A schwannoma is a benign (non-cancerous), soft-tissue mass that presents on the outer, protective layer of a nerve, called the epineurium. To treat, a schwannoma can be marginally excised, meaning only the schwannoma is surgically removed, to spare or protect the nerve from excision.
Schwannoma is a benign (non-cancerous) soft-tissue mass that forms on the outer, protective layer of a nerve, called the epineurium. They commonly occur in the peripheral nerves of the head, neck, upper extremities, and lower extremities. They may present as a painful or painless slow-growing mass. It is often difficult to distinguish a schwannoma with its cancerous counterpart, the malignant peripheral nerve sheath tumor, so a biopsy is needed to confirm the diagnosis.
Surgical treatment includes wide or radical resections to remove the complete tumor and additional margins. The removal of additional, surrounding margins ensures that the tumor is completely removed and decreases the chances of the tumor coming back.
An incision is made surrounding the previous biopsy site to ensure that the tumor is properly removed.
Developing surgical planes (margins that are tumor free) and separating muscles that can be preserved and leaving those in continuity with the tumor that should be removed. This is based on preoperative MRI and intraoperative findings as well as the type of tumor.
Separating important nerves and blood vessels from the tumor to preserve the nerve function and blood supply to the region. Soft-tissue tumors usually compress, displace and stretch these structures and rarely encase them. Once these are separated, they are retracted gently and preserved throughout the surgery. Rarely, nerves and blood vessels may be removed with the tumor and then restored with various techniques.
Remove the soft-tissue tumor. Sarcomas are removed en-bloc with a margin. Margins are also usually sent for analysis during surgery (frozen section analysis) to make sure there are no residual microscopic cells.
The tumor is typically removed with margins to ensure that the entirety of the tumor is resected from the patient.
Depending on the size and extent of the mass, reconstruction may be needed. Reconstruction of the dead space is often accomplished with local muscle rotational flaps. This also may help restore function from the deficiency caused by removal. Occasionally a free microvascular free muscle flap may be performed where the muscle or tissue is harvested from a different area of the body with its attached blood vessels and moved to the defect and the vessels reattached to restore the blood supply to the muscle or tissues. The surgical bed is marked with hemoclips (small clips for blood vessels) so the area can be identified if radiation is needed after surgery.
To reconstruct the area after the tumor is removed, muscle is attached and may be reinforced with surgical tape.
Closure and drains often placed for a period of time to evacuate fluid that can collect after surgery. Drains may be left in place for up to several weeks depending on size of defect, weight of patient and other factors until the wound heals. A bulky or compression bandage may be applied to control swelling and protect the extremity.
This is an example of a schwannoma, a common benign soft-tissue mass, located in the patient's arm.
This is an intraoperative photo of a schwannoma, a common benign soft-tissue tumor.
I've seen many doctors and I can confidently attest Dr. Wittig is the preeminent orthopaedic specialist. He is genuinely kind and caring, as he demonstrated by completely addressing my concerns and compassionately relating to what I was dealing with. He clearly outlined the plan of attack, and recommended the two additional doctors who would become part of my 'team'. Dr. Wittig was so effective in allaying our fears and bringing us optimism. My surgery was significant, but I was up and walking the next day and back at the gym 5 weeks later. This is further testament to Dr. Wittig's skill. He saved my leg and my life, and I feel so very blessed to say he is my doctor. I have already recommended him to others, and I will continue to do so. I would trust him with my closest family and lifelong friends. BEST DOCTOR EVER.
S.G.
Myself and my amazing team are dedicated to saving your life and your limb. Losing a limb because of a tumor can be a terrifying experience. But, it does not have to be the only option. I’ve spent 20+ years as a Board-Certified Orthopedic Surgeon and Orthopedic Oncologist.
I’ve devoted my career to helping children and adults afflicted with bone and soft tissue masses by performing complex limb saving surgeries. Most patients can have their limb saved, which may require innovative techniques.
Patients afflicted with musculoskeletal tumors have complex conditions that are best taken care of at large hospitals. I am the Chairman of Orthopedics and Chief of Orthopedic Oncology at Morristown Medical Center. My philosophy is a multidisciplinary team approach, working together to tailor treatment to individual patients. Education and research are essential to my practice, providing the best setting for extraordinary patient care. Because of this, we have some of the top results in the country.
