Brachial Plexus Large Neurofibroma; Case Report And Surgical Techniques

Abstract

Background: Primary tumors arising in the brachial plexus are rare. Presenting signs and symptoms included: mass, paresthesia/numbness, radiating pain, local pain, and weakness. The duration of symptoms ranged from 2 months to 10 years prior to treatment, according to literature. They are include schwanomma, neurofibroma, malignant peripheral never sheet tumor (MPNST), and desmoid tumor. Some of neurofibromas are associated with von Recklinghausen's disease (VRD).

Case presentation: In this case a 31 years old lady with history of 2 months of supraclavicular mass and left arm paresthesia present. On examination only a large mass palpated but motor force of upper limb was normal. She underwent fine needle biopsy in another center with pathologic diagnosis of neurofibroma, and referred to our center. In brachial plexus MRI a large well defined tumor of neural plexus was seen. She operated through supraclavicular approach (with alertness to infra-clavicular approach if needed), and tumor totally resected by microscopic dissection. Pathologic diagnosis was neurofibroma. After surgery she was neurologically intact and improved her paresthesia gradually. On follow up MRI no tumor remnant or recurrence occurred and she is well clinically.

Conclusions: Primary tumors arising in the brachial plexus are rare. Careful workup, surgical technique, and attention to pathological diagnosis optimize management