Philippine Journal of Surgical Specialties Vol. 77, No. 2, July-December 2022, pp 51-65

Multiple Strategies to Avoid Life-threatening Blood Loss During Intralesional Resection of a Giant Plexiform Neurofibroma: A Case Report

Author(s): Ma. Katrina B. Guillermo, MD and Rodney B. Dofitas, MD, FPCS

Giant plexiform neurofibroma (PNs) are benign peripheral nerve sheath tumors known to contain multiple fascicles of nerve and numerous friable vascular components. Most consult due to significant disfigurement and functional deficit. Though surgery is the current standard of therapy, there is high reservation in pushing through with resection in most cases. The reservation stems from the recognized difficulty in controlling intraoperative life-threatening hemorrhage. A 25-year-old female came in our institution due to multiple debilitating giant PNs on her scalp, back, neck, shoulder, and chest. She opted for debulking surgery despite possible complications and recurrence.
Multiple modalities used to prevent massive bleeding in this case included preoperative arterial embolization, energy sealing device, cutting linear stapler, and interlocking retention sutures. The aim of this case report was to discuss the utility of each of these techniques, the advantages and disadvantages of each approach based on our experience.

Key words: Neurofibromatosis type-1, plexiform neurofibroma, hemorrhage, neurofibroma resection, preoperative arterial embolization