Fence-Like Surgical Technique Tackles Giant Nerve Tumors

Surgeons at Shanghai Jiao Tong University have developed a technique that creates a “fence” of sutures around massive nerve tumors before removal, dramatically improving safety for patients with plexiform neurofibromas that can grow larger than footballs.

The FENCY ligation method, combined with preoperative blood vessel blocking, has shown promising results in 11 patients with giant tumors measuring up to 55.6 centimeters.

These rare tumors, associated with neurofibromatosis Type 1, affect roughly 1 in 3,000 people and can cause severe disfigurement and functional problems. Traditional surgical approaches often fail due to massive bleeding during operation, leaving patients with limited treatment options.

The Fence Strategy

“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,” explains Dr. Zhichao Wang, the study’s lead researcher. The FENCY technique addresses this by methodically placing sutures around the tumor in a fence-like pattern before cutting.

The surgical process involves marking the tumor area with blue dye, then placing heavy silk sutures about 2-3 centimeters apart in a continuous perimeter around the marked zone. Each suture penetrates deep enough to compress blood vessels feeding the tumor, creating visible pallor within the enclosed area before any cutting begins.

This systematic approach proved effective even in challenging locations like the face and neck, where proximity to critical structures typically makes surgery extremely risky.

Dramatic Results in Complex Cases

The research team tracked outcomes for 11 patients with giant tumors, finding remarkable success rates:

• Median tumor size treated was 30.4 cm, with the largest reaching 55.6 cm
• Most patients showed significant functional improvement post-surgery
• Patient satisfaction scores averaged 10 out of 10
• Only one patient developed post-surgical infection
• Median hospital stay was 17 days

Revolutionary Case: 14-Kilogram Tumor Removal

The technique’s most striking success involved a 23-year-old woman whose back and buttock tumor weighed 14 kilograms—roughly 31 pounds. Despite requiring significant blood transfusion during the lengthy operation, she achieved remarkable mobility improvement and returned 21 months later for removal of remaining tumor tissue.

“Despite the complexity of the surgeries, most patients reported significant functional improvement and high levels of satisfaction,” Wang noted. “It’s gratifying to see how these patients, some of whom had been dealing with these tumors for years, regained mobility and improved their quality of life after surgery.”

Enhanced Safety Through Embolization

For the most vascular tumors, surgeons added preoperative embolization—a procedure that blocks blood vessels feeding the tumor using tiny coils inserted through catheters. Three patients received this additional treatment, which helped reduce bleeding during subsequent surgery.

The study revealed interesting patterns in blood loss. Without embolization, the median bleeding during surgery was 208 milliliters, while patients who received both embolization and FENCY ligation experienced higher median bleeding of 756 milliliters—likely reflecting the selection of more complex cases for the combined approach.

Addressing a Critical Medical Gap

The research addresses a significant clinical challenge, as current treatment options for these tumors remain extremely limited. While MEK inhibitor drugs exist for inoperable cases, they come with substantial costs, strict medication schedules, and significant side effects that many patients find difficult to tolerate.

The technique shows particular promise for tumors in anatomically complex regions where traditional approaches like tourniquets cannot be used. The study found that 63.6% of giant tumors occurred on the face, where surgical precision proves especially critical.

Looking ahead, researchers envision combining FENCY ligation with emerging technologies like AI-assisted surgical planning and image-guided techniques to further enhance precision and safety. The team emphasizes that larger patient studies will be needed to fully establish the method’s effectiveness and refine patient selection criteria.