Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Carpal Tunnel Syndrome Caused by Lipofibromatous Hamartoma of the Median Nerve

  • Roh, Youn-Tae (Department of Orthopaedic Surgery, H Plus Yangji Hospital) ;
  • Song, Seok-Whan (Department of Orthopaedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jeong, Changhoon (Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kang, Younghoon (Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Park, Il-Jung (Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2020.03.17
  • Accepted : 2020.04.14
  • Published : 2020.09.01
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Abstract

Lipofibromatous hamartoma (LFH) is a rare tumor of the peripheral nerves, which usually involves the median nerve. The authors reported on two rare cases of carpal tunnel syndrome due to LFH of the median nerve. A 49-year-old female patient complained of the mass and symptoms consistent with LFH. Magnetic resonance imaging (MRI) showed typical LFH findings. The symptoms were successfully ameliorated with carpal tunnel release and external neurolysis. A 37-year-old female patient complained of weakening thumb abduction and the mass where the MRI showed atypical findings. Opponensplasty and debulking operations were performed after which thumb abduction was improved; however, neurological sequelae remained. LFH of the median nerve is managed on a case-by-case basis as treatment guidelines are not very clearly defined yet. However, the less invasive treatment such as carpal tunnel release and external neurolysis than more aggressive surgical treatment should be recommended as a treatment option.

Keywords

Acknowledgement

We thank Chang Deok Weon, a medical photographer of Bucheon St. Mary's hospital, the Catholic University of Korea for helping in preparing the photo.

References

  1. Afshar A : Carpal tunnel syndrome due to lipofibromatous hamartoma of the median nerve. Arch Iran Med 13 : 45-47, 2010
  2. Agarwal S, Haase SC : Lipofibromatous hamartoma of the median nerve. J Hand Surg Am 38 : 392-397; quiz 397, 2013 https://doi.org/10.1016/j.jhsa.2012.10.042
  3. Agrawal R, Garg C, Agarwal A, Kumar P : Lipofibromatous hamartoma of the digital branches of the median nerve presenting as carpal tunnel syndrome: a rare case report with review of the literature. Indian J Pathol Microbiol 59 : 96-98, 2016
  4. Al-Jabri T, Garg S, Mani GV : Lipofibromatous hamartoma of the median nerve. J Orthop Surg Res 5 : 71, 2010 https://doi.org/10.1186/1749-799X-5-71
  5. Clavijo-Alvarez JA, Price M, Stofman GM : Preserved neurologic function following intraneural fascicular dissection and nerve graft for digital and median nerve lipofibromatous hamartoma. Plast Reconstr Surg 125 : 120e-122e, 2010 https://doi.org/10.1097/PRS.0b013e3181cb66b7
  6. Hoellwarth JS, Goitz RJ : Lipofibromatous hamartoma of the palmar cutaneous branch of the median nerve. J Hand Microsurg 10 : 109-112, 2018 https://doi.org/10.1055/s-0038-1626682
  7. Kitridis D, Dionellis P, Xarchas K, Givissis P : Giant median nerve due to hamartoma causing severe carpal tunnel syndrome. J Orthop Case Rep 8 : 57-60, 2018
  8. Mason ML : Proceedings of the American Society for Surgery of the Hand: presentation of cases. J Bone Joint Surg Am 35 : 273-275, 1953
  9. Mohammed Saeed MA, Dawood AA, Mahmood HM : Lipofibromatous hamartoma of the median nerve with macrodactyly of middle finger. J Clin Orthop Trauma 10 : 1077-1081, 2019 https://doi.org/10.1016/j.jcot.2019.05.023
  10. Nardella D, Sohawon S, Carlier A : Lipofibromatous hamartoma of the median nerve. Three case reports. J Plast Reconstr Aesthet Surg 62 : e314-e317, 2009 https://doi.org/10.1016/j.bjps.2007.11.061
  11. Razzaghi A, Anastakis DJ : Lipofibromatous hamartoma: review of early diagnosis and treatment. Can J Surg 48 : 394-399, 2005
  12. Silverman TA, Enzinger FM : Fibrolipomatous hamartoma of nerve. A clinicopathologic analysis of 26 cases. Am J Surg Pathol 9 : 7-14, 1985 https://doi.org/10.1097/00000478-198501000-00004
  13. Tahiri Y, Xu L, Kanevsky J, Luc M : Lipofibromatous hamartoma of the median nerve: a comprehensive review and systematic approach to evaluation, diagnosis, and treatment. J Hand Surg Am 38 : 2055-2067, 2013 https://doi.org/10.1016/j.jhsa.2013.03.022
  14. Toms AP, Anastakis D, Bleakney RR, Marshall TJ : Lipofibromatous hamartoma of the upper extremity: a review of the radiologic findings for 15 patients. AJR Am J Roentgenol 186 : 805-811, 2006 https://doi.org/10.2214/AJR.04.1717
  15. Ulrich D, Ulrich F, Schroeder M, Pallua N : Lipofibromatous hamartoma of the median nerve in patients with macrodactyly: diagnosis and treatment of a rare disease causing carpal tunnel syndrome. Arch Orthop Trauma Surg 129 : 1219-1224, 2009 https://doi.org/10.1007/s00402-008-0695-6

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  1. Lipofibromatous Hamartoma in a Hispanic Patient with macrodactyly: a rare peripheral nerve tumor causing recurrent carpal tunnel syndrome vol.2020, pp.10, 2020, https://doi.org/10.1093/jscr/rjaa418