Introduction:

Primary tumors of the brachial plexus are rare and correspond to schwannomas and neurofibromas. These are treated as cervical-mediastinal masses with apical intrathoracic extension. They may debut with symptoms of neural compression.

Case description:

14-year-old woman with neurofibromatosis type I, pain in the left upper limb, paresis and paresthesia, atrophy and decreased muscle strength with generalized dermatosis and increased volume in the left side of the neck; in the MRI with extradural lesion originating at the level of left C7-T1 and displacement of the trachea and esophagus and invasion towards the mediastinal region; electromyography with decreased sensory and motor amplitude of the left ulnar nerve. Tumor excision was performed through anterior thoracic cervical approach with neurophysiological monitoring, finding: encapsulated mass resected by central enucleation dependent on nerve roots C5, C6 and C7, extrapleural. Pathology report with cervicothoracic schwannoma; gradual recovery of mobility at seven years of follow-up with rehabilitation support.

Conclusion:

Approaching masses located in the brachial plexus with mediastinal extension and to the cervicothoracic junction is a surgical challenge. Intraoperative neurophysiological monitoring increases safety and prognostic benefit.