Name of the Procedure:

Excision of Neurofibroma or Neurolemmoma; Major Peripheral Nerve

Summary

This procedure involves the surgical removal of benign tumors known as neurofibromas or neurolemmomas from major peripheral nerves. These tumors can cause pain, nerve damage, or other complications and need to be excised to relieve symptoms and prevent further issues.

Purpose

The procedure addresses benign nerve sheath tumors that may cause compression, pain, or functional impairment of the affected nerve. The goal is to safely remove the tumor while preserving as much nerve function as possible.

Indications

• Persistent pain localized to the tumor site.
• Symptoms of nerve compression such as numbness, tingling, or weakness.
• Rapid tumor growth or changes in tumor characteristics.
• Diagnostic imaging that suggests the tumor might cause future complications.

Preparation

• Patients may need to fast for 8-12 hours prior to surgery.
• Adjustments in medication may be necessary, especially blood thinners.
• Pre-operative imaging studies like MRI or CT scans help in planning the surgery.
• Patients will undergo a pre-operative assessment to evaluate overall health.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision: A surgical incision is made over the site of the tumor.
3. Exposure: Surgeons meticulously expose the nerve and the tumor while taking care to protect surrounding tissues.
4. Excision: The tumor is carefully dissected and removed from the nerve.
5. Closure: The surgical site is then closed with sutures, and a sterile bandage is applied.

Tools used include surgical scissors, scalpels, and possibly magnification devices to aid in the delicate dissection process.

Duration

Typically, the procedure lasts between 1 to 3 hours, depending on the tumor's size and location.

Setting

The procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon: Specializes in neurosurgery or peripheral nerve surgery.
• Nurses: Assist during the procedure and with patient care.
• Anesthesiologist: Manages anesthesia and monitors the patient's vital signs.

Risks and Complications

• Infection at the surgical site.
• Bleeding or hematoma formation.
• Nerve damage leading to motor or sensory loss.
• Recurrence of the tumor.
• Adverse reaction to anesthesia.

Benefits

• Relief from pain and other symptoms caused by the tumor.
• Preservation or improvement of nerve function.
• Improved quality of life.

Recovery

• Initial recovery involves monitoring in a recovery room until the effects of anesthesia wear off.
• Pain management strategies include prescribed pain relievers.
• Patients often return to normal activities within 4-6 weeks.
• Follow-up appointments are necessary to monitor healing and nerve function.

Alternatives

• Observation: Monitoring the tumor with regular imaging if it's not causing severe symptoms.
• Medications: Pain management and other supportive therapies.
• Radiation therapy: Rarely used unless malignancy is suspected or confirmed.

Patient Experience

During the procedure, patients will be unconscious and pain-free. Post-procedure, some discomfort and swelling at the incision site are expected. Pain can be managed with medications. Full recovery and return to normal activities can take several weeks, during which time patients may need to limit strenuous activities and follow specific instructions for wound care.