Abstract: Examining Surgical and Patient-Reported Outcomes in the Operative Management of Peripheral Neurofibromas

INTRODUCTION: Peripheral nerve tumors, especially of the extremities, impart significant disability with potential malignant transformation, yet surgical management risks permanent deficits. Outcomes with peripheral nerve tumor excision and comparative results with surgical intervention for neurofibromas and schwannomas remain to be elucidated. METHODS: Patients undergoing excision of peripheral nerve neurofibromas or schwannomas from 2009 to 2015 were reviewed. Outcomes, including results of a post-operative outcome survey, were compared between the two groups. RESULTS: Ninety-two peripheral nerve tumors were excised; 72 neurofibromas (78.3%) were removed from 26 patients while 20 schwannomas (21.7%) were removed from 17 patients. Average age in the neurofibroma and schwannoma groups were 34.69 and 39.65 years (p=0.2291). Patients in the neurofibroma group were significantly more likely to carry a diagnosis of neurofibromatosis type 1 or 2 while the schwannoma group was significantly more likely to be diagnosed with schwannomatosis (p<0.0001). Patients in the neurofibroma group were significantly more likely to present complaining of pain (p=0.0144); those in the schwannoma group were significantly more likely to present with motor weakness (p=0.0047). Anatomic tumor distribution to the upper or lower extremities, head/neck, or trunk was equivalent (p=0.3663). Follow-up was significantly greater in the schwannoma group (p=0.0015). Tumors had an equal size distribution between the two groups (p=0.1520). Excised schwannomas were significant more likely to be associated with a motor or named sensory nerve compared to excised neurofibromas (p=0.0377). Nerve monitoring was employed in an equivalent fashion between the groups (p=0.3332); however, nerve repair was significantly more frequently employed in the schwannoma group (p=0.0110). Nerve tube repair was more commonly utilized in the schwannoma group (p=0.0004); epineural, fascicular, and nerve graft techniques were utilized equivalently. There were no significant differences in post-operative motor weakness (6.9% vs. 15.0%; p=0.1529) or sensory changes (2.8% vs. 10.0%; 0.0510) between the groups. Ten patients in the neurofibroma group and seven in the schwannoma groups responded to a post-operative survey. There were no significant differences for any responses. Both groups reported improvement in post-operative quality of life (p=0.7806), no regret with surgery (p=1.000), and a positive proclivity towards proceeding with surgery for potential future peripheral nerve tumors (p=0.8029). CONCLUSION: Peripheral neurofibromas and schwannomas are unique in terms of presentation, tumor characteristics, and operative outcomes; however, both may be safely managed surgically.