Department of Neurological Surgery, University of California, San Francisco, California.
Department of Orthopedic Surgery, University of California, San Francisco, California.
Oper Neurosurg (Hagerstown). 2018 Nov 1;15(5):516-521. doi: 10.1093/ons/opx304.
Traditional approaches for retroperitoneal lumbar plexus schwannomas involve anterior open or laparoscopic resection. For select tumors, the lateral retroperitoneal approach provides a minimally invasive alternative.
To describe a minimally invasive lateral transpsoas approach for the resection of retroperitoneal schwannomas.
A lateral retroperitoneal transpsoas approach was used to resect a 3.1 × 2.7 × 4.1 cm schwannoma embedded within the psoas muscle. A minimally invasive retractor system allows for appropriate visualization and complete resection with the aid of the microscope. The patient tolerated the procedure without complication and was discharged on postoperative day 2 in good condition at her neurological baseline.
The lateral retroperitoneal approach provides a minimally invasive alternative for select retroperitoneal schwannomas. In theory, this procedure allows for faster recovery and less blood loss compared to traditional open anterior approaches. For a subset of tumors, anterior laparoscopy may provide better access, but the lateral approach is well known to most neurosurgeons who perform lateral interbody fusions and can be easily tailored to extraforaminal tumor resection.
Retroperitoneal schwannomas pose a challenge due to their deep location. The lateral retroperitoneal approach provides a useful alternative for resection of a subset of retroperitoneal schwannomas.
传统的腹膜后腰椎丛神经鞘瘤的治疗方法包括前路开放或腹腔镜切除。对于某些肿瘤，侧腹膜后入路是一种微创的选择。
描述一种用于切除腹膜后神经鞘瘤的微创侧经腰大肌入路方法。
采用侧腹膜后经腰大肌入路切除 3.1×2.7×4.1cm 大小的嵌入腰大肌内的神经鞘瘤。微创牵开器系统允许在显微镜的辅助下进行适当的可视化和完全切除。患者在无并发症的情况下耐受了该手术，并在术后第 2 天以良好的神经学基础状态出院。
侧腹膜后入路为选择的腹膜后神经鞘瘤提供了一种微创的替代方法。理论上，与传统的前路开放手术相比，这种手术方法可实现更快的恢复和更少的失血。对于一部分肿瘤，前腹腔镜可能提供更好的通道，但侧入路为大多数进行侧路椎间融合术的神经外科医生所熟知，并且可以很容易地根据需要进行改良，以用于治疗椎间孔外肿瘤。
腹膜后神经鞘瘤由于其位置深而具有挑战性。侧腹膜后入路为切除一部分腹膜后神经鞘瘤提供了一种有用的替代方法。
