The Effect of Clinical, Radiological and Surgical Factors on Postoperative Complications in Solitary Extremity Schwannomas

<b>Background/Objectives</b>: To evaluate the clinical and MRI characteristics of benign solitary schwannomas of the extremities, compare pre- and postoperative neurological symptoms, and identify preoperative and intraoperative risk factors for postoperative complications. <b>Methods:</b> A retrospective review was conducted on 47 patients with histopathologically confirmed benign solitary schwannomas of the extremities who underwent surgical excision. Demographic data, MRI characteristics (tumor volume, perilesional edema, and degenerative changes such as cystic components or intratumoral hemorrhage), fascicular relationship, and use of tru-cut biopsy were recorded. Pre- and postoperative neurological symptoms were compared. Univariate logistic regression analysis was performed to identify factors associated with postoperative complications. <b>Results</b>: The mean age was 38.6 ± 15 years, and the mean follow-up period was 109.8 ± 65.1 months. Lesions were predominantly located in the upper extremity (65.9%), with a mean volume of 9.6 ± 4.8 cm³; perilesional edema and/or degenerative changes were present in 53.1% of cases. Postoperative complications occurred in 19.1% of patients, with intrafascicular involvement being a significant predictor (OR = 5.4, <i>p</i> = 0.037) and a positive preoperative Tinel's sign showing a trend toward significance (OR = 4.2, <i>p</i> = 0.084). Tumor volume, perilesional edema, degenerative changes, tru-cut biopsy, and anatomical location were not significantly associated with complications. At final follow-up, pain remission was 82.1%, and paresthesia improvement was 63.6%. <b>Conclusions</b>: Intrafascicular involvement was associated with postoperative complications in univariate analysis, whereas preoperative MRI characteristics, biopsy, and Tinel's sign showed no predictive value for postoperative risk.