Nerve Tumors
Details on these varied conditions
Exploring nerve tumors
Animation: Distal Femoral Branch Tumor Seen in Survey Image.
The image at left is from a 28-year-old man who developed hand pain and numbness. Because of the area of the hand that was affected, his doctors assumed that he had an entrapment of the ulnar nerve at the elbow and proceeded to do an elaborate surgery on the nerve. Only when the surgery failed completely to affect the problem did they consider imaging of the region to see what the cause was.
In the past, doctors have always imaged an area before doing surgery unless the problem involved nerves. Now that MR Neurography is available and effective, it is important for patients and doctors to understand that imaging should be employed for nerve problems just like other medical problems treated by surgery.
In this case, the imaging revealed a nerve tumor abour 1.5 centimeters in diameter that was easily removed solving the problem. He suffered no harm from his unnecessary nerve release surgery. Operating before imaging is no longer appropriate in the management of nerve conditions.
Imaging revealed an 1.3 centimeter mass within the ulnar nerve in the upper arm. The tumor spreads the fibers of the nerve.
MR Neurography was invented and developed by Dr. Aaron Filler of Neurological Injury Specialists. Imaging is an essential part of diagnostic evaluations at the NIS.
There are many diagnoses and treatments of nerve tumors. Please click on any of the links below to learn more about individualized cases from the files of Dr. Filler.
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.
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Meet Dr. Filler
A globally recognized expert in the treatment of peripheral nerve disorders and the development of nerve imaging technology, Dr. Aaron Filler is the world’s leading expert in treatment of nerve pain. He has revolutionized nerve-pain treatment by inventing several new technologies. One such technology, MR Neurography, enables doctors to use an MRI scanner to examine nerves, previously a difficult-to-impossible tissue to visualize with MR imaging.
Dr. Filler’s research in axonal transport is leading to a whole new generation of advanced pain medications. He has developed many new “minimal access” surgery methods that allow him to treat complex nerve problems with small outpatient surgeries. He has also pioneered the use of the Open MRI scanner to do surgeries and other therapies with the ultra-high precision and safety of the magnetic resonance imaging.
At Dr. Filler’s Neurological Injury Specialists Management Group in Santa Monica, California, the key to success remains a very traditional endeavor: listening to the patient and doing a thorough and expert neurological examination. Dr. Filler typically spends more than an hour with each new patient. The results of the initial examination are then strengthened and perfected with application of advanced technology available nowhere else in the world.
Dr. Aaron Filler combines three key components in his treatment of each patient:
- Compassionate personal attention,
- Expert medical skills, and
- The best technology in the world
He combines these components to turn insoluble pain problems into specific treatable diagnoses. Prior to coming to the Institute for Nerve Medicine, many of Dr. Filler’s patients have seen a dozen doctors (or more), experienced failed surgeries, and have even had their very pain questioned. Time and again, Dr. Filler demonstrates that in many of these cases the problem is the doctor and not the patient. A cure is in reach when the best available medical care is brought to bear.
Dr. Filler has an MD from the University of Chicago, a PhD from Harvard University, and is also a Fellow of the Royal College of Surgeons in England. His medical training included four years of medical school, eight years of neurosurgical training at one of the leading neurosurgery programs in the US, an additional one-year fellowship in neuroimaging at the University of London, another year of training in complex spinal surgery at UCLA, and a fellowship in peripheral nerve surgery with Dr. David Kline in New Orleans.
He is the inventor on ten major patents, has published more than twenty prominent scientific publications, and has done more than a hundred presentations at scientific and medical meetings. He is also the author of Do You Really Need Back Surgery? from Oxford University Press, a well-received 300-page book for the general public. He enjoys medical staff privileges at Cedars-Sinai Medical Center in Los Angeles.
