 tumors removed: 74 fusiform tumor s (58 of which were completely removed) and six plexiform tumors. Fort y-eight of the 58 patients with gross total removal of fusiform tumors were available for follow-up evaluation, of whom 83% had improved or unchanged motor function and 74% had partial or complete resolution of pain syndromes. All six patients with plexiform tumors had progressio n of symptoms postoperatively. One brachial plexus schwannoma recurred and was re-excised without subsequent recurrence at the 5-year follow -up evaluation. Several incompletely excised plexiform neurofibromas h ave recurred with a symptomatic presentation.