Brachial Plexus Schwannomas: Insights from a Case Series and an In-Depth Literature Review

Abstract

Tumours of the brachial plexus are rare and pose a clinical challenge for most neurosurgeons, even in major medical centres. The two most common brachial plexus tumours are the schwannomas and the neurofibromas, both of which are benign and arise from the nerve sheath. While brachial plexus schwannomas (BPS) are uncommon, they present a considerable challenge because of the intricate neuroanatomy of the region and the risk of affecting the patient’s quality of life, functional capacity, and financial well-being. We present our experience with three cases of successful intracapsular enucleation of brachial plexus schwannomas (BPS) performed under intraoperative neuromonitoring (INM), with no postoperative motor or sensory deficits. A retrospective review of 3 consecutive BPS cases operated at our tertiary medical research institute was conducted between April 2021 and March 2024. The clinical and demographic data were retrieved from clinical notes. Intraoperative neuromonitoring (INM) with 1.0-mA stimulation was used to identify specific trunks and divisions by observing muscle responses in the upper extremity. This allowed us to pinpoint the origin of the brachial plexus schwannomas (BPS). Post-operative recovery of all three was uneventful and histopathology examination confirmed the diagnosis of schwannoma in all 3 cases. In follow-up, no recurrence was observed, the same was confirmed in 2nd patient with a repeat CEMRI which showed no residual lesion. Meticulous dissection of nerve fascicles and gentle tissue handling to avoid excessive traction on the plexus are essential for optimizing surgical outcomes. In conclusion, Brachial plexus schwannomas (BPS) pose a formidable challenge due to their complex anatomy, diagnostic uncertainty, and potential for neurological deficits. However, with precise dissection and the strategic use of intracapsular enucleation aided by intraoperative neuromonitoring (INM), surgeons can achieve complete tumour removal while safeguarding neurological function, ensuring optimal patient outcomes.