What's New in the Management of Benign Peripheral Nerve Lesions?
Section snippets
Intraneural Benign Tumors of Neural Sheath Origin (eg, Schwannoma, Neurofibroma)
A large experience with these relatively common tumors has demonstrated that benign nerve sheath tumors can be identified correctly on MRI and can often be resected safely and effectively from peripheral nerves. The typical MRI appearance is of a well- marginated oval lesion that is isointense to muscle on T1-weighted imaging, hyperintense on T2-weighted imaging, and with prominent enhancement after contrast administration (Fig. 1). There often is an area of low signal on T2-weighted imaging
Benign tumors of nonneural sheath origin
A wide variety of nonneural sheath tumors are being evaluated and often times, operated on and resected. The authors feature intraneural ganglia, lipomatous lesions of nerve, and desmoids. Others are neuritis ossificans, vascular tumor of nerve, ganglioneuroma, meningioma, glomus tumor, and granular cell tumor, among others.29
Extraneural Tumors
A whole host of (benign or malignant) extraneural tumors may extrinsically compress peripheral nerves. The most common benign entities include lipomas (Fig. 12) and ganglia (Fig. 13), but these extraneural tumors can include bony (eg, osteoid osteoma, osteochondroma, myositis ossificans) or soft tissue (eg, lymphangioma, cystic hygroma) lesions. Mass effect by the lesion itself or by surrounding edema41 can give rise to symptoms and signs of nerve compression. Many of these lesions have
MRI of peripheral nerve lesions
Significant benefits have been obtained from advances in MRI techniques and equipment (high-resolution MRI, new dedicated coils, and the clinical availability of 3-T scanners) in addition to musculoskeletal or neuroradiologists interested and experienced in peripheral nerve imaging. High-resolution MRI (“magnetic resonance neurography”) allows the identification and characterization of lesions primarily and secondarily affecting nerves, the relation to surrounding important anatomic structures,
Summary
The past 2 decades have been important ones for advancing the practice and the science related to benign peripheral nerve lesions. Further improvements lie ahead in improving outcomes by the appreciation of imaging characteristics before surgery, refinement of medical and operative interventions, and comprehension of the pathologic findings. Continuing experience and technical advances and understanding by physicians engaged in diagnosing and treating disease of the peripheral nervous system
References (54)
- et al.
Clinical presentation and physical examination
Neurosurg Clin N Am
(2004) Diagnostic steps, imaging, and electrophysiology
Neurosurg Clin N Am
(2004)- et al.
Peripheral nerve tumors: surgical principles, approaches, and techniques
Neurosurg Clin N Am
(2004) Complication avoidance. Peripheral nerve tumors: diagnosis and management
Neurosurg Clin N Am
(2004)- et al.
Management of patients with schwannomatosis: report of six cases and review of the literature
Surg Neurol
(2004) - et al.
Germline mutation of INI1/SMARCB1 in familial schwannomatosis
Am J Hum Genet
(2007) - et al.
Magnetic resonance imaging of peripheral nerves
Neurosurg Clin N Am
(2008) - et al.
Compression nerveuse par pseudo-kyste mucoide: a propos de 23 cas
Rev Chir Orthop Reparatrice Appar Mot
(2004) - et al.
Tibial intraneural ganglia in the tarsal tunnel: is there a joint connection?
J Foot Ankle Surg
(2007) - et al.
Catamenial Bernard-Horner's syndrome related to thoracic endometriosis
Ann Thorac Surg
(2006)