Enrico Martin

270 Chapter 11 Strengths and limitations This study is limited by its retrospective nature. Functional outcomes were not routinely and completely registered resulting in common missingness of exact deficits, more so for sensory deficits. For this reason further in-depth analyses were avoided. Nonetheless, this study included a large dataset of patients. MPNSTs are rare and it is unlikely that prospective datasets will include more patients to give further insight. Furthermore, by including data from several centers this study was able to identify large number of MPNSTs and possibly reduce referral bias. In turn, it was able to identify patient groups that are at risk of persisting critical motor and sensory deficits. Based on the high prevalence of postoperative functional morbidities and low incidence of functional reconstructions identified in this study it could be concluded that combining expertise from surgical oncologists and peripheral nerve surgeons may be beneficial when resecting MPNSTs from major nerves or large MPNSTs. By including peripheral nerve surgeon expertise, both epineural dissection and reconstructive possibilities can be taken into consideration. Unfortunately, these collaborations are still rare. Future research should attempt to further identify ideal candidates for reconstruction who are anticipated to have reasonable oncological outcomes. Conclusion Surgical resection of MPNSTs commonly results in major motor deficits and loss of critical sensation. Loss of function is more likely when resecting MPNSTs in NF1 patients, large, and deep-seated tumors, and those arising from major nerves. Whenever patients present with motor or sensory deficits, these will likely persist. Peripheral nerve surgeons are more commonly involved in high-risk patients, but not in the majority of cases. Functional reconstructions are infrequently performed, but may result in good regain of function regardless of the use of multimodal oncological treatment.