Difficulties and Challenges in the Management of Large Neurogenic and Non-Neurogenic Tumors Secondarily Involving Nerves: An Experience of Six Cases

Introduction: Large tumours arising primarily from nerves or secondarily involving nerves are not uncommon. Symptomatic patients need surgical excision. We narrate our experience dealing with a few large tumours and highlight the problems that we encountered managing these complex tumours.

Methods: In our experience of 30 years, six patients with large neurogenic and non-neurogenic tumours secondarily involving the surrounding neurovascular structures were managed at the Department of Neurosurgery, P D Hinduja Hospital and MRC. The complexity involved and the difficulties faced during the management are highlighted. One patient each had a desmoid tumour and hemangioma in the region of the brachial plexus in the neck. In one patient each, there was a large schwannoma of the lumbosacral plexus and radial nerve in the arm. In one patient each, there were neurofibromas involving multiple nerve plexuses in the body and a large mediastinal neurofibroma. Patients were evaluated with a contrast MRI, and a pre-operative biopsy was performed in all six patients. Radical to complete excision was performed in 5 patients. In one patient with multiple neurofibromas involving plexuses, symptomatic treatment was offered.

Results: The management of these six patients was extremely challenging concerning decision-making, intra-operative difficulties like bleeding, neural preservation and dilemmas in diagnosis. We share our experience in the management of these patients and highlight our limitations despite our experience over 3-decades.

Conclusion : Large symptomatic tumours need surgical excision. However, the surgery involves challenges and can be life-threatening.