Function Preserving Surgery forBrachial Plexus Fibromatosis withMediastinal Extension
Abstract:
Background:
Surgical considerations for extensive brachial plexus fibromatosis with mediastinal extension
are inadequately described in the literature.
Objective:
To describe the multidisciplinary collaborative operative technique and surgical nuances associated
with resection of a brachial plexus fibromatosis extending into the mediastinum while preserving neurological
function.
Surgical Procedure:
An intracapsular surgical decompression was performed using anterior transclavicular
approach taking proximal and distal control of subclavian vessels, under intraoperative neuromonitoring
guidance to attain a maximal‑safe‑resection along with preservation of neurological function. The histopathology
was suggestive of a desmoid tumor.
Results: The patient had a significant reduction in the size of the lesion on follow‑up imaging, had functional
improvement at 4 months follow‑up and is currently being managed by medical oncologists with maintenance
chemotherapy.
Conclusion:
A tailored multidisciplinary function preserving surgical approach with maintenance chemotherapy
is an acceptable management strategy in preserving a patient’s quality of life for infiltrating desmoid tumors
encasing brachial plexus with mediastinal extension.
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