Removal of Benign Neural Tumors

Much like in every other cell or tissue in our bodies, the tissue of our nervous system can develop various Tumors as well – tumors of the peripheral nervous system. Two of the most common of these types of tumors, Schwannomas and Neurofibromas, are usually benign. Their presence adjacent to or on nerve tissue can cause intense pain in the area, and impair the function of the nerve fibers, necessitating their removal in a delicate operation performed by expert and experienced neurosurgeons.

Prof. Shimon Rochkind, a senior surgeon at the Neurosurgical Center for Excellence at the Herzliya Medical Center, is considered to be a world-renowned expert in this type of operation.

Schwannomas: Features and Symptoms

Schwannomas are tumors that develop on peripheral nerves, which are the nerves that are located outside the central nervous system, which is composed of the brain and the spinal cord. Schwannomas are named for the cells from which they are derived – Schwann cells – which envelope the nerve fibers.

They are typically benign tumors, though this does not prevent them from causing extensive symptoms, mainly when they are very advanced. The primary manifestation is chronic pain and a feeling of discomfort in and around the area where the tumor develops. Schwannomas are usually slow-growing and therefore they are often only discovered when they reach a relatively large size and begin to cause serious pain.

Apart from the sensation of pain and discomfort, these tumors can cause many additional symptoms, depending on their location. Thus, for example, a schwannoma in the spine can cause a pins-and-needles sensation and weakness in the legs, while a schwannoma that develops around the auditory vestibular nerve will cause hearing impairment and create chronic ‘noise’ in the ear that is closer to the location where the tumor developed.

Schwannomas develop, as we can understand, along the spine and in the region of the auditory vestibular nerve which is within the skull, as well as around the brachial plexus in the region of the shoulder and on the cauda equina located at the lower spine.

Neurofibromas: Features and Symptoms

Neurofibromas (NFs) are also benign tumors that develop from the Schwan cells that envelope nerve fibers, but they contain additional cells. Apart from this detail, the biggest difference between neurofibromas and schwannomas is the cause of the tumor: in the vast majority of cases, neurofibromas only occur in patients who suffer from a hereditary disease called neurofibromatosis type 1 (NF-1) and are very rarely found in people who do not have this disease.

Neurofibromas often develop under the skin, so they can be seen and felt: in these cases, the tumor will be rubbery and dark in color. However, they can also grow on internal organs – around the spine and on organs inside the abdomen. These tumors can also press on nerve fibers, causing pain, discomfort and sometimes also disturbances of sensation in the area where they develop.

Modes of diagnosis and approaches for the treatment of these tumors

Due to their similar nature, schwannomas and neurofibromas are diagnosed and treated in a fairly similar manner. Diagnosis is usually made using an MRI scan or other advanced imaging techniques, depending on the patient’s specific symptoms and based on the findings previous examinations (including findings visible to the eye in the case neurofibromas under the skin).

The only treatment in these instances is the microsurgical removal of the tumor. These operations require extensive skill, as it is crucial that the nerve tissue upon which the tumors have developed be preserved in order to ensure their integrity as much as possible while the tumor is removed. The operation thus achieves two important objectives: firstly – removal of the tumor in its entirety; and secondly – preservation of the normal function of the nerves in the area of the tumor.

Prof. Rochkind, an expert in the treatment of peripheral nerves, has so far performed a long series of operations of this type. Alongside the team that has been working closely with him in these operations over many years, he achieves impressive results, enabling the complete rehabilitation of the nerves in the region of the tumor.

During the operation itself, the nerve fibers and nerve canals that are not part of the tumor are carefully separated, maintaining their normal structure. The tumor is then removed in its entirety. The operation includes the use of the most advanced surgical instruments, which are available to the surgical team at the Neurosurgical Center for Excellence at the HMC, including a surgical microscope that enables the handling of delicate and microscopic blood vessels and nerve fibers. The operation takes several hours, depending on the nature of the tumor, its location and the degree of involvement of nerve tissue with the tumor.

Herzliya Medical Center Hospital offers its patients hospitalization rooms at the level of a five-star hotel, is proud of its medical team, one of the best in Israel, led by Prof. Shimon Rochkind, the peripheral nervous system expert. Sanitary conditions are superb, reducing to zero the risk of hospital-acquired infection during the patient’s stay – which is one of the biggest dangers to which patients are exposed in hospitals in Israel.

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