Non-Neural Sheath Lesions of Brachial Plexus Region: Case Series and Literature Review

Abstract

Objectives Symptomatic: non-neural sheath lesions in the brachial plexus region are rare. However, surgical excision in some cases becomes challenging owing to the secondary involvement of neural elements, encasement of the vital neurovascular structures, and involvement of multiple anatomical compartments.

Material and Methods: A retrospective search of surgically treated brachial plexus region non-neural sheath lesions (BPNNSLs) was performed, and 15 patients were included in the analysis. The benign BPNNSLs included 4 lipomas, 2 desmoid tumors, 1 meningioma, and 1 arteriovenous malformation. The malignant BPNNSLs included two patients, each with synovial sarcomas, non-Hodgkin’s lymphomas, and metastasis. In our series, one patient had recurrent myxoid sarcoma.

Results: The patient demographics, clinical, radiological, and operative details, treatment options, and outcomes were analyzed and compared with the available literature. The study highlighted the challenges and outcomes associated with the surgical management of these rare lesions.

Conclusions:  Complete surgical excision of benign BPNNSLs usually produces favorable outcomes with rare new deficits. Malignant lesions often require adjuvant therapy, and the prognosis varies based on the type and extent of the lesion. A multidisciplinary approach with insight into differentiating features helps in successfully treating these lesions.