Brachial Plexus Tumors; Pathological Types and Surgical Approaches: Multi Center Experience

Brachial plexus tumors, are rare, present significant challenges due to their intricate anatomical location and potential impact on upper limb function. These tumors arise from nerve sheath cells, including either benign schwannomas and neurofibromas, or as malignant peripheral nerve sheath tumors (MPNSTs), which require early diagnosis and intervention to improve patient outcomes (1). Surgical resection remains the primary treatment modality, aiming to alleviate symptoms and prevent further neurological compromise.

The choice of surgical approach is influenced by the tumor's size, location, and relationship with surrounding neurovascular structures. Anterior approaches, including supraclavicular and infraclavicular incisions, provide excellent exposure for lesions in the upper and middle parts of the plexus, whereas posterior approaches are preferred for deep-seated or retroclavicular tumors (2). Intraoperative neurophysiological monitoring (IONM) has significantly improved surgical precision, reducing the risk of postoperative deficit .

Advancements in microsurgical techniques, such as nerve grafting and nerve transfers, have improved functional recovery in patients undergoing brachial plexus tumor resection. Early intervention and meticulous dissection help preserve nerve function and minimize postoperative deficits (3). Minimally invasive techniques, including endoscopic and robotic-assisted approaches, are being explored to reduce morbidity and improve surgical precision (4).

Despite progress in surgical management, challenges remain, particularly in cases of malignant tumors where complete resection may not be feasible. Adjuvant therapies, including radiation and chemotherapy, are increasingly utilized for malignant brachial plexus tumors to enhance local control and reduce recurrence rates (5). Long-term follow-up and rehabilitation play a crucial role in optimizing functional recovery, emphasizing the need for a multidisciplinary approach (6).

This review aims to analyze the indications, techniques, and outcomes of different surgical approaches for brachial plexus tumors, providing insights into optimizing patient outcomes while minimizing surgical morbidity.