447 Is Surgical Management of Brachial Plexus Schwannomas Safe and Effective: A Review of Clinical Experience

INTRODUCTION: Tumors of the brachial plexus represent a challenge because of the plexus neuroanatomical complexity and the scarce literature on the management of such rare tumors. One of these tumors is schwannomas which arise from the nerve sheath. METHODS: The medical records of 213 patients diagnosed with schwannomas between July 2003 and February 2020 at Johns Hopkins Medical Institutes were reviewed. The patients who had surgery for brachial plexus schwannomas were identified. Their demographic characteristics, clinical presentations, and surgical outcomes were described. RESULTS: Of 29 patients with brachial plexus schwannoma, 26 had surgical resection and were included in this study [Mean ± SD age, 45.00 ± 16.87 (range, 18-77); Women, 16 (61.5%)]. The most common presenting symptoms were pain (19, 73.1%) and palpable mass (18, 69.2%). Sensory and motor deficits were reported in 19 (73.1%) and 11 (42.3%) patients, respectively. The mean ± SD duration of symptoms was 20.34 ± 21.04 months, and the tumor was discovered as an incidental finding in 7 (26.9%) patients. The gross total resection was achieved in 20 (76.9%) patients. During their hospitalization for a mean of 1.58 ± 1.14 (range, 1-6) days, one patient developed postoperative wound infection, with no recorded deaths. Postoperatively, the mean follow-up duration was 17.04 ± 23.78 months. After follow-up, 12 patients reported improvements in their preoperative pains, with a recovery rate of 63.2%. Among those with preoperative neurological deficits, complete recovery from sensory and motor deficits was documented in 10 (52.6%) and 8 (72.7%) patients, respectively. However, a total of 6 patients developed new sensory and/or motor deficits. Tumor recurrence was reported in two (6.9%) patients. CONCLUSIONS: Brachial plexus schwannomas are surgically curable lesions by gross total resection with favorable outcomes, acceptable risks, and low incidence of tumor recurrence.