Giant plexiform neurofibromas (PNF) are benign tumors commonly associated with neurofibromatosis Type 1 (NF1), a genetic disorder affecting approximately 1 in 3,000 live births. These tumors, which occur in around 25% of NF1 patients, can grow to enormous sizes and cause severe disfigurement and functional impairments. Resection of giant PNFs has been particularly challenging due to their high vascularity and proximity to critical anatomical structures, leading to significant risks of bleeding and irreversible nerve damage. To address these complications and improve recovery time, researchers have developed an innovative approach that enhances the safety and effectiveness of these surgeries.

The new technique, created by researchers from Shanghai Jiao Tong University School of Medicine (Shanghai, China), is a combination of FENCY ligation and preoperative embolization. The FENCY technique involves a thorough suture ligation of the tumor's surrounding vasculature in a "fence-like" pattern, while preoperative embolization helps reduce blood flow to the tumor. This dual intervention approach enhances hemostasis and surgical precision, which are crucial when operating on such complex and high-risk tumors. The method is designed to improve the overall outcome and minimize complications during the removal of giant PNFs, particularly in sensitive areas such as the face and neck.

The technique was tested in a study involving 11 patients, all of whom showed promising results. The median tumor size was 30.4 cm, with one tumor reaching as large as 55.6 cm. Despite the complexity of these surgeries, most patients reported significant functional improvements and high satisfaction, with many regaining mobility and an enhanced quality of life after surgery. The research, published in the Chinese Journal of Plastic and Reconstructive Surgery, suggests that this technique can be widely applied to similar cases of giant PNF resection. The researchers aim to expand their patient cohort in future studies to refine the procedure and understand its long-term impacts.

“It has been challenging resecting giant PNF, particularly when the tumors are highly vascular and located in critical anatomical regions where bleeding and irreversible nerve damage are likely to occur,” shares Dr. Zhichao Wang, lead researcher of the study. “The FENCY ligation technique, combined with preoperative embolization, provides a dual preoperative and intraoperative intervention that effectively addresses these challenges. By improving hemostasis and enhancing surgical precision, this approach facilitates better overall outcomes and minimizes complications.”

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