Giant Long-Standing Median Nerve Schwannoma Requiring Segmental Resection and Immediate Microsurgical Reconstruction Using a Reversed Autologous Sural Nerve Graft: A Case Report

Dr. Shashank Khandelwal, Dr. Prem Shankar, Dr. Geetika Anand

Abstract: Introduction and importance: Schwannomas are benign encapsulated peripheral nerve sheath tumours originating from Schwann cells and represent the most common benign neoplasms of peripheral nerves. Median nerve schwannomas are uncommon and usually present as slowly enlarging painless masses. Their eccentric growth generally permits nerve-preserving intracapsular enucleation; however, giant long-standing lesions may produce extensive distortion of the parent nerve, making preservation of functional fascicles impossible. In such circumstances, segmental nerve resection followed by immediate microsurgical reconstruction may be required to restore nerve continuity and function. Case presentation: A 60-year-old right-hand-dominant woman presented with a gradually enlarging swelling over the volar aspect of the right distal forearm that had been present for approximately 30 years. During the preceding few months, she developed intermittent pain and paraesthesia in the median nerve distribution without motor weakness or impairment of grip or pinch strength. Clinical examination revealed a firm, well-defined 6 ? 3 cm swelling with restricted transverse mobility and a positive Tinel's sign. Ultrasonography demonstrated a well-defined benign-appearing soft-tissue lesion in continuity with the underlying median nerve, suggestive of a benign peripheral nerve sheath tumour. Owing to financial constraints, magnetic resonance imaging could not be performed. Surgical exploration under an axillary brachial plexus block demonstrated circumferential involvement of the median nerve with complete distortion of the fascicular architecture, precluding safe intracapsular enucleation. Complete tumour excision resulted in a 4-cm nerve defect, which was reconstructed using a single reversed 4.5-cm autologous sural nerve graft. Microsurgical epineural neurorrhaphy was performed under loupe magnification using four interrupted 6-0 polypropylene (Prolene) sutures at each coaptation site. Histopathological examination confirmed a benign schwannoma characterized by Antoni A and Antoni B areas with focal Verocay body formation. At one-year follow-up, the patient demonstrated Medical Research Council Grade 4/5 motor recovery, restoration of protective sensation, satisfactory hand function, and no evidence of tumour recurrence. Clinical discussion: Although most median nerve schwannomas can be treated successfully by intracapsular enucleation, giant long-standing tumours may completely disrupt normal fascicular anatomy. In these uncommon situations, complete excision followed by immediate autologous nerve grafting provides a biologically favourable conduit for axonal regeneration and can achieve meaningful neurological recovery. Conclusion: Long-standing median nerve schwannomas requiring segmental nerve excision are rare. When preservation of the parent nerve is not technically feasible, immediate microsurgical reconstruction using a reversed autologous sural nerve graft represents a reliable reconstructive option capable of restoring useful neurological function while maintaining excellent local disease control.

Keywords: Schwannoma, Median Nerve Sural Nerve Nerve Grafting Microsurgery Peripheral Nerve Injuries

How to Cite?: Dr. Shashank Khandelwal, Dr. Prem Shankar, Dr. Geetika Anand, "Giant Long-Standing Median Nerve Schwannoma Requiring Segmental Resection and Immediate Microsurgical Reconstruction Using a Reversed Autologous Sural Nerve Graft: A Case Report", Volume 15 Issue 7, July 2026, International Journal of Science and Research (IJSR), Pages: 1720-1725, https://www.ijsr.net/getabstract.php?paperid=SR26720221012, DOI: https://dx.doi.org/10.21275/SR26720221012

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