Giant Neurofibroma of Sciatic Nerve: Function Preserving Excision

Abstract

Peripheral nerve sheath tumors are commonly small and involve superficial nerves. Giant tumors are rare, but usually involve deep nerves. Massive lesions need customized surgery to enable complete excision without sacrifice of residual nerve function. A middle age female presented with a swelling of 2 yrs duration occupying the entire left posterior thigh. CT scan and trucut biopsy were indicative of a massive benign spindle cell tumor arising from the sciatic nerve. This was completely excised by microsurgical dissection safeguarding uninvolved fascicles with no post operative sensory motor deficit. The excised specimen weighed 1950 grams and contained 1300 ml of hemorrhagic fluid within thick walls. Histopathology and Immunohistochemistry confirmed the lesion to be a benign neurofibroma. At 18 months follow up, the patient has no evidence of neurologic deficit or recurrence. Giant neurofibromas are rare, with this case probably the largest reported. Function preserving approach is desirable and possible.