Nerve sheath tumours grow from the tissue that wraps around nerves. Almost all are benign, and many need nothing more than observation.
Two quite different situations arise. A discrete nodule has an edge, can be excised completely and usually does not return. A plexiform lesion grows along the nerve and out through the tissue around it with no capsule to dissect, is strikingly vascular, and cannot usually be removed without sacrificing the nerve and a great deal of surrounding tissue.
For the second kind, surgery is about reducing bulk, restoring contour and relieving pressure, in planned stages, with the clear understanding that the lesion remains and may regrow. What matters most in follow up is not size but change: new pain, rapid growth or a hard area within a previously soft lesion needs investigation rather than reassurance.
Almost every decision here follows from which of these two you are dealing with.
Plexiform lesions have no bloodless plane to dissect. Blood is cross matched beforehand and surgery is staged partly for this reason.
MRI shows how far a plexiform lesion extends and its relationship to nerves and vessels. These lesions are not operated on without it.
The nerve and the tumour are intertwined. Reducing bulk usually costs some sensation in that nerve's territory, and the balance is agreed beforehand.
Debulking is deliberately incomplete. Knowing that in advance turns expected regrowth from a shock into part of a plan.
Most of these lesions are stable for years. These particular changes are the ones that matter.
Most come from families living with neurofibromatosis.
Ask your question →Neurofibromas are benign. A small proportion of plexiform lesions can undergo malignant change over time, which is why new pain, rapid growth or a hard area should be investigated rather than watched.
A discrete one usually can. A plexiform one usually cannot, because it grows through tissue around the nerve without a clear edge. There the aim is reducing bulk and improving function.
Fully excised discrete lesions rarely recur. Debulked plexiform lesions frequently regrow over years, and further stages are often planned in advance.
No. People with neurofibromatosis may have many lesions, and removing them all is neither practical nor useful. Those that are painful, catching, disfiguring or pressing on something are the ones that are treated.
