Brachial Plexus Nerve Tumors

Localization of Schwannomas Within the Brachial Plexus for Planning of Tumor Resection

Animation: 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.

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.

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 diagnsostic 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.