Management of Brachial Plexus Neurogenic Tumors: A Retrospective Study of 25 Cases.

INTRODUCTION: To investigate the clinical characteristics of cervical brachial plexus neurogenic tumors and enhance the diagnostic and therapeutic management of this condition.

METHODS: A retrospective analysis was performed on the clinical data of 25 patients diagnosed with brachial plexus neurogenic tumors who were treated at a tertiary teaching hospital between January 2019 and December 2024. Clinical manifestations, treatment strategies, and follow-up outcomes were systematically summarized.

RESULTS: A total of 25 patients were included, treated across multiple departments: otorhinolaryngology-head and neck surgery, neurosurgery, orthopedics, thyroid surgery, and vascular surgery. There were 13 male and 12 female patients, aged 16-76 y, with a disease duration ranging from 1 wk to 2 y, defined as the interval from symptom onset to initial clinical evaluation. The primary presenting symptom was a neck root mass in 21 patients, among whom seven experienced ipsilateral upper limb numbness, soreness, or electric shock-like pain upon palpation and four reported sensory disturbances in the upper extremity or shoulder-back pain. All patients underwent cervical contrast-enhanced computed tomography, and 18 additionally received 3.0 T magnetic resonance imaging. Preoperative ultrasound-guided fine needle aspiration cytology was performed in all cases, revealing spindle cell tumors with morphological features suggestive of schwannoma. Of the 25 patients, 23 underwent surgical resection, while two with small tumors (<2 cm), no neurological symptoms, and cytologically benign findings opted for conservative management with close observation. Surgical approaches included the anterior supraclavicular approach, the posterior cervical paravertebral approach, and clavicle-splitting (transclavicular) approach. Postoperative pathological examination confirmed benign schwannoma in 22 cases and malignant peripheral nerve sheath tumor in one case. Follow-up duration ranged from 12 to 60 mo. Transient postoperative neurological dysfunction occurred in five patients, manifesting as limited shoulder abduction, reduced wrist extensor strength, or limb numbness; all deficits resolved within 6 mo following structured rehabilitation programs.

CONCLUSIONS: Brachial plexus neurogenic tumors commonly present as a mass in the neck root, with a subset of cases accompanied by neurological symptoms. Computed tomography and magnetic resonance imaging are valuable modalities for tumor localization and qualitative characterization. Preoperative fine needle aspiration cytology enables a preliminary assessment of tumor histology. The selection of an appropriate surgical approach should be guided by tumor location and anatomical involvement. Intralesional enucleation is a key strategy for preserving neurological function, and when combined with microsurgical techniques and intraoperative nerve monitoring, even transient postoperative neurological deficits can be effectively managed through structured rehabilitation programs.