Ajello Marco, Lo Bue Enrico, Colonna Stefano, De Marco Raffaele, Panico Flavio, Morello Alberto, Castaldo Margherita, Palmieri Giuseppe, Marengo Nicola, Garbossa Diego, Cofano Fabio
Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", "Città della Salute e della Scienza" University Hospital, University of Turin, Turin, Italy.
Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", "Città della Salute e della Scienza" University Hospital, University of Turin, Turin, Italy.
World Neurosurg. 2025 Jun;198:124004. doi: 10.1016/j.wneu.2025.124004. Epub 2025 Apr 25.
Extradural spinal nerve sheath tumors with foraminal involvement are rare, and the gold standard for surgical resection is not established yet. Traditionally, lumbar intra-extraforaminal schwannomas have been resected through a posterior midline or paraspinal open approach. The lateral transpsoas approach represents a suitable, minimally invasive approach which can provide direct access to the extraforaminal and lumbar plexus region avoiding bone removal, hence the necessity of lumbar fusion. The aim of this study is to share our experience of extraforaminal lumbar schwannomas approached through a minimally invasive lateral transpsoas technique with intraoperative neurophysiological monitoring.
This is a single-center retrospective case series study. Seven adult patients who underwent extraforaminal lumbar schwannoma removal through a lateral retroperitoneal approach were enrolled. A detailed description of the surgical technique is reported. The outcome measures included mean surgical duration, mean blood loss, postoperative mobilization, day of discharge, complication, postoperative symptoms, and extent of removal. All patients had a minimum follow-up of 1 year.
The average age was 51 years. Surgery lasted 225 minutes on average, with minimal blood loss. One patient had a cerebrospinal fluid leak, which was successfully repaired. Most patients were mobilized the day after surgery and 6 were discharged within 2-4 days. At a 12-month follow-up, 6 patients showed symptom improvement and magnetic resonance imagings confirmed complete tumor resection in all cases.
Retroperitoneal transpsoas approach represents a safe tool in the neurosurgeon's armamentarium, particularly suitable for this subset of tumors representing a short and direct way to approach them. Surgeon confidence of working inside the psoas and close to the lumbar plexus is increased using continuous electromyography monitoring. At the end, the retroperitoneal transpsoas approach for extraforaminal lumbar schwannoma can provide minimal soft tissue damage, better pain control, decreased blood loss, and short hospitalization.
累及椎间孔的硬脊膜外脊神经鞘瘤较为罕见，目前尚未确立手术切除的金标准。传统上，腰椎椎间孔内外的神经鞘瘤通过后正中或椎旁开放入路进行切除。经腰大肌外侧入路是一种合适的微创入路，可直接进入椎间孔和腰丛区域，避免去除骨质，从而无需进行腰椎融合。本研究的目的是分享我们采用微创经腰大肌外侧技术并术中进行神经电生理监测治疗椎间孔外腰椎神经鞘瘤的经验。
这是一项单中心回顾性病例系列研究。纳入了7例通过侧腹膜后入路切除椎间孔外腰椎神经鞘瘤的成年患者。报告了手术技术的详细描述。观察指标包括平均手术时长、平均失血量、术后活动情况、出院日期、并发症、术后症状以及切除范围。所有患者的随访时间均至少为1年。
平均年龄为51岁。手术平均持续225分钟，失血量极少。1例患者出现脑脊液漏，已成功修复。大多数患者术后第一天即可活动，6例在2 - 4天内出院。在12个月的随访中，6例患者症状改善，磁共振成像证实所有病例肿瘤均完全切除。
腹膜后经腰大肌入路是神经外科医生手术工具中的一种安全方法，特别适用于这类肿瘤，是一种接近肿瘤的短而直接的途径。使用连续肌电图监测可增强外科医生在腰大肌内及靠近腰丛处操作的信心。最后，经腹膜后经腰大肌入路治疗椎间孔外腰椎神经鞘瘤可使软组织损伤最小化，更好地控制疼痛，减少失血量，并缩短住院时间。
