Romanian Neurosurgery (Jun 2016)
Nerve sheath tumor, benign neurogenic slow-growing solitary neurilemmoma of the left ulnar nerve
Abstract
This paper represent a report of a case with ulnar nerve schwannoma(neurilemmoma), benign neurogenic slow-growing, tumors originating from Schwann cells along the course of a nerve (1) (2) (3). Schwannomas are the most common tumors of the peripheral nerves which occur in the adults (0.8–2%) (5). Usually they progress slowly and so they can remain painless swellings for a few years before other symptoms appear. Most of these lesions could be diagnosed clinically, are mobile in the longitudinal plane along the course of the involved nerve but not in the transverse plane (7). EMG, MRI, and ultrasonography are useful tools in the diagnosis. The definitive treatment of benign peripheral nerve schwannomatosis is complete enucleation of the tumor mass without damaging the intact nerve fascicles followed by confirmatory hystopathological examination (12). We present the case of a 62 years old right hand-dominant female who notice a slow increasing bulge over the inner aspect of her distal volar left forearm superior to the wrist, for a longer period of time not exactly specified; this was tracked and associated by pain, tingling and numbness over inner one and half fingers of her left hand in progress until the presentations. A diagnosis of soft-tissue tumor was presumed clinically. The other investigations were ultrasonography (US), nerve conduction studies (NCSs) such as sensory nerve action potential (SNAP) and compound muscle action potential (CMAP). In this case IRM was suggestive of a benign growth in her left ulnar nerve in the forearm region. Microsurgical techniques were used for ample enucleation of the tumor the distal volar left forearm. Subsequent histopathological examination confirmed the presumed diagnosis of a benign cellular schwannoma. At her last follow-up one month after surgery, the patient was neurological gradually improving sensory and motor function and she is highly satisfied with the results of surgery.
