Surgical treatment of recurrences of peripheral nerve sheath tumors

INTRODUCTION. One of the complex problems of surgical treatment of peripheral nerve sheath tumors is their  recurrence, which, according to various authors, ranges from 17.3 % to 26.4 %. The defeat of several anatomical regions,  the prevalence of the tumor, the gross involvement of internal organs and great vessels in the neoplastic process make it  difficult to perform a radical surgical intervention with the removal of affected tissues in a single block. 

MATERIALS AN D METHODS. We analyzed the data of 35 patients with recurrences of peripheral nerve sheath  tumors of various histological structures in the period from 2018 to 2021, who were treated at the Russian Research  Neurosurgical Institute n.a. A. L . P olenov — FSBI “SMRC n.a. V. A. Almazov” of Ministry of Health of Russian Federation.  The histological diagnosis was verified by biopsy examination of the tumor material and was established according to the  2020 WHO classification. Follow-up in postoperative patients was observed from three months to 12 years. The most frequent relapses of neurofibromas were 13 (37.1 %) patients. Patients with recurrence of MRAF were slightly  less common — 12 (34.3 %), recurrence of schwannoma was observed in 10 (28.6 %) patients. There were no patients with  recurrence of perineurioma and hybrid tumor in our observations. 

RESULTS. A statistically significant relationship was found between complete and partial microsurgical removal of  the tumor. With partial removal of a peripheral nerve sheath tumor, the frequency and time of recurrence is much higher.  The use of a differential approach to the choice of the method of surgical treatment and access, based on the characteristics  of tumor growth, the somatic condition of the patient, the appropriate equipment in the medical institution and the practical  skills of the neurosurgical team, allows not only to radically remove the recurrence and continued growth of ARF, but also  to perform reconstructive interventions on the nerves structures. 

DISCUSSION OF THE RESULTS. The desire for the maximum volume of resection is a relative guarantor of  a decrease in the number of relapses, on the other hand, it increases the risk of neurological disorders. With pronounced  neurological deficits, it is necessary to strive for the maximum radicalism of surgical treatment, but in the absence of  a clinical manifestation, it is necessary to remember this during the operation. 

1. Belakhoua Sm, rodriguez Fj. diagnostic pathology of Tumors of peripheral Nerve. Neurosurgery. 2021 Feb 16;88(3):443–456. doi: 10.1093/neuros/nyab021.

2. Bersnev, v. p . practical guide to nerve surgery / v. p . Bersnev, g. S. Kokin, T. o . Izvekov. — St. p etersburg, 2009. — T.1.-2.— 561 p.]

3. orlov, A. y u. Types of surgical interventions in the removal of tumors of peripheral nerves of extremities / A. y u. o rlov, g. S. Kokin // ros. neurosurgeon. magazine them. prof. A. l . p olenov.— 2012. — v. 4, No. 2. — p. 22–27]

4. orlov A. y u. relapses and continued growth of peripheral nerve tumors after surgical treatment / A. y u. o rlov / / russian Neurosurgical journal. prof. A. l . p olenov. — vol. vIII. — No. 2. — St. p etersburg, 2016. — p. 38–45.]

5. murzaeva d . A., Zabrodskaya yu. m., dolgushin A. A., dobrogorskaya l . N., orlov A. y u. A retrospective cohort study of the pathological features of recurrent schwannomas and neurofibromas. Sechenovskiy vestnik.2021]

6. orlov A. yu. Zlokachestvennye opuholi iz obolochek perifericheskih nervov. — rossijskij nejrohirurgicheskij zhurnal im. prof. A. l . p olenova. — t.vII.— № 3. –Spb.-2015. — S.21–28.]

7. diagnosis and treatment of recurrence of a malignant tumor from the sheaths of peripheral nerves (literature review and clinical observation). Kaprin A. d ., rubtsova N. A., Khalimon A. I., l evshakova A. v ., ryabov A. B., p ikin o . v ., Amiraliev A. m., volchenko N. N., Bruslinskaya A. B. radiology — practice. 2017; 3(63):29–38]

8. orlov A. y u., dolgushin A. A., Nazarov A. S., Kudziev A. v ., oleinik e . A. l arge and giant peripheral nerve sheath tumors. russian neurosurgical journal. professor A. l . p olenov. 2020. v. 12. No. 3. S. 22–30.]

9. Shelekhova, K. v . Intraneural perineurioma: clinical and morphological characteristics and molecular genetic study of the neurofibromatosis type 2 gene / K. v . Shelekhova, r. p ima, A. y u. o rlov, d. v . Kazakov//Archive of pathology. –2008. –No 4. –S.20–22.]

10. liu q., Zhang H., jiang x ., et al. Factors involved in cancer metastasis: a better understanding to «seed and soil» hypothesis. mol Cancer. 2017 dec 2; 16(1): 176. https://doi.org/10.1186/s12943-017-0742-4. pmId: 29197379.

11. Kuzet Se, gaggioli C. Fibroblast activation in cancer: when seed fertilizes soil. Cell Tissue res. 2016 Sep; 365(3): 607–19. https://doi.org/10.1007/s00441–016–2467-x. epub 2016 jul 29. pmId: 27474009.

12. Ishii g., ochiai A., Neri S. p henotypic and functional heterogeneity of cancer-associated fibroblast within the tumor microenvironment. Adv drug deliv rev. 2016 Apr 1; 99( pt B): 186–196. https://doi.org/10.1016/j.addr.2015.07.007. epub 2015 Aug 14. pmId: 26278673.

13. eble j.A., Niland S. The extracellular matrix in tumor progression and metastasis. Clin exp metastasis. 2019 jun; 36(3): 171–198. https://doi.org/10.1007/s10585-019-09966-1. epub 2019 Apr 11. pmId: 30972526.