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J Neurol Surg A Cent Eur Neurosurg 2022; 83(01): 001-005
DOI: 10.1055/s-0041-1726110
Original Article

Perineurioma: A Rare Entity of Peripheral Nerve Sheath Tumors

Christine Brand
1   Department of Neurosurgery, München Klinik Bogenhausen, Muenchen, Bayern, Germany
,
Maria Teresa Pedro
2   Department of Neurosurgery, University of Ulm, Guenzburg, Germany
,
Andrej Pala
2   Department of Neurosurgery, University of Ulm, Guenzburg, Germany
,
Christian Heinen
3   Department of Neurosurgery, University of Oldenburg/ Evangelisches Krankenhaus, Oldenburg, Germany
,
Angelika Scheuerle
4   Department of Neuropathology, University of Ulm, Guenzburg, Bayern, Germany
,
Michael Braun
5   Department of Neuroradiology, University of Ulm, Guenzburg, Bayern, Germany
,
Gregor Antoniadis
6   Neurosurgery, Peripheral Nerve Surgery Unit, University of Ulm, Günzburg, Germany
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Abstract

Objective Intraneural perineurioma is a rare tumor entity. It is a benign, very slow growing peripheral nerve sheath tumor that typically occurs in children and young adults. Motor deficits and muscle atrophy are classic presenting symptoms, while sensory deficits are rare at the onset of the disease. Recommended treatment strategies are lacking. We have evaluated the clinical follow-up and our experience with treatment of this rare entity.

Methods A total of 30 patients with intraneural perineuriomas were assessed retrospectively. Demographic data, clinical symptoms, diagnostic examinations, therapy strategies, and clinical outcome were analyzed. Descriptive statistical methods were used for evaluation.

Results The mean age was 22 years. Eleven women and 19 men were affected. The lesion occurred in the area of the upper extremity in 16 patients and in the area of the lower extremity in 14 patients. The most frequently affected nerve was the sciatic nerve, followed by the radial nerve. All patients showed a motor deficit to some extent. Seventy percent (n = 21) revealed atrophy, 43.3% (n = 13) had sensitive deficits, and 17% (n = 5) suffered of pain. Fascicle biopsies were performed in 26 patients (87%). In four patients (13%), the tumor was completely resected and then reconstructed via nerve grafts. Seventy percent of the patients (n = 21) received a magnetic resonance imaging (MRI) within 5 years postoperatively, in which no progress was shown.

Conclusions To diagnose perineurioma, it is essential to take a biopsy of an enlarged, nonfunctional fascicle. Furthermore, a long-distance epineuriotomy to decompress the hypertrophic fascicle is reasonable. To preserve the nerves' residual function, a complete resection is not recommended. Results after grafting are poor. One reason for this might be residual tumor cells along the nerve that cannot be visualized. Malignant transformation is not yet reported and tumor growth is stable for years.

Keywords

perineurioma - peripheral nerve sheath tumor - epineuriotomy - epithelial membrane antigen


Publication History

Received: 13 April 2020

Accepted: 28 October 2020

Article published online:
24 May 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
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