Guedes Fernando, Sanches Gabriel Elias, Brown Rosana Siqueira, Cardoso Rodrigo Salvador Vivas, Siquara-de-Sousa Ana Caroline, Ascenção Agostinho, Iglesias Antônio Carlos
Department of Surgery, Division of Neurosurgery, Gaffrée e Guinle University Hospital, School of Medicine, Federal University of Rio de Janeiro State (UNIRIO), 775 Mariz e Barros Street, Rio de Janeiro, RJ, 20270-901, Brazil.
Department of Pathology, Antônio Pedro University Hospital, Fluminense Federal University (UFF), Niterói, RJ, Brazil.
Acta Neurochir (Wien). 2021 Jul;163(7):2063-2074. doi: 10.1007/s00701-021-04789-0. Epub 2021 Mar 10.
Data concerning the surgical treatment of lumbosacral plexus tumors (LSPTs) is scarce. This study aims to present our experience with a series of 19 patients surgically treated for symptomatic LSPTs at our institution.
This is a retrospective study of 19 patients surgically treated for symptomatic LSPTs from 2011 to 2019. Clinical data were retrieved from medical records and consisted of age, gender, clinical presentation, location of the lesion, surgical approach, final histopathologic diagnosis, follow-up time, outcomes, and complications.
Nineteen surgical procedures were conducted. Thirteen patients were female and six, male. The median age of patients was 45 years (range 20 to 63 years). No patients harbored genetic syndromes. Surgical treatment appears to be correlated to the reduction of pain in patients with peripheral nerve sheath tumors (PNSTs), as assessed by visual analog scale (VAS). Sixteen patients did not present with new-onset deficits during follow-up (84.2%), two of whom recovered from their preoperative deficit. Four patients presented with postoperative weakness. The histopathological diagnoses were 11 schwannomas, four neurofibromas, three metastases, and one lymphoma.
LSPTs are rare. When surgical treatment is indicated, it usually requires multidisciplinary management. Surgery appears to be effective concerning the reduction of pain in PNSTs and may also recover neurological deficits. Iatrogenic neurological deficits are an evident risk, such that intraoperative multimodal monitoring should always be performed if available. In lesions involving the sacral plexus, we found it to be indispensable.
关于腰骶丛肿瘤（LSPTs）手术治疗的数据稀缺。本研究旨在介绍我们机构对19例有症状的LSPTs患者进行手术治疗的经验。
这是一项对2011年至2019年期间接受手术治疗的19例有症状的LSPTs患者的回顾性研究。从病历中检索临床数据，包括年龄、性别、临床表现、病变位置、手术入路、最终组织病理学诊断、随访时间、结果和并发症。
共进行了19例手术。13例为女性，6例为男性。患者的中位年龄为45岁（范围20至63岁）。无患者患有遗传综合征。通过视觉模拟量表（VAS）评估，手术治疗似乎与周围神经鞘瘤（PNSTs）患者疼痛减轻相关。16例患者在随访期间未出现新发神经功能缺损（84.2%），其中2例从术前神经功能缺损中恢复。4例患者术后出现肌无力。组织病理学诊断为11例神经鞘瘤、4例神经纤维瘤、3例转移瘤和1例淋巴瘤。
LSPTs罕见。当需要手术治疗时，通常需要多学科管理。手术似乎对减轻PNSTs患者的疼痛有效，也可能恢复神经功能缺损。医源性神经功能缺损是一个明显的风险，因此如果可行，术中应始终进行多模式监测。在涉及骶丛的病变中，我们发现这是必不可少的。
