Peripheral Nerve Tumors

A general term for masses that develop on nerves in the arms, legs, and trunk, most commonly benign.

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Peripheral Nerve Surgery

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1Overview

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What is this Condition?

Peripheral nerve tumors are masses that develop from cells forming the sheath of nerves outside the brain and spinal cord (nerves in the arms, legs, and trunk). The vast majority are benign; the two most common types are schwannoma and neurofibroma. The much rarer malignant type (MPNST) has a faster course. It typically begins as a slowly growing lump felt under the skin. Sometimes pain, numbness, or tingling in the distribution of that nerve may occur. A tingling sensation traveling to the fingers when the mass is gently tapped (Tinel's sign) suggests a nerve-related mass. The prognosis after treatment in benign tumors is usually very good.

Symptoms

A lump felt under the skin that grows slowly over months or even years

Tingling or electrical sensation along the course of the nerve when pressure is applied to or the lump is gently tapped

Dull pain; in some patients, burning or stabbing sensation

Numbness and reduced sensation in the area supplied by that nerve

Muscle weakness in advanced cases (more common in neurofibroma and malignant types)

Warning signs in malignant type: rapid growth of the mass, increasing pain, hardening, weight loss

Diagnosis Methods

Diagnosis begins with physical examination: the location, size, and mobility of the mass and whether tapping causes tingling are evaluated. MRI is the most important imaging for definitive evaluation; it shows the relationship of the mass to the nerve and the likelihood of benign/malignant nature. Ultrasound provides rapid initial assessment. EMG (nerve-muscle testing) can be performed to measure how much the nerve is affected. If malignancy is suspected, tissue samples are obtained by needle or open biopsy for definitive pathological diagnosis.

Treatment Methods

The primary treatment for benign tumors is surgical removal of the mass. In schwannoma, the mass is usually located alongside the nerve, so it can often be removed intact using microsurgical technique while preserving nerve fibers. In neurofibroma, the mass is intertwined with nerve fibers, making removal more difficult; sometimes partial removal is preferred. For small asymptomatic masses, regular MRI follow-up instead of immediate surgery may be chosen. For certain small masses in the vestibulocochlear nerve, radiation therapy (Gamma Knife, CyberKnife) may be an option. In malignant type, wide surgical removal is planned, with radiation and chemotherapy combined if necessary.

Microsurgical removal of the mass — in schwannoma, intact removal while preserving nerve fibers is usually possible

Regular MRI and clinical follow-up in asymptomatic small masses (watch-and-wait)

Radiation therapy (Gamma Knife / CyberKnife) option for small masses in the vestibulocochlear nerve

Wide surgical removal and combined radiation/chemotherapy if necessary in malignant type

References

Winn HR, ed. Youmans and Winn Neurological Surgery. 6th ed. Elsevier; 2011:2518-2519.
Winn HR, ed. Youmans and Winn Neurological Surgery. 6th ed. Elsevier; 2011:2532-2536.
Greenberg MS. Handbook of Neurosurgery. 10th ed. Thieme; 2023:769, 982.

This content is based on academic sources and is for general information only; individual assessment requires a medical examination.

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Peripheral Nerve Tumors

Peripheral Nerve Surgery

1Overview

What is this Condition?

Symptoms

Diagnosis Methods

Treatment Methods

References

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