Pearls
1. The most common peripheral nerve tumors occur in any peripheral nerve but especially the spinal nerves, peroneal nerve, ulnar nerve, sympathetic nerves and vagus nerves.
2. In a peripheral nerve the presentation is that of a mass that is often painless with paresthesias and positive Tinel's sign over the nerve. The exception of greater findings occurs if the nerve is in a restricted space such as carpal or fibular tunnel.
3. Schwannomas of deep nerves such as sciatic are difficult to detect.
4. Scwannomas that arise from spinal or sympathetic nerves may extend into and compress the spinal cord.
5. Multiple schwannomas occur primarily but not exclusively in NF-2.
6. 62% neurofibromas, 38% schwannomas
In schannomas function preserved in 89% after resection
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2 comments:
Schwannomas of the peripheral nerve have may cause little nerve damage and have deceptively normal electrodiagnostic tests.
X rays, and CT are used, but MRi WITH CONTRAST is the best test even for small tumors or even pseudotumors. The ability to type tumors based on MRI is debated.
Ultrasound also can detect tumors and be a useful test.
"5. Multiple schwannomas occur only in NF-2."
This is not true and is misleading. As a Schwannomatosis suffer myself I can tell you I am not an NF2 sufferer yet have had more than 30 schwannomas removed from my ulnar and radial nerves.
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