Partial Nerve Repair with Connector-Assisted Coaptation after Resection of Schwannoma

Abstract

　Schwannomas can be categorized into three types: Type 1 branches from a main nerve, Type 2 grows inside the nerve and may be enucleated, and Type 3 occupies the nerve, requiring amputation of the nerve to remove the tumor.
　In this study, we report four cases of Type 2 schwannoma, which we repaired with connector-assisted coaptation after resection, along with a review of the literature.
　Each operation was performed using a microscope. The schwannoma was first resected, and the axonal defect was repaired using connector-assisted coaptation. There was no tumor recurrence in any case. Cases 1 and 2 had tumors in the palms. They experienced a lack of finger sensation immediately after surgery, which had almost fully recovered within six months. Cases 3 and 4 had tumors near the cubital joint. They showed limited recovery of motor nerves, resulting in muscle atrophy and fine motor disability despite recovery of the sensory nerves.
　This report demonstrates that connector-assisted coaptation can be used for partial nerve rupture as well as its primary use for complete nerve rupture. This procedure may prevent neuroma formation after the resection of schwannoma.