A Case of Nerve Integrity Monitor for Neurofibroma Resection

Abstract

 In patients with neurofibromatosis type 1 (NF1), neurofibromas are resected for pain relief and cosmetic improvement. If the tumor has invaded a major nerve, preservation of the nerve is desirable to prevent postoperative disabilities. Herein, we report a patient with a large neurofibroma in the wrist, which was partially resected with the assistance of the nerve integrity monitoring (NIM) system.
 A 26-year-old woman presented with a wrist tumor. She had previously undergone partial resection of the same tumor and was diagnosed with localized NF1. Plain radiography revealed bone resorption in the triquetrum and hamate as well as pisiform dislocation toward the ulnar side. Magnetic resonance imaging was unable to confirm the course of the ulnar nerve within the tumor; therefore, NIM-assisted partial resection was performed. The patient experienced immediate postoperative paralysis of ulnar nerve motor function; however, this resolved within 1 month. NIM is useful not only for facial nerve repair but also for extremity surgery.