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BACKGROUND Giant presacral schwannomas are extremely rare in neurosurgery. There are various approaches to the surgical treatment of symptomatic giant presacral schwannomas. The least traumatic is the one-stage surgery with a dorsal approach. OBSERVATIONS The authors describe a case of a 52-year-old male with pain in the sacral region and partial urinary dysfunction. A total tumor resection through a minimally invasive dorsal approach was performed, and anatomical and functional preservation of all sacral nerves with no postoperative complications was achieved. LESSONS The authors have shown the possibility of total tumor resection with a minimally invasive dorsal approach without the development of intra- and postoperative complications. Operative corridors that have been created by a tumor can be used and expanded for a minimally invasive dorsal approach to facilitate resection and minimize tissue disruption.

Цель. Cоздание упрощенного макета барабанной полости, соответствующего основным анатомическим ориентирам, для отработки процедуры постановки поршневого стапедиального протеза. Материалы и методы. Для изготовления макета-тренажера использовался шприц объемом 5 мл, который всегда доступен и обладает низкой рыночной стоимостью и в то же время соответствует основным анатомическим параметрам смоделированной барабанной полости. В эксперименте принимали участие 13 человек – ординаторы и врачи, которые не имели опыта подобных хирургических вмешательств. Результаты. По результатам проведенного исследования все участники эксперимента при апробации макета для стапедопластики успешно справились с поставленной задачей. Среднее количество времени, затраченного на установку поршневого протеза, составило 1 мин. 55 сек. При выполнении задания участникам давалось 5 попыток установки стапедиального протеза с соблюдением времени отдыха в количестве 2 минут между подходами. Использование созданного макета экономически более выгодно, удобно для понимания процедуры стапедопластики начинающими специалистами, эффективно в развитии микрохирургических мануальных навыков, которые в перспективе положительно отражаются на результатах при работе с кадаверным материалом животных и живой хирургии стремени. Заключение. По результатам проведенного исследования созданный макет барабанной полости соответствует всем анатомическим параметрам и может успешно применяться в учебной практике для отработки процедуры постановки стапедиального протеза. Purpose. To create a simplified prototype of the tympanic cavity, corresponding to the main anatomical parameters, for practicing the technique of piston stapedial prosthesis placement. Materials and methods. A 5 ml syringe was used to make the model, which is always available and has a low market value, corresponding at the same time to the basic anatomical parameters of the simulated tympanic cavity. The experiment involved 13 participants: residents and doctors having no experience of such surgical interventions. Results. According to the results of the study, all participants successfully coped with the task of testing the stapedoplasty model. The average time spent on placing the piston prosthesis was 1 min. 55 sec. When performing the task, the participants were given 5 attempts to place the stapedial prosthesis with a rest time of 2 minutes between approaches. The use of the created prototype of tympanic cavity is more cost-effective, convenient for understanding the stapedoplasty technique by novice specialists, effective in developing microsurgical manual skills, which in the long term have a positive effect on the results when manipulating cadaveric animal material and in live stapes’s surgery Conclusion. According to the results of the study, the created model of the tympanic cavity corresponds to all anatomical parameters and can be successfully used in educational practice to work out the technique of stapedial prosthesis placement.

BACKGROUND: The treatment of giant presacral schwannomas is currently a grand challenge for neurosurgeons. Although these tumors are benign and do not infiltrate the surrounding tissues, it is difficult to choose the best surgical approach because they are surrounded by the pelvic organs and great vessels. There is no universally accepted approach to the surgical treatment because giant presacral schwannomas are rare in the population. The anterior approach through laparotomy is more often recommended in the literature. A dorsal approach that involves laminotomy and stabilization is also described in the literature. However, these approaches are rather traumatic for the patient and have both intraoperative and postoperative risks. OBJECTIVE: To report a minimally invasive dorsal approach for the treatment of giant presacral schwannomas. METHODS: We present a fundamentally new approach to the treatment of these tumors using a minimally invasive dorsal approach, based on the specific anatomy and growth of giant presacral schwannomas. This approach is using the potential of modern neurosurgery. RESULTS: We describe 2 cases of successful total tumor resection using this novel surgical approach. No complications have been registered after the surgery. CONCLUSION: A minimally invasive dorsal approach for the treatment of giant presacral schwannomas is sufficient for complete tumor removal, minimizes intraoperative and postoperative risks, is associated with good cosmetic effect, and can be successfully applied in surgical practice.

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