F.10 Management of peripheral nerve sheath tumours: the Toronto Western Hospital experience

Abstract

Background: We retrospectively review benign peripheral nerve sheath tumours (BPNST) managed surgically at the Toronto Western Hospital. The incidence of BPNST is classified by anatomic location and predisposition syndrome. Independent predictors of tumour recurrence and symptom resolution are identified. Methods: 175 patients with 201 tumours were eligible for analysis. Data was collected on patient age, gender, diagnosis of neurofibromatosis (NF), tumour histopathology, tumour location, tumour volume, and extent of resection. Postoperative motor, sensory and pain outcomes were dichotomized as stable/improved or worse than preoperative scores. Relationships between tumour recurrence, or symptom resolution, and predictor variables were assessed with univariate and multiple logistic regression models. Results: Among Schwannomas, subtotal resection, a diagnosis of Schwannomatosis, and larger tumour volume were associated with recurrence (p=0.012, p=0.048, p=0.049, respectively); for neurofibromas, subtotal resection and a diagnosis of NF1 were associated with recurrence (p=0.036, p=0.022, respectively). Multivariate analyses revealed subtotal resection as an independent predictor of recurrence for BPNSTs (p=0.007, OR=13.16, 95%-CI 2.34-52.63). Gross-total resection (p=0.023, OR=4.01, 95%-CI 1.21-13.22) and presence of a preoperative motor deficit (p=0.038, OR=8.06, 95%-CI 4.65-90.91) were independent predictors of stable/improved postoperative motor function for BPNSTs. Conclusions: Gross-total resection is associated with both reduced recurrence and improved postoperative motor function, and should be attempted for all eligible BPNSTs.