Single Stage Posterior Approach for Total Resection of Presacral Giant Schwannoma: A Technical Case Report

Abstract

The neurogenic tumor of frequent occurrence in the presacral area is a schwannoma. Giant presacral schwannoma has a risk for anterior surgical approach because of its massive size and proximity to abundant vascularity of presacral region. We report a single stage posterior approach for total resection of a giant presacral schwannoma. A 40-year-old female patient experienced left buttock pain and tingling sensation at left S1 dermatome. Magnetic resonance imaging showed that the presacral huge mass at S1–3 level with osseous extension and structural remodeling in left sacral ala. The presacral mass was ranging in maximum diameter from 8.0 to 8.6 cm. S2 foramen laminectomy was performed to expose the mass. The tumor capsule and the root were carefully dissected away. The tumor was removed while preserving the capsule by dissecting the plane between the inner wall of the capsule and the tumor. The single stage posterior approach for presacral giant schwannoma is feasible, and it can be a good surgical alternative to prevent pelvic organ or vascular damage and anterior approach related dystocia and infertility.

Total Deformity Angular Ratio as a Risk Factor for Complications after Posterior Vertebral Column Resection Surgery

“…To reduce the complications of conventional VCR, Suk et al [ 21 ] described a posterior VCR (PVCR) technique. Nevertheless, there is still a risk of complications with PVCR [ 3 , 14 , 18 ]. The incidence of complications after PVCR was reported to range from 40% to 67% [ 6 , 10 , 25 ].…”

Bicortical Screw Purchase at Upper Instrumented Vertebra (UIV) Can Cause UIV Fracture After Adult Spinal Deformity Surgery: A Finite Element Analysis Study

“…Adult long spinal instrumented fusion may be necessary for various conditions such as degenerative lumbar scoliosis, sagittal imbalance, transition syndrome, and revision cases to alleviate back pain and to achieve balance and stabilization of the fused segments. 7 However, stress concentration on the proximal junction after posterior long spinal instrumented fusion, from the thoracolumbar spine to S1 or the pelvis, has demonstrated several junctional changes: PJF including fractures, proximal junctional kyphosis, junctional disc rupture, and junctional spinal stenosis. [8][9][10][11] Several previous studies have reported various risk factors associated with PJF, known risk factors include older age, osteoporosis, female sex, high UIV angle, preoperative kyphosis adjacent to the UIV, inadequate implant systems, the level of the UIV, preoperative hyperkyphotic thoracic alignment, sagittal imbalance, and acute correction of sagittal imbalance.…”

Surgical Outcomes According to Dekyphosis in Patients with Ossification of the Posterior Longitudinal Ligament in the Thoracic Spine

“…However, direct removal of OPLL has a high risk of complications such as dural tear and neurologic deficit, etc 12,24,26) . Diverse results of surgical techniques have been reported 2,5,8,[13][14][15]25) . Posterior approach is considered to be relatively safe, but the guidelines for surgical treatment have not yet been clarified.…”

“…This is because of the high risk of complication related with surgery 19) . Different results of various surgical approaches and techniques have been reported 2,8,[13][14][15]25) . Posterior approach is considered to be relatively safe, although definitive results of an optimal surgical method have not been presented.…”