Surgical management of a large neurofibroma in the thenar Region: A case report

Introduction: Neurofibromas are rare benign tumors of peripheral nerve sheaths, and hand involvement is particularly uncommon. This case report presents a large neurofibroma located in the thenar region, a critical area for thumb opposition and hand dexterity, posing unique surgical challenges.

Presentation of case: A 23-year-old female presented with a 3-year history of a progressively enlarging mass in the thenar region of the right hand, accompanied by nocturnal pain but no neurological deficits. MRI revealed a well-circumscribed, multilobulated tumor measuring 54 × 55 × 33.4 mm. Surgical excision was successfully performed while preserving the median nerve. Postoperative recovery was assessed using the QuickDASH questionnaire, yielding a score of 6, indicative of excellent functional outcomes. Histopathology confirmed a benign neurofibroma.

Clinical discussion: The large size and rare location of this tumor, combined with the absence of neurofibromatosis type 1, make this case noteworthy. Early diagnosis and meticulous surgical planning enabled complete excision while preserving critical structures, resulting in full functional recovery with no recurrence after 18 months.

Conclusion: This case underscores the importance of individualized surgical strategies for managing neurofibromas in functionally critical areas. While excellent long-term outcomes were achieved in this instance, further studies are needed to validate these findings and refine management approaches.