Benjamin Carolina G, Oermann Eric K, Thomas J Alexander, Distaso Casey T, Sandhu Faheem A
Georgetown Medical School, Washington, District of Columbia.
Department of Neurosurgery, Medstar Georgetown University Hospital, Washington, District of Columbia.
Surg J (N Y). 2016 Aug 6;2(3):e66-e69. doi: 10.1055/s-0036-1587692. eCollection 2016 Jul.
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. 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. 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. A minimally invasive direct lateral transpsoas access approach is an effective technique to safely and adequately resect extradural retroperitoneal lumbar plexus tumors.
传统的腰椎丛肿瘤切除技术与手术入路相关的发病率有关。我们描述了一例采用微创经腰大肌外侧入路切除腹膜后腰椎丛肿瘤的病例。 我们报告了一例L4神经根硬膜外腹膜后神经鞘瘤病例，采用微创直接外侧经腰大肌入路，使用无创组织扩张器和可扩张管状牵开器进行治疗。使用定向和连续肌电图监测对于定位神经丛并将牵开器置于肿瘤正前方至关重要。 患者对手术耐受性良好，无术后并发症。手术入路直接，术中失血可忽略不计。患者左腿力量和行走能力有所改善，感觉异常消失。 微创直接外侧经腰大肌入路是一种安全、充分切除硬膜外腹膜后腰椎丛肿瘤的有效技术。
