Brachial Plexus Schwannoma: A Systematic Review of Clinicopathological Features, Surgical Outcomes, and Prognosis of 341 Cases.

Abstract

Introduction: Although primary tumors of the brachial plexus (BP) are rare, schwannomas are the most frequently encountered type. This study evaluated the clinicopathological presentation, surgical outcomes, and prognosis of patients with BP schwannomas.

Methods: A systematic review was conducted using PubMed/MEDLINE, Embase, and Cochrane on the 25th of March 2024. All English human studies that reported surgically managed BP schwannomas were included.

Results: This review included 341 patients from 82 studies, with a mean age of 41.49 years and a female majority (55.72%). The most common clinical presentation was swelling, observed in 245 patients (71.85%). Surgical intervention was performed in all cases, with gross total resection (86.80%) being the most common approach. Surgical complications included new motor deficits in 41 (12.02%), sensory deficits in 33 (9.68%), and new-onset pain in 6 cases (1.76%). Prognostic information was available for all the 280 patients. At the last follow-up, only a small number of patients showed no postoperative improvement. Of the 164 patients initially presenting with pain, 3 (1.83%) reported persistent symptoms. In addition, continued sensory deficits were noted in 13 (8.67%) of the 150 cases, and continued motor deficits in 4 (9.30%) of the 43 cases. Furthermore, 14 (19.71%) of 71 postoperative new-onset symptoms persisted at the last follow-up. One (16.67%) of the 6 patients experienced constant pain. Additionally, sensory deficits persisted in 8 (28.57%) of the 28 patients, and motor deficits persisted in 5 (13.51%) of the 37 patients. No local recurrence has been reported.

Conclusions: This systematic review highlights the complexity of BP schwannoma. Despite the occurrence of postoperative complications, the overall prognosis remains favorable with minimal rates of persistent preoperative symptoms and permanent surgical complications. Accurate diagnosis and effective surgical management are necessary to improve the outcomes of patients with this rare, yet clinically significant condition.