Bezirkskrankenhaus Günzburg, Peripheral Nerve Surgery Unit, University of Ulm, Lindenallee 2, 89312, Günzburg, Germany.
Department of General and Visceral Surgery, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
World J Surg Oncol. 2024 Oct 22;22(1):277. doi: 10.1186/s12957-024-03557-5.
Nerve tumors in the retroperitoneal space are a rarity. Radical surgery according to soft tissue tumors can lead to persistent pain and neurological deficits. This study aims to evaluate clinical outcomes of patients treated by a visceral- / neurosurgical approach. 33 patients with a retroperitoneal nerve tumor underwent surgery between 01/2002 and 12/2022 at our department. A visceral surgeon provided access to the retroperitoneal space, followed by micro-neurosurgical tumor preparation under neuromonitoring. Clinical examination and MRI were performed 12 weeks after surgery and further 3 months (WHO grade > 1) or 12 months (WHO grade 1). Further examinations were based on MRI findings and residual symptoms with median follow-up time of 24 months. One patient was treated for two distinct masses resulting in a total of 34 histological findings. Schwannomas (n = 15; 44.1%) and neurofibromas (n = 10; 29.4%) were the most common tumors. Long-term improvements were noted in radicular pain (15/18 patients; 83.3%), motor deficits (7/16 patients; 43.8%), abdominal discomfort and pain (5/7 patients; 71.4%). Recurrences were observed in 3/33 (9,1%) patients. This study represents the largest series of retroperitoneal BPNSTs treated with microsurgical techniques. Prospective multicenter studies are warranted to establish standardized treatment guidelines.
腹膜后神经鞘瘤较为罕见。根据软组织肿瘤进行根治性手术可能导致持续性疼痛和神经功能缺损。本研究旨在评估采用内脏/神经外科方法治疗的患者的临床结果。2002 年 1 月至 2022 年 12 月期间，我们科室对 33 例腹膜后神经鞘瘤患者进行了手术。内脏外科医生提供进入腹膜后空间的途径，然后在神经监测下进行微神经外科肿瘤准备。术后 12 周以及进一步的 3 个月（WHO 分级>1）或 12 个月（WHO 分级 1）进行临床检查和 MRI。进一步的检查基于 MRI 结果和残留症状，中位随访时间为 24 个月。有 1 例患者因两个不同的肿块接受了治疗，共进行了 34 次组织学检查。神经鞘瘤（n=15；44.1%）和神经纤维瘤（n=10；29.4%）是最常见的肿瘤。18 例神经根痛患者中有 15 例（83.3%）、16 例运动功能障碍患者中有 7 例（43.8%）、7 例腹部不适和疼痛患者中有 5 例（71.4%）长期改善。33 例患者中有 3 例（9.1%）复发。本研究代表了采用显微外科技术治疗腹膜后 BPNST 的最大系列研究。需要进行前瞻性多中心研究，以制定标准化的治疗指南。
