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Neurosurgery
Surgical Management of Peripheral Nerve Tumors
Built from Feldman — Neurosurgical Operative Atlas: Neuro-Oncology
What’s inside
10 sections · 59 slides
What Peripheral Nerve Tumors Are
A rare, diverse family of nerve lesions
- The problem in one picture
- Where these tumors come from
- The two great divides
- Classifying peripheral nerve tumors
- Imaging clues that point to a diagnosis
Evaluating the Patient
History, examination, and the syndromes to look for
- Taking the history
- Examining the mass
- NF-1: how the diagnosis is made (two or more features)
- NF-2 and schwannomatosis: the defining criteria
- Who actually needs surgery
Imaging and Preoperative Preparation
Reading the scan before touching the nerve
- Which test, and why
- Telling schwannoma from neurofibroma on MRI
- The malignancy question
Core Operative Technique
Principles common to most nerve-tumor surgery
- Setting up the operation
- Exposure and protecting function
- Entering and removing the tumor
Schwannoma
The commonest peripheral nerve tumor
- Axillary schwannoma of the median nerve
- What a schwannoma is
- How a schwannoma looks under the microscope
- The atypical variants
- Schwannomas and inherited syndromes
- NF-2 with bilateral vestibular schwannomas
- Schwannomatosis with multiple peripheral schwannomas
Neurofibroma
The intrafascicular tumor of NF-1
- What a neurofibroma is
- The three subtypes
- Plexiform neurofibroma: behaviour and warning signs
- When to operate on a plexiform neurofibroma
- NF-1 neurofibromas of the femoral and sciatic nerves
Other Benign Lesions of Nerve
Perineurioma, fat, cysts, and outside compressors
- Intraneural perineurioma
- Intraneural perineurioma of the tibial nerve
- Fatty (adipose) lesions of nerve
- Intraneural ganglion cyst
- Extraneural tumors and desmoids
Malignant Nerve Sheath Tumors
The aggressive end of the spectrum
- What an MPNST is
- Making the diagnosis
- Why sampling is tricky: heterogeneity
- Managing an MPNST
- MPNST arising in a plexiform neurofibroma (NF-1)
- Prognosis and adjuvant therapy
Secondary Malignant Involvement
When cancer reaches the nerve from elsewhere
- Intraneural metastasis and perineural spread
- The radiation-neuritis dilemma
- Prostate cancer spreading along the sciatic nerve
- Pancoast tumors
Putting It Together
Principles that guide safe management
- The numbers that shape decisions
- Three management mindsets
- Key takeaways
- Viva: How do you distinguish a schwannoma from a neurofibroma at the fascicular level?
- Neurosurgical Operative Atlas: Neuro-Oncology