Laparoscopic resection of a recurrent etroperitoneal schwannoma (case report and review of the literature)

Retroperitoneoscopic Resection of a Lumbosacral Plexus Schwannoma: Case Report and Literature Review

“…It is worth mentioning that previous reports justified en bloc resection together with the parent nerve by retroperitoneoscopy, mainly because of an uncertain diagnosis preoperatively or clinical suspicion of a malignant transformation. 5,6,17 This is not in accordance with the current concept of preserving the nerve using the fascicle-sparing technique 19,20 that consists of promoting a longitudinal incision over the epineurium away from functioning fascicles with the help of electrical mapping.…”

“…10 To the best of our knowledge, only four patients underwent pure retroperitoneoscopic resection of retroperitoneal nerve sheath tumors (schwannomas and neurofibromas) in the literature (►Table 2). 5,6,16,17 Lacarriere et al 18 reported three patients, in whom a combined open and retroperitoneoscopic resection was performed, due to tumor size or involvement of vascular structures. The mean maximum tumor diameter was 52 mm (range: 20-120 mm), and tumors were mostly resected en bloc with three trocars.…”

“…Four patients had paravertebral retroperitoneal nerve sheath tumors (type 1). 5,6,16,17 Trocar position was subcostal (at the middle axillary line [MAL] or PAL), above the iliac crest (also at the MAL or PAL), and in the AAL. One patient underwent surgery for treatment of a lateral-positioned tumor (type 2).…”

“…3 RSs pose a significant diagnostic challenge because most patients are asymptomatic or have highly unspecific symptoms, in such a way that diagnosis is usually delayed to an advanced stage when the tumor reaches a significant size. [3][4][5] Clinical presentation depends very much on tumor location and size, but abdominal pain and neurologic dysfunction are regarded as the most common. 3,4 Thus imaging plays a major role in the diagnosis.…”

Lateral access to paravertebral tumors

“…2, [4][5][6]16 Traditionally, transabdominal and retroperitoneal approaches have been employed for the treatment of these lesions. Less invasive techniques, such as laparoscopy 3,10,11,13 (including robot-assisted laparoscopy), 7,18 CyberKnife radiosurgery, 8 and CT-guided radiofrequency ablation 19 have also been noted as treatment options.…”