Intraoperative neuromonitoring combined with high-definition endoscopy in brachial plexus schwannoma surgery

This retrospective cohort study examined the surgical management of twenty patients diagnosed with brachial plexus schwannoma. The intervention involved the combined use of intraoperative neuromonitoring (IONM) and high-definition endoscopy during the surgical procedure. The primary outcome assessed the value of this combined approach, while secondary outcomes included complete intracapsular tumor resection, postoperative nerve function, tumor recurrence, and patient quality of life. Follow-up assessments were conducted over a period of one to four years.

All twenty patients underwent complete intracapsular tumor resection. Postoperative motor function remained unaffected in all twenty patients. No tumor recurrence was observed among the cohort during the follow-up period. Regarding sensory outcomes, two patients developed numbness in their fingers, and one patient developed numbness in the shoulder. These findings indicate that while the procedure supports complete resection, some patients experienced postoperative sensory disturbances.

Safety and tolerability data were limited, with no serious adverse events reported. The study did not report discontinuations or specific tolerability metrics. Key limitations include the small sample size of twenty patients and the retrospective nature of the design, which may introduce selection bias. The authors note that the combined approach helps identify nerve trajectories and detect early nerve injuries, potentially improving quality of life. However, the observed sensory deficits highlight the need for careful monitoring of nerve conduction function postoperatively. Further research with larger cohorts is required to confirm these findings.