The patient, a known case of plexiform neurofibroma of the right median nerve was operated 2001 and 2005 elsewhere. She is complaining of paresthesia of the median distribution of the right hand with painful swelling of the wrist and thenar region.

MRI of the right forearm performed 21-June-2013 showed swelling the proximal part of the median nerve and soft tissue mass in the right thenar area.

On examination: the patient has scar of previous surgeries running from the mid third of the forearm running down to the carpal tunnel area turning to the thumb.

Exposure of the median nerve at the lower third of the right forearm. The median nerve is missing. The wound extended up and the median nerve was seen with neuroma around 2x3 cm diameter ending with scar. Using Inomed IOM with brachial plexus set, the proximal part of the nerve was studied and the running motor branches were dissected off the neuroma. There is no tumor and the neuroma was cut to see any fibrillary structures. Only scar was seen without any neural structures. The median nerve was missing even at the carpal tunnel level. The ulnar nerve was studied and all the preoperative functions were observed to be through the ulnar nerve. They were achieved even with 1-2mA DNS stimulation. The median nerve trajectory was stimulated even with 10 mA current without response. The neuroma was cut at the fibrillary part of the nerve. Considering that the patient was using her hand in excellent way, no attempt was paid for applying a bridge anastamosis. Routine closure of the wound.

Smooth postoperative recovery. 

The patient have no record about the previous surgeries. It seems in retrospective manner, that the median nerve was resected with the supposed to be tumor. The painful mass was that of painful neuroma, which was resected.

Considering that the hand function before surgery was acceptable, with the resected median nerve, no attempt for anastamosis with graft was paid.