Neuroma Surgery Notes

Neural Tumours Neuroma

They are uncommon benign tumours which occur in relationship with the sympathetic nervous system or spinal cord. They can be classified into true neuromas and false neuromas.

True Neuroma

1. Ganglioneuroma consist
   

   Neurofibroma Clinical Types

   s of ganglion cells and nerve fibres of the sympathetic chain. They are slow-growing tumours. When present in the neck as a parapharyngeal mass, it can cause dysphagia. These tumours can occur in the neck, retroperitoneum or mediastinum. Treatment: Excision of the tumour.

2. Neuroblastoma consists of poorly differentiated cells. It occurs in young children. It is interesting to know that this tumour can undergo spontaneous regression.
3. Myelinic neuroma is very rare. It arises in relationship with the spinal cord made up of myelinic fibres.

• • Does not contain any ganglion cells.

All these 3 tumours are called true neuromas.

Read And Learn More: Clinical Medicine And Surgery Notes

Clinical Notes

An 18-year-old student had backache and was examined by an orthopaedician and referred to general surgery. CT scan of the abdomen revealed a mass in the paraspinal region in the retroperitoneum. Laparotomy and excision of mass were done. It was reported as ganglioneuroma.

False Neuroma

These tumours arise from the connective tissue of the sheath of nerve endings. They occur following nerve injuries, lacerations, or after amputation. They are of 2 types.

1. End neuroma occurs after amputation due to the proliferation of nerve fibres from the distal cut end of the nerve. This produces a bulbous swelling. If it is caught in the suture line or due to pressure on the prosthesis, it produces severe neuralgia pain. To avoid this, when an amputation is being done, the nerve is pulled downwards and cut as high as possible so that it retracts upwards.
2. Lateral neuromas occur due to partial injury to the nerve on the lateral aspect.

False Neuroma Treatment

Excision of the neuroma.

Neurofibroma

It is a benign tumour arising from the connective tissue of the nerve sheath. Typically, it produces a fusiform swelling in the direction of the nerve fibres.

Neurofibroma Clinical Types

1. Single subcutaneous neurofibroma

Commonly affects the peripheral nerves, such as the ulnar nerve, vagus nerve or cutaneous nerves.

Neurofibroma Clinical features

• Tingling and numbness, paraesthesia in the distribution of the nerve.
• Round to oval swelling in the direction of nerve fibre.
• Smooth surface, with a round border. The swelling moves at right angles to the direction of nerve fibres. Vertical mobility is absent.
• Consistency is firm. Sometimes, it is hard.
• Being a subcutaneous swelling, the skin can be lifted up.

Neurofibroma Treatment

• It is treated by excision.
• In most of the cases, excision is easy as the tumour is well encapsulated.

2. Generalised neurofibromatosis: von Recklinghausen’s disease

• This is an autosomal dominant disorder transmitted by both sexes. The whole body is studded with cutaneous nodules of varying sizes. They are soft and non-tender. The coffee brown pigmentation is characteristic of this condition (Cafe-au-lait spots). Café-au lait spots can be associated with the involvement of cranial nerves — VIIIth nerve (auditory nerve) acoustic neuroma— A cerebellopontine angle tumour.
• Fibroepithelial skin tags are often present.
• The presence of skin pigmentation is an indication of the common neuroectodermal origin of nerve sheath cells and melanocytes.
• Skeletal deformities such as kyphoscoliosis or osteoporosis are common.
• It may be associated with phaeochromocytoma (high blood pressure).
• Sarcomatous changes do occur.

3. Plexiform neurofibromatosis (Trigeminal)

• In this condition, the branches of the 5th cranial nerve are commonly affected. It can also involve the peripheries.
• The affected part is grossly thickened due to the fibro-myxomatous degeneration.
• When it involves the branches of the trigeminal nerve, the following problems can occur:
  • Tingling paraesthesia in the distribution of the 5th nerve, especially ophthalmic division.
  • When it attains a huge size, it can obstruct the vision. As it grows bigger in size, it hangs in front of the neck, as a grossly thickened pendulous fold of skin.
• Treatment: Very difficult. Excision can be attempted with plastic surgery repair.

4. Elephantiasis neuromatosa

• This condition affects the limbs. It represents an advanced stage of plexiform variety. Gross thickening of subcutaneous tissue gives the appearance of an elephant’s leg. The skin is dry and coarse.

5. Pachydermatocoele

This refers to the plexiform lesions mainly found in the neck as a thickened, coiled single mass.

Neurilemmoma (Schwannoma)

• This is a benign tumour arising from Schwann cells.
• They can be single or multiple and present with a fusiform swelling in relationship with the nerves.
• They can occur from cutaneous nerves.
• They can also be seen in mediastinum and retroperitoneum.
• They are soft, lobulated, well-encapsulated tumours. They are benign and do not turn into malignancy.

Complications Of Neurofibroma

• Atrophy of muscles
• Dumb-bell tumours from dorsal spinal nerve root can cause backache or paralysis
• Acoustic neuroma—Deafness
• Cystic degeneration
• Sarcomatous change

Neurilemmoma Treatment

Excision of the tumour can be done without sacrificing the nerves because the tumour is well encapsulated and displaces the nerve.