Brachial Plexus Lipoma Causing Neurological Impairment: A Case Series and Systematic Review.

Abstract

Background and objectives: Lipomas are benign adipocyte tumors that typically present as painless, firm nodules. In rare cases, lipomas may grow near the brachial plexus (BP) and compress various peripheral nerves. This can manifest as upper extremity motor and/or sensory deficits, numbness, tingling, or burning sensations. Surgical intervention of a brachial plexus lipoma (BPL) may be challenging because of variability in location and size. This study reviews previously reported cases of BPL causing neurological impairment and presents 5 additional cases, focusing on operative details and patient outcomes.

Methods: A systematic review of PubMed, Scopus, and World of Science was performed to identify all previously reported cases of BP lipomas resulting in neurological deficit. A retrospective review of a neurosurgeon's prospectively collected database was conducted to identify all patients operated on for BPL. Patient demographics, tumor characteristics, presentation, surgical notes, and outcomes were collected for both reviews.

Results: Our literature review yielded 13 articles presenting at least one case meeting the eligibility criteria, resulting in 22 eligible patients. The surgeon's database provided an additional 5 patients meeting the criteria. Of the 27 total cases, 15 were men and 12 were women. The average age was 46.5 with a range of 25 to 70. All patients had upper extremity motor and/or sensory dysfunction preoperatively. Tumors were found in various regions, with the involvement of the supraclavicular fossa reported in 52% of cases. Gross tumor resection was achieved in all but 2 of the 27 operations. Four patients had a nonconventional lipoma type on histology. Sixteen patients experienced complete resolution of neurological symptoms.

Conclusion: BP lipomas are rare but can cause a wide range of neurological symptoms depending on their size and location. A thorough patient examination and imaging studies are essential for creating a successful surgical plan for tumor resection.