Technical Considerations for Peripheral Nerve Sheath Tumor Excision With Intraoperative Neuromonitoring and Magnification.

Background: Peripheral nerve sheath tumors (PNSTs) are benign tumors arising from Schwann cells within the peripheral nerve sheath that frequently present with pain but may also have accompanying focal neurological deficits. As there is limited literature describing techniques for PNST excision, this article aims to introduce our institution's technique. Methods: A retrospective review of patients undergoing surgery for neurofibromatosis type 1, neurofibromatosis type 2, and schwannomatosis was conducted based on a single surgeon's experience, including patients from 2009 to 2020. Chart review included patient demographics, clinical presentation, surgical details, pathology, and postoperative course. Results: A total of 78 operations were performed on 69 patients, excising 157 peripheral nerve tumors. The majority of patients were diagnosed with neurofibromatosis type 1 (41.0%), followed by neurofibromatosis type 2 (24.4%). Pain was the most common presenting symptom (82.1% of patients). Average follow-up was 5.56 ± 12.8 months. Lesions were most frequently located in the upper extremity (48.7%). The average number of tumors excised per case was 2.04 ± 1.59. Intraoperative nerve monitoring was used in 55.1% of cases, and nerve repair was required in 46.2% of cases. The overall surgical complication rate was 2.7%, and neurological complications accounted for 16.7% of cases. Conclusions: PNSTs present a difficult reconstructive challenge. By using intraoperative nerve monitoring, tourniquet control of the extremity, magnification, microsurgical instruments, enucleation from the tumor capsule where applicable, epineural repair, and fascicular repair when there is interfascicular resection, effective results can be achieved with low complication rates.