Fence-like surgical techniques to deal with giant neurotomas

Surgeons at Qiaotang University in Shanghai have developed a technology that produces a large number of “fences” of sutures around the nerve tumor before removal, significantly improving the safety of patients with plexiform neurofibromas with larger size than football.

In combination with preoperative vascular obstruction, patients measuring up to 55.6 cm showed encouraging results in 11 patients with giant tumors.

These rare tumors associated with type 1 neurofibromatosis affect approximately 1 in 3,000 people and can cause serious disfigurement and functional problems. Traditional surgical methods often fail due to large amounts of bleeding during the surgery, so the patient’s treatment options are limited.

Fence Strategy

“This has been challenging giant PNF, especially when the tumor is highly vascular and is located in a critical anatomical area where bleeding and irreversible nerve damage can occur.” Stubborn technology is addressed by methodically placing sutures around the tumor in a fence-like manner before cutting.

The surgical procedure involves labeling the tumor area with a blue dye, and then placing heavy silk sutures weighing about 2-3 cm in a continuous circumference near the marked area. Each suture penetrates deep enough to compress the blood vessels feeding the tumor, creating visible paleness in the enclosed area before any cleavage begins.

Even in challenging locations such as the face and neck, this systematic approach has proven to be effective, and proximity to key structures often makes surgery extremely risky.

Dramatic results in complex situations

The team tracked the results of 11 patients with giant tumors and found significant success rates:

• The median tumor size treated was 30.4 cm, with the largest reaching 55.6 cm
• Most patients show significant functional improvement after surgery
• The average patient satisfaction score was 10 points.
• Only one patient suffered from postoperative infection
• The median hospital stay is 17 days

Revolutionary case: Clearing 14 kilometers of tumors

The most amazing success of the technology involved a 23-year-old woman whose back and hip tumor weighed 14 kg – 31 lbs. Although she required a large amount of blood transfusion during prolonged surgery, she achieved significant mobility and returned after 21 months to remove the remaining tumor tissue.

“Although the surgery is complex, most patients reported significant functional improvements and high levels of satisfaction,” Wang noted. “It is delightful to see how these patients handle these tumors over the years, restore mobility and improve quality of life after surgery.”

Enhance safety through embolization

For the most blood vessel-free tumors, surgeons add preoperative embolism—a procedure that can block blood vessels that feed the tumor using a tiny coil inserted into the catheter. Three patients received this additional treatment, which helped reduce bleeding during subsequent surgery.

This study reveals interesting patterns of blood loss. In the absence of embolism, the median bleeding during surgery was 208 ml, while patients who received the embolism and fixed junction experienced a higher median bleeding of 756 ml, which clearly reflects the choice of more complex cases of the concomitant method.

Solve key medical gaps

The study addresses a significant clinical challenge, as current treatment options for these tumors remain extremely limited. Although there are untreatable cases of MEK inhibitor drugs, they have significant costs, a strict drug schedule, and side effects that are difficult to tolerate in many patients.

This technique shows special hope for tumors in anatomical areas where traditional methods are not available in areas with complex anatomical areas. The study found that 63.6% of giant tumors occur on the surface, and surgical accuracy is particularly critical.

Going forward, researchers envision combining fixed connections with emerging technologies such as AI-assisted surgical planning and image guidance technology to further improve accuracy and safety. The team stressed that a large number of patient studies will be needed to fully determine the effectiveness of the method and improve patient selection criteria.

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