Nerve tumors may cause pain, tingling and other symptoms. John R. Barbour, MD, FACS, is a triple board-certified plastic and reconstructive surgeon who uses his expertise as a fellowship trained hand and peripheral nerve specialist to provide expert care for nerve tumor treatment. Dr. Barbour offers nerve tumors treatment to the residents of the Washington, DC, area, including Fairfax, Arlington, Alexandria and surrounding communities in Virginia.
Tumors of almost any type can form along peripheral nerves. Peripheral nerve sheath tumors (PNSTs) are uncommon masses which grow from the nerve itself and generally are benign (non-cancerous). Generally slow growing, these tumors can form within the nerve itself, and cause the nerve to gradually expand. Untreated nerve tumors begin to compress the adjacent nerve fibers, causing nerve dysfunction. Patients may report pain, numbness, and/or weakness in their hands or feet in the distribution of the affected peripheral nerve.
Neurofibromas and Schwannomas are the most common forms of nerve sheath tumors. These tumors can occur in isolation or as part of a syndrome, such as congenital neurofibromatosis. Once they start to cause pain or other problems, it may be good to remove them to prevent them from growing too large and causing problems. In almost all cases surgical excision to obtain a diagnosis and to cure the tumor is needed. It is important to have an experienced peripheral nerve surgeon perform this operation, as most peripheral nerve tumors form within the nerve itself, and thus are surrounded and intertwined with functional nerve fibers that must be preserved during excision of the tumor.
In rare cases, the tumor is so involved with the nerve that complete excision is impossible without sacrificing the nerve. Generally Dr. Barbour will be able to tell from your MRI scan whether this is likely to be the case before the surgery is performed. There is often no way to tell for sure pre-operatively if a tumor is malignant. Pathological analysis of tumor tissue obtained via open surgery is the only way to know for sure if a tumor is malignant. Removal of tumors often can be performed without causing paralysis in the muscles supplied by that nerve, and usually only a small area of the skin experiences some numbness, which is usually temporary. Surgery to remove a schwannoma is the least complicated and to remove a neurofibroma slightly more complex.
Schwannoma
These are benign, slow growing nerve tumors that can occur anywhere in the peripheral nervous system. Generally patients discover a painless, firm lump. Though these tumors form within nerves and are surrounded by normal nerve fibers, they are easily separated from the nerve and removed by an experienced peripheral nerve surgeon.
Neurofibroma
These are benign, slow-growing nerve tumors, similar to schwannomas. They commonly occur in patients who suffer from neurofibromatosis, a genetic disorder resulting in multiple tumors throughout the body. Cutaneous neurofibromas grow along small branches of nerves under the skin of patients with neurofibromatosis. They may present as painful lumps under the skin. They are not associated with large nerves, and are easily removed. Larger neurofibromas tend to grow within large, important nerves.
Unlike schwannomas, however, they are more intimately intertwined with the nerve fibers, making removal more difficult. Nevertheless, with meticulous surgical technique, these difficult tumors may be safely removed, causing few if any deficits.
When a neurofibroma involves a particularly long segment of nerve or nerves, it is called a plexiform neurofibroma. These are generally impossible to remove without removing the entire nerve, causing a major neurological deficit. Therefore, these variants are not usually subjected to surgery unless there is a high suspicion of the nerve tumor being malignant. It is important to note that a small percentage of plexiform neurofibromas change from benign to malignant, and can spread to other parts of the body. If a plexiform neurofibroma becomes exceptionally painful and/or begins to rapidly expand, this suggests it has become cancerous, and it must be definitively treated.
Malignant Peripheral Nerve Sheath Tumors
These include cancers that arise within peripheral nerves as well as plexiform neurofibromas that start out as benign tumors but then subsequently become cancerous. Nerve cancers are generally rapidly-growing and painful. The operation becomes significantly more difficult when peripheral nerve surgeons remove malignant tumors or plexiform neurofibromas, which are thick, irregular and can entwine supportive structures.
It is important to operate on these lesions in a timely fashion before they have a chance to spread to other parts of the body. Goals of surgery for malignant nerve tumors are to obtain a tissue diagnosis, but not to necessarily remove the tumor. That is because cancer cells have already spread along the course of the affected nerve before surgery is performed. Therefore just removing the tumor that the surgeon can see and feel will always leave some of the cancer behind.
Once these tumors are diagnosed by an open biopsy, treatment generally requires removal of the entire adjacent nerve and all of the surrounding tissues, including muscle, blood vessels, and fat. Sometimes radiation and/or chemotherapy can be helpful, depending upon the exact type of tumor it turns out to be. With either malignant peripheral nerve tumors or plexiform neurofibromas, the Dr. Barbour may need to remove the nerve. If this occurs, nerve transfers or nerve grafting can be used to restore the important function after treatment for the tumor has been planned.
For a detailed consultation from Dr. Barbour, contact our office today.
