Surgical treatment of recurrences of peripheral nerve sheath tumors
Introduction. One of the complex problems of surgical treatment of peripheral nerve sheath tumors is their recurrence, which, according to various authors, ranges from 17.3 % to 26.4 %. The defeat of several anatomical regions, the prevalence of the tumor, the gross involvement of internal organs and great vessels in the neoplastic process make it difficult to perform a radical surgical intervention with the removal of affected tissues in a single block. Materials AND METHODS. We analyzed the data of 35 patients with recurrences of peripheral nerve sheath tumors of various histological structures in the period from 2018 to 2021, who were treated at the Russian Research Neurosurgical Institute n.a. A. L . P olenov-FSBI “SMRC n.a. V. A. Almazov” of ministry of Health of Russian Federation. The histological diagnosis was verified by biopsy examination of the tumor material and was established according to the 2020 WHO classification. Follow-up in postoperative patients was observed from three months to 12 years. The most frequent relapses of neurofibromas were 13 (37.1 %) patients. Patients with recurrence of MRAF were slightly less common - 12 (34.3 %), recurrence of schwannoma was observed in 10 (28.6 %) patients. There were no patients with recurrence of perineurioma and hybrid tumor in our observations. RESULTS. A statistically significant relationship was found between complete and partial microsurgical removal of the tumor. With partial removal of a peripheral nerve sheath tumor, the frequency and time of recurrence is much higher. The use of a differential approach to the choice of the method of surgical treatment and access, based on the characteristics of tumor growth, the somatic condition of the patient, the appropriate equipment in the medical institution and the practical skills of the neurosurgical team, allows not only to radically remove the recurrence and continued growth of ARF, but also to perform reconstructive interventions on the nerves structures. DISCUSSION OF THE RESULTS. The desire for the maximum volume of resection is a relative guarantor of a decrease in the number of relapses, on the other hand, it increases the risk of neurological disorders. With pronounced neurological deficits, it is necessary to strive for the maximum radicalism of surgical treatment, but in the absence of a clinical manifestation, it is necessary to remember this during the operation.