Minimally Invasive Direct Lateral Transpsoas Approach for the Resection of a Lumbar Plexus Schwannoma: Technique Report

Abstract

Objective Traditional techniques for resection of lumbar plexus tumors have been associated with approach-related morbidity. We describe a case utilizing a minimally invasive transpsoas lateral access approach to resect a retroperitoneal tumor of the lumbar plexus.

Methods We report a case with an extradural retroperitoneal schwannoma of the L4 nerve root that was treated with a minimally invasive direct lateral transpsoas approach using atraumatic tissue dilators and an expandable tubular retractor. The use of directional and continuous electromyographic monitoring was critical in locating the plexus and positioning the retractor immediately anterior to the tumor.

Results The patient tolerated the procedure well without postoperative complications. The operative approach was direct and intraoperative blood loss was negligible. The patient demonstrated improved left leg strength and ambulation and resolution of paresthesias.

Conclusions A minimally invasive direct lateral transpsoas access approach is an effective technique to safely and adequately resect extradural retroperitoneal lumbar plexus tumors.

Keywords

lateral - retroperitoneal - transpsoas - minimally invasive - lumbar plexus tumors - schwannoma

• References

• 1 Benglis DM, Vanni S, Levi AD. An anatomical study of the lumbosacral plexus as related to the minimally invasive transpsoas approach to the lumbar spine. J Neurosurg Spine 2009; 10 (02) 139-144
• 2 Celli P. Treatment of relevant nerve roots involved in nerve sheath tumors: removal or preservation?. Neurosurgery 2002; 51 (03) 684-692 , discussion 692
• 3 Datta G, Gnanalingham KK, Peterson D. , et al. Back pain and disability after lumbar laminectomy: is there a relationship to muscle retraction?. Neurosurgery 2004; 54 (06) 1413-1420 , discussion 1420
• 4 Jinnai T, Koyama T. Clinical characteristics of spinal nerve sheath tumors: analysis of 149 cases. Neurosurgery 2005; 56 (03) 510-515 , discussion 510–515
• 5 Hayasaka K, Tanaka Y, Soeda S, Huppert P, Claussen CD. MR findings in primary retroperitoneal schwannoma. Acta Radiol 1999; 40 (01) 78-82
• 6 Keshavarzi S, Park MS, Aryan HE. , et al. Minimally invasive thoracic corpectomy and anterior fusion in a patient with metastatic disease: case report and review of the literature. Minim Invasive Neurosurg 2009; 52 (03) 141-143
• 7 Moro T, Kikuchi S, Konno S, Yaginuma H. An anatomic study of the lumbar plexus with respect to retroperitoneal endoscopic surgery. Spine 2003; 28 (05) 423-428 , discussion 427–428
• 8 Sihvonen T, Herno A, Paljärvi L, Airaksinen O, Partanen J, Tapaninaho A. Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine 1993; 18 (05) 575-581
• 9 Lu DC, Dhall SS, Mummaneni PV. Mini-open removal of extradural foraminal tumors of the lumbar spine. J Neurosurg Spine 2009; 10 (01) 46-50
• 10 Taylor H, McGregor AH, Medhi-Zadeh S. , et al. The impact of self-retaining retractors on the paraspinal muscles during posterior spinal surgery. Spine 2002; 27 (24) 2758-2762
• 11 Tonetti J, Vouaillat H, Kwon BK. , et al. Femoral nerve palsy following mini-open extraperitoneal lumbar approach: report of three cases and cadaveric mechanical study. J Spinal Disord Tech 2006; 19 (02) 135-141
• 12 Vialle R, Court C, Khouri N. , et al. Anatomical study of the paraspinal approach to the lumbar spine. Eur Spine J 2005; 14 (04) 366-371
• 13 O'Toole JE, Eichholz KM, Fessler RG. Minimally invasive approaches to vertebral column and spinal cord tumors. Neurosurg Clin N Am 2006; 17 (04) 491-506
• 14 Asazuma T, Toyama Y, Maruiwa H, Fujimura Y, Hirabayashi K. Surgical strategy for cervical dumbbell tumors based on a three-dimensional classification. Spine 2004; 29 (01) E10-E14
• 15 Bergey DL, Villavicencio AT, Goldstein T, Regan JJ. Endoscopic lateral transpsoas approach to the lumbar spine. Spine 2004; 29 (15) 1681-1688
• 16 Li Q, Gao C, Juzi JT, Hao X. Analysis of 82 cases of retroperitoneal schwannoma. ANZ J Surg 2007; 77 (04) 237-240
• 17 Nishio A, Adachi W, Igarashi J, Koide N, Kajikawa S, Amano J. Laparoscopic resection of a retroperitoneal schwannoma. Surg Laparosc Endosc Percutan Tech 1999; 9 (04) 306-309
• 18 Ozgur BM, Aryan HE, Pimenta L, Taylor WR. Extreme lateral interbody fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J 2006; 6 (04) 435-443
• 19 Shah M, Kaminsky J, Vougioukas VI. Minimally invasive removal of an extradural intraradicular lumbar schwannoma. Acta Neurochir (Wien) 2008; 150 (07) 691-693 , discussion 693–694
• 20 Celli P, Trillò G, Ferrante L. Extrathecal intraradicular nerve sheath tumor. J Neurosurg Spine 2005; 3 (01) 1-11
• 21 Phan K, Mobbs RJ. Anterior retroperitoneal approach for removal of L5-S1 foraminal nerve sheath tumor-case report. Spine J 2016; 16 (04) e283-e286
• 22 Wiltse LL, Spencer CW. New uses and refinements of the paraspinal approach to the lumbar spine. Spine 1988; 13 (06) 696-706
• 23 Lee S, Srikantha U. Surgical management of giant lumbar extradural schwannoma: report of 3 cases. Int J Spine Surg 2015; 9: 18
• 24 Gonçalves VM, Santiago B, Ferreira VC, Cunha E Sá M. Minimally invasive resection of an extradural far lateral lumbar schwannoma with zygapophyseal joint sparing: surgical nuances and literature review. Case Rep Med 2014; 2014: 739862