Peripheral Nerve Tumors
Conveniently located to serve Dallas and Fort Worth
Dr. Nader Pouratian is able to diagnose and treat peripheral nerve tumors for Dallas patients using a variety of methods. Peripheral nerve tumors can arise anywhere in the body. They grow in or on the nerves that communicate signals from the brain, spine, and other parts of the body.
The vast majority of peripheral nerve tumors are non-cancerous. The most commonly found peripheral nerve tumor in adults is called a schwannoma, followed by neurofibromas. These benign tumors may cause pain, numbness, tingling, or even weakness. But in many cases, they may not cause any symptoms at all. These are usually called “incidental” tumors, in which case nothing may need to be done except watch it closely.
What Is a Schwannoma?
A schwannoma is a tumor that originates from the Schwann cells of the nervous system. Schwann cells are the cells that cover or “insulate” our nerves to help them send signals quickly from one part of the body to another. To do this, schwann cells produce insulating myelin sheaths around neuronal axons in the peripheral nervous system.
Causes of Schwannomas
Most schwannomas occur sporadically, which means we don’t know why they happen. Because they can come up randomly and they are benign, we sometimes think of them like a mole on a nerve. Just like a mole, they are most often benign and unless there is something concerning, surgery may not be required. Genetic disorders like schwannomatosis, neurofibromatosis 2 (NF2), and Carney Complex can also cause schwannomas to form. These syndromes are usually accompanied by other signs and symptoms, like having numerous nerve tumors, having brain tumors, having problems with the eyes, or having dermatologic findings (like café au lait spots or freckling in the armpit or groin).
These tumors can appear at any age, and they are most commonly diagnosed between the ages of 20 and 50.
Symptoms of Schwannomas
In many cases, schwannomas are not symptomatic. People can discover them when getting imaging for another reason or because they feel a bump under the skin.
When a schwannoma becomes larger, it puts pressure on the nerves around it, causing symptoms such as the following:
- Tingling or a pins-and-needles sensation
- Weakness in the muscles
- Sharp, burning, or aching pains
The exact symptoms depend on which nerve is affected. A special kind of schwannoma is a vestibular schwannoma, also called an acoustic neuroma. These can be associated with hearing loss, ringing in the ears (tinnitus), balance problems, or facial weakness.
Tests Used to Diagnose Schwannomas
To diagnose schwannomas, Dr. Pouratian will meet with you for a consultation and may ask you about any signs and symptoms you are currently experiencing. If he suspects a peripheral nerve tumor, he may recommend one or more of the following tests.
Magnetic resonance imaging (MRI): An MRI scan uses radio waves and a magnet to give a 3-D view of the nerves.
Ultrasound: An ultrasound uses sound energy to create images of the nerve and is a particularly useful way to look at nerves and tumors.
Electromyogram (EMG) and nerve conduction studies: Small needle electrodes are inserted into certain muscles. An electromyogram records the electrical activity in the muscles as the patient tries to move the area. For nerve conduction studies, electrical impulses are delivered to the nerves through electrode patches.
Tumor biopsy: Cells are removed from the tumor and then carefully analyzed in a lab setting. For this procedure, patients may need local or general anesthesia.
Regular checkups and follow-up scans can also be conducted every 6 months to help monitor peripheral nerve tumors and their growth.
Peripheral Nerve Tumor Treatment Options
Many schwannoma treatment options are available. Treatment options are chosen for patients depending on factors like the location of the schwannoma and whether or not it is growing or causing pain.
Observation: Peripheral nerve tumors grow very slowly, and sometimes stop growing. If a tumor is relatively small, is not causing symptoms, and has not yet grown on imaging, we may recommend just watching the tumor. Usually a repeat scan will be requested in 6 months.
Surgical removal of the schwannoma: Although we call these “nerve tumors”, these tumors can actually be surgically removed usually with very low risk in an outpatient surgery center. Just like a cable has many wires, a nerve has many fascicles. These tumors usually grow on a single fascicle, pushing the rest of the tumor out of the way. During a surgery, we open up the cable, push the other wires (fascicles) out of the way, and are able to completely remove the tumor without injuring the normal nerve. This surgery is performed using anesthesia.
Radiation therapy: Radiation therapy is very effective at controlling tumor growth, usually with >90% tumor control. Because surgical removal is so effective and safe, we usually only consider radiation for those in whom surgery may be particularly difficult, due to the location of the tumor or other concerns.
Arrange a Consultation
If you are experiencing the symptoms of a schwannoma, arrange a consultation with Dr. Nader Pouratian for diagnosis of peripheral nerve tumors in Dallas. Dr. Pouratian will be able to recommend the proper course of treatment and can answer any questions you might have.