Nerve Tumors

Exploring nerve tumors.

Animation: Distal Femoral Branch Tumor Seen in Survey Image.
The image at left is from a 28-year-old man who developed hand pain and numbness. Because of the area of the hand that was affected, his doctors assumed that he had an entrapment of the ulnar nerve at the elbow and proceeded to do an elaborate surgery on the nerve. Only when the surgery failed completely to affect the problem did they consider imaging of the region to see what the cause was.
In the past, doctors have always imaged an area before doing surgery unless the problem involved nerves. Now that MR Neurography is available and effective, it is important for patients and doctors to understand that imaging should be employed for nerve problems just like other medical problems treated by surgery.
In this case, the imaging revealed a nerve tumor abour 1.5 centimeters in diameter that was easily removed solving the problem. He suffered no harm from his unnecessary nerve release surgery. Operating before imaging is no longer appropriate in the management of nerve conditions.
Imaging revealed an 1.3 centimeter mass within the ulnar nerve in the upper arm. The tumor spreads the fibers of the nerve.
MR Neurography was invented and developed by Dr. Aaron Filler of the Institute for Nerve Medicine. Imaging is an essential part of diagnostic evaluations at the INM.
There are many diagnoses and treatments of nerve tumors.

Information on Nerve Tumors

Tumors and Schwannomas

Localization of Schwannomas Within the Brachial Plexus for Planning of Tumor Resection
Slideshow: Position of schwannoma in brachial plexus in patient with asymptomatic palpable neck mass.

The oblique coronal view (A) allows counting and identification of the cervical spinal nerves and establishes that only the C5 root is involved with this Schwannoma. “Nerve perpendicular” image slices can be obtained by using the image from the oblique coronal view to depict the direction of travel of the nerve trunks near the tumor.
The resulting oblique sagittal (B) view demonstrates each of the cervical spinal nerves in cross section and demonstrates their relationship to the tumor.
(C) Relationship of nerve trunks to tumor. The surgical approach and risks of nerve injury can be greatly influenced by the relative position of nerve and tumor. In many cases, MR Neurography allows the position of the traversing nerve elements relative to the tumor can be clearly established in advance of surgery. This is a “nerve perpendicular” image in which a double oblique image orientation is prescribed so that the image plane crosses most of the plexus elements at right angles in the region of interest.

Nerve Root Avulsions

Pseudomeningocoele after Brachial Plexus Nerve Root Avulsion
Animation: Demonstration of traumatic pseudomeningocoeles.
The MR Neurography imaging technique also provides a useful MR myelogram capable of efficient demonstrations of traumatic pseudomeningocoeles. This term refers to the residual nerve lining left behind when the nerve elements are literally pulled out of the spinal cord by a severe injury
Although, these images are still not always definitive in the confirmation of true nerve root avulsion they are more reliable for making this diagnosis than the other available imaging techniques.

Post-Irradiation Plexopathy

Plexopathy and Plexitis After Irradiation for Breast Cancer
Animation: Late plexopathy after mastectomy and irradiation for breast cancer.
A) This patient had a bright irregular nerves of normal caliber suggestive of a radiation neuritis treatable with steroids.
(B) Hyperintense brachial plexus elements of extremely narrow caliber suggest encircling mechanical entrapment associated with post-irradiation fibrosis. Surgical neurolysis may be helpful.
(C) Grossly swollen nerve roots and hydrothorax associated with aggressive tumor recurrence and nerve invasion by tumor.

Multiple Nerve Tumors in Neurofibromatosis

Multiple Schwannomas on Spinal Nerves in Neurofibromatosis
Animation: Neurofibromatosis with multiple schwannomas.
(A1) and (A2) Multiple schwannomas of the cervical spinal nerves in a patient with neurofibromatosis.
(B) In some cases, diagnosis is more subtle and this patient with chronic complaints of body wall pain would be quite difficult to diagnose with conventional imaging.

Brachial Plexus Trauma

Diagnosis of Traumatic Discontinuities in Brachial Plexus Elements
Animation: Confirmation of total nerve disruption in trauma.
(A) The right brachial plexus of a 15-year-old with flail arm - lacking any movement or sensation, two months after a motorcycle accident. The image demonstrates gross discontinuities ro disruptions in the upper plexus elements (ue), meningocoeles proximally (me), and bright swollen nerve trunks (st).
(B) Disconnected and retracted lower trunk (lt) in traumatic injury of brachial plexus.

Sciatic Nerve Tumors Presenting as Sciatica

Sciatic Schwannomas Presenting with Sciatica
Animation: Sciatic schwannoma image diagnosis.
(A) 32-year-old man who had back school physical therapy, lumbar discectomy and piriformis muscle section all without benefit proved to have schwannomas in the sciatic nerve just above the level of the ischial tuberosity. A1 – axial. A2 and A3 coronal reformats in slightly different planes demonstrate and confirm the relationship of the larger (*) and smaller (**) tumors to the sciatic nerve (s). His symptoms resolved after tumor excision.
(B) This mass (m) in the sciatic nerve (s) was discovered in a patient with sciatica, positive straight leg raising and lumbar spondylosis.

Anterior Leg Pain from Schwannoma

Distal Femoral Branch Tumor Seen in Survey Image
Animation: Image diagnosis of nerve tumor at distal femoral branch.
A 35-year-old woman with a three year history of progressively severe leg pain was being followed for pain management after all diagnostic evaluations were negative including normal EMG.
(A) Small Schwannoma was detected on coronal survey image.
(B) The tumor is very evident in the Neurographic axial section, but
(C) is essentially undetectable in a routine T1 image.
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