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Feigl GC, Britz G, Staribacher D, Kuzmin D. Minimally Invasive Dorsal Approach for the Treatment of Giant Presacral Schwannomas. Oper Neurosurg (Hagerstown) 2023; 25:e66-e70. [PMID: 37039579 DOI: 10.1227/ons.0000000000000708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/08/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND The treatment of giant presacral schwannomas is currently a grand challenge for neurosurgeons. Although these tumors are benign and do not infiltrate the surrounding tissues, it is difficult to choose the best surgical approach because they are surrounded by the pelvic organs and great vessels. There is no universally accepted approach to the surgical treatment because giant presacral schwannomas are rare in the population. The anterior approach through laparotomy is more often recommended in the literature. A dorsal approach that involves laminotomy and stabilization is also described in the literature. However, these approaches are rather traumatic for the patient and have both intraoperative and postoperative risks. OBJECTIVE To report a minimally invasive dorsal approach for the treatment of giant presacral schwannomas. METHODS We present a fundamentally new approach to the treatment of these tumors using a minimally invasive dorsal approach, based on the specific anatomy and growth of giant presacral schwannomas. This approach is using the potential of modern neurosurgery. RESULTS We describe 2 cases of successful total tumor resection using this novel surgical approach. No complications have been registered after the surgery. CONCLUSION A minimally invasive dorsal approach for the treatment of giant presacral schwannomas is sufficient for complete tumor removal, minimizes intraoperative and postoperative risks, is associated with good cosmetic effect, and can be successfully applied in surgical practice.
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Affiliation(s)
- Guenther C Feigl
- Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, USA
- Department of Neurosurgery, General Hospital Bamberg, Bamberg, Germany
| | - Gavin Britz
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | | | - Dzmitry Kuzmin
- Department of Neurosurgery, General Hospital Bamberg, Bamberg, Germany
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Feigl GC, Jugovic D, Staribacher D, Buslei R, Kuzmin D. Total resection of presacral giant schwannoma via minimally invasive dorsal approach: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21319. [PMID: 35855057 PMCID: PMC9265199 DOI: 10.3171/case21319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Giant presacral schwannomas are extremely rare in neurosurgery. There are various approaches to the surgical treatment of symptomatic giant presacral schwannomas. The least traumatic is the one-stage surgery with a dorsal approach. OBSERVATIONS The authors describe a case of a 52-year-old male with pain in the sacral region and partial urinary dysfunction. A total tumor resection through a minimally invasive dorsal approach was performed, and anatomical and functional preservation of all sacral nerves with no postoperative complications was achieved. LESSONS The authors have shown the possibility of total tumor resection with a minimally invasive dorsal approach without the development of intra- and postoperative complications. Operative corridors that have been created by a tumor can be used and expanded for a minimally invasive dorsal approach to facilitate resection and minimize tissue disruption.
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Affiliation(s)
- Guenther C. Feigl
- Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas
- Departments of Neurosurgery and
| | - Domagoj Jugovic
- Departments of Neurosurgery and
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Rolf Buslei
- Pathology and Neuropathology, General Hospital Bamberg, Bamberg, Germany; and
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Abstract
INTRODUCTION Pelvic schwannomas are rare, mostly benign tumors. They are usually asymptomatic until their massive growth compresses adjacent organs. We describe the case of a 53-year-old man with a pelvic schwannoma who initially complained of constipation and urinary retention. AREAS COVERED We analyzed the clinical presentation, histopathology, diagnostic imaging tools, and the treatment options for pelvic schwannomas, compared with the few other cases reported in the literature. EXPERT COMMENTARY Pelvic schwannomas are masses that can grow to considerable size, producing symptoms over time. Due to their size and localization, surgery, although difficult, is the only available treatment.
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Kalagi D, Bakir M, Alfarra M, Aborayya A, Anwar I. Two Unusual Presentations of Presacral Schwannoma; A Case Series. Int J Surg Case Rep 2019; 61:165-168. [PMID: 31374466 PMCID: PMC6675969 DOI: 10.1016/j.ijscr.2019.07.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 06/13/2019] [Accepted: 07/17/2019] [Indexed: 11/19/2022] Open
Abstract
Schwannomas are benign tumors that commonly occur in the head and neck, mediastinum and extremities. Pelvic schwannomas are very rare. Patients with pelvic schwannomas have different clinical presentations. We reported 2 cases of schwannomas found at the presacral area. The mass was found incidentally in one of the cases and the patient was completely asymptomatic.
Introduction Schwannomas are benign tumors that arise from the Schwann cells of nerve fibers. They commonly occur in the head and neck, mediastinum and extremities. However, they are extremely rare to be found in the pelvis. Case presentation We report two cases of pelvic presacral schwannomas found in our hospital. The first case is a 50 years old lady who was seen in the outpatient clinic complaining of pelvic heaviness. Investigations were done including Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) which showed a solid mass in the presacral area. Biopsy was taken, and results came back as schwannoma. The patient underwent exploratory laparotomy and total tumor resection. The second case is a 19 years old gentleman who was referred from a local hospital to our hospital for further evaluation of an asymptomatic left retroperitoneal pelvic mass. The mass was found incidentally after a Road Traffic Accident. The patient underwent exploratory laparotomy and total tumor resection. In the two cases, specimen histopathology report came back positive for schwannoma and patients were doing fine in the post-operative period with no signs of recurrence till this date. Conclusion Due to the few cases in the literature, the diagnosis of presacral schwannoma is challenging. Some patients presented with vague symptoms like pelvic heaviness as seen with the patient in the first case, and some presented completely asymptomatic as seen with the patient in the second case. In symptomatic and asymptomatic cases, surgical excision is the mainstay of treatment of these tumors.
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Affiliation(s)
- Dana Kalagi
- Alfaisal University, College of Medicine, Riyadh, Saudi Arabia; Department of Surgery, Section of General and Oncology Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
| | - Mohammed Bakir
- Alfaisal University, College of Medicine, Riyadh, Saudi Arabia
| | - Mohammad Alfarra
- Department of Surgery, Section of General and Oncology Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Alaa Aborayya
- Department of Surgery, Section of General and Oncology Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ihab Anwar
- Alfaisal University, College of Medicine, Riyadh, Saudi Arabia; Department of Surgery, Section of General and Oncology Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Pennington Z, Westbroek EM, Ahmed AK, Cottrill E, Lubelski D, Goodwin ML, Sciubba DM. Surgical management of giant presacral schwannoma: systematic review of published cases and meta-analysis. J Neurosurg Spine 2019; 31:711-722. [PMID: 31277062 DOI: 10.3171/2019.4.spine19240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 04/19/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Giant presacral schwannomas are rare sacral tumors found in less than 1 of every 40,000 hospitalizations. Current management of these tumors is based solely upon case reports and small case series. In this paper the authors report the results of a systematic review of the available English literature on presacral schwannoma, focused on identifying the influence of tumor size, tumor morphology, surgical approach, and extent of resection (EOR) on recurrence-free survival and postoperative complications. METHODS The medical literature (PubMed and EMBASE) was queried for reports of surgically managed sacral schwannoma, either involving 2 or more contiguous vertebral levels or with a diameter ≥ 5 cm. Tumor size and morphology, surgical approach, EOR, intraoperative and postoperative complications, and survival data were recorded. RESULTS Seventy-six articles were included, covering 123 unique patients (mean age 44.1 ± 1.4 years, 50.4% male). The most common presenting symptoms were leg pain (28.7%), lower back pain (21.3%), and constipation (15.7%). Most surgeries used an open anterior-only (40.0%) or posterior-only (30%) approach. Postoperative complications occurred in 25.6% of patients and local recurrence was noted in 5.4%. En bloc resection significantly improved progression-free survival relative to subtotal resection (p = 0.03). No difference existed between en bloc and gross-total resection (GTR; p = 0.25) or among the surgical approaches (p = 0.66). Postoperative complications were more common following anterior versus posterior approaches (p = 0.04). Surgical blood loss was significantly correlated with operative duration and tumor volume on multiple linear regression (both p < 0.001). CONCLUSIONS Presacral schwannoma can reasonably be treated with either en bloc or piecemeal GTR. The approach should be dictated by lesion morphology, and recurrence is infrequent. Anterior approaches may increase the risk of postoperative complications.
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An X, Zhu M, Zhang N, Lu S, Wei P, Jiang L, Yang X. Schwannoma of the vagina - a common tumor but a rare location: A case report. Mol Clin Oncol 2017; 7:783-786. [PMID: 29181168 PMCID: PMC5700289 DOI: 10.3892/mco.2017.1420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/30/2017] [Indexed: 12/12/2022] Open
Abstract
Schwannomas are nerve sheath tumors arising from Schwann cells. These tumors usually present as benign, relatively slow-growing, solitary, encapsulated, painless masses. Schwannomas rarely occur in the vagina, and have not been fully recognized as gynecological tumors. We herein describe the case of a patient who presented with a schwannoma occurring in the wall of vagina, with non-specific symptoms lasting for ~1 year. The vaginal mass was incidentally detected during a sonographic examination and the patient was referred for surgical resection. The surgery was uncomplicated and the vaginal tumor was diagnosed as benign schwannoma. The immunohistochemical examination revealed positivity for vimentin, S-100 and glial fibrillary acidic protein, whereas discovered on GIST-1, CD117, CD34, desmin, smooth muscle actin and cytokeratin were negative. Tumors occurring in the vagina are common and are of variable histological types, with a wide range of pathological characteristics and complications. Schwannoma should be considered in the differential diagnosis in patients presenting with atypical symptoms from the gynecological tract. Immunohistochemical staining is required for confirmation of the diagnosis of schwannoma, and for distinguishing this entity from other homologous tumors.
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Affiliation(s)
- Xin An
- Department of Pathology, Handan First Hospital, Handan, Hebei 056002, P.R. China
| | - Meng Zhu
- Department of Gastroenterology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Ning Zhang
- Department of Pathology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
| | - Sanjun Lu
- Department of Pathology, Handan First Hospital, Handan, Hebei 056002, P.R. China
| | - Pin Wei
- Department of Pathology, Handan First Hospital, Handan, Hebei 056002, P.R. China
| | - Linna Jiang
- Department of Pathology, Handan First Hospital, Handan, Hebei 056002, P.R. China
| | - Xueli Yang
- Department of Pathology, Handan First Hospital, Handan, Hebei 056002, P.R. China
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Lee BH, Hyun SJ, Park JH, Kim KJ. Single Stage Posterior Approach for Total Resection of Presacral Giant Schwannoma: A Technical Case Report. KOREAN JOURNAL OF SPINE 2017; 14:89-92. [PMID: 29017303 PMCID: PMC5642101 DOI: 10.14245/kjs.2017.14.3.89] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/25/2017] [Accepted: 08/31/2017] [Indexed: 12/13/2022]
Abstract
The neurogenic tumor of frequent occurrence in the presacral area is a schwannoma. Giant presacral schwannoma has a risk for anterior surgical approach because of its massive size and proximity to abundant vascularity of presacral region. We report a single stage posterior approach for total resection of a giant presacral schwannoma. A 40-year-old female patient experienced left buttock pain and tingling sensation at left S1 dermatome. Magnetic resonance imaging showed that the presacral huge mass at S1–3 level with osseous extension and structural remodeling in left sacral ala. The presacral mass was ranging in maximum diameter from 8.0 to 8.6 cm. S2 foramen laminectomy was performed to expose the mass. The tumor capsule and the root were carefully dissected away. The tumor was removed while preserving the capsule by dissecting the plane between the inner wall of the capsule and the tumor. The single stage posterior approach for presacral giant schwannoma is feasible, and it can be a good surgical alternative to prevent pelvic organ or vascular damage and anterior approach related dystocia and infertility.
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Affiliation(s)
- Byoung Hun Lee
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong-Hwa Park
- Department of Neurosurgery, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Presacral Myelolipoma: Diagnosis on Imaging With Pathologic and Clinical Correlation. AJR Am J Roentgenol 2016; 207:470-81. [DOI: 10.2214/ajr.15.15280] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Toh JWT, Morgan M. Management approach and surgical strategies for retrorectal tumours: a systematic review. Colorectal Dis 2016; 18:337-50. [PMID: 26663419 DOI: 10.1111/codi.13232] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/20/2015] [Indexed: 12/11/2022]
Abstract
AIM The management strategy for retrorectal tumours is complex. Due to their rarity, few surgeons have expertise in management. METHOD A systematic literature review was conducted using the PubMed database. English language publications in the years 2011-2015 that assessed preoperative management, surgical strategies and chemoradiotherapy for presacral tumours were included. Two hundred and fifty-one abstracts were screened of which 88 met the inclusion criteria. After review of the full text, this resulted in a final list of 42 studies eligible for review. RESULTS In all, 932 patients (63.2% female, 36.8% male; P < 0.01) with a retrorectal tumour were identified. Most were benign (65.9% vs. 33.7%, P < 0.01). Imaging distinguished benign from malignant lesions in 88.1% of cases; preoperative biopsy was superior to imaging in providing an accurate definitive diagnosis (91.3% vs. 61.4%, P < 0.05) with negligible seeding risk. Biopsy should be performed in solid tumours. It is useful in guiding neoadjuvant therapy for gastrointestinal stromal tumours, sarcomas and desmoid type fibromatosis and may alter the management strategy in cases of diffuse large B-cell lymphoma and metastases. Biopsies for cystic lesions are not recommended. The gold standard in imaging is MRI. The posterior Kraske procedure is the most common surgical approach. Overall, the reported recurrence rate was 19.7%. CONCLUSION This review evaluated the management strategies for retrorectal tumours. A preoperative biopsy should be performed for solid tumours. MRI is the most useful imaging modality. Surgery is the mainstay of treatment. There is limited information on robotic surgery, single-port surgery, transanal endoscopic microsurgery, chemoradiotherapy and reconstruction.
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Affiliation(s)
- J W T Toh
- Department of Colorectal Surgery, Bankstown Hospital, Sydney, New South Wales, Australia
| | - M Morgan
- Department of Colorectal Surgery, Bankstown Hospital, Sydney, New South Wales, Australia
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Emohare O, Stapleton M, Mendez A. A minimally invasive pericoccygeal approach to resection of a large presacral schwannoma: case report. J Neurosurg Spine 2015; 23:81-5. [PMID: 25909273 DOI: 10.3171/2014.11.spine14396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Resection of large presacral schwannomas can present a challenge. The posterior approach is commonly associated with coccygeal disarticulation, partial sacral resection, and muscular disarticulation, which can all result in significant morbidity. Minimally invasive surgery may obviate some of the morbidity traditionally associated with this approach. The authors present the case of a morbidly obese 49-year-old man with an enlarging presacral schwannoma. The patient refused laparoscopic resection because of the morbidity he had experienced with a previous laparoscopic surgery. The tumor was resected using a minimally invasive paracoccygeal approach, which affords improved access with minimal morbidity.
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Affiliation(s)
- Osa Emohare
- Department of Neurosurgery, Regions Hospital, St. Paul, Minnesota
| | - Molly Stapleton
- Department of Neurosurgery, Regions Hospital, St. Paul, Minnesota
| | - Alejandro Mendez
- Department of Neurosurgery, Regions Hospital, St. Paul, Minnesota
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Pan J, Jing H, Tian X, Fan Z. Schwannoma with an uncommon anal location. Oncol Lett 2014; 8:1945-1946. [PMID: 25295076 PMCID: PMC4186604 DOI: 10.3892/ol.2014.2459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 07/18/2014] [Indexed: 02/05/2023] Open
Abstract
Schwannomas are slow-growing mesenchymal neoplasms that arise from Schwann cells with low malignant potential. These uncommon neoplasms are nerve sheath tumors that arise at almost any anatomical site. The majority of schwannomas are benign, and few are malignant. The current study presents the rare case of an anal schwannoma that was successfully treated by surgery; there are few such cases previously reported in the literature. The patient was admitted to hospital following the identification of a mass incidentally. The tumor was so large that it compressed the tissue around it, although no symptoms were caused. The pre-operative clinical diagnosis was inconclusive in this case, and a final diagnosis was established based on radiographic and histopathological examination. The current study aimed to provide a possible differential diagnosis for such anally-located masses.
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Affiliation(s)
- Jiyong Pan
- Department of General Surgery, The Third People's Hospital of Dalian, Dalian, Liaoning 116000, P.R. China
| | - Huirong Jing
- Department of General Surgery, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116000, P.R. China
| | - Xiaofeng Tian
- Department of General Surgery, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116000, P.R. China
| | - Zhe Fan
- Department of General Surgery, The Third People's Hospital of Dalian, Dalian, Liaoning 116000, P.R. China
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Spinal cord compression revealing an intraosseous schwannoma. Case Rep Med 2014; 2013:913218. [PMID: 24381595 PMCID: PMC3870097 DOI: 10.1155/2013/913218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 10/02/2013] [Accepted: 10/03/2013] [Indexed: 11/24/2022] Open
Abstract
A 68-year-old female presented with inflammatory lumbalgia and cruralgia. Physical examination revealed a lumbar stiffness without neurological deficit. Secondarily, paraplegia and urinary retention appeared. Magnetic resonance imaging showed a vertebral compaction of L3 vertebra with medullar compression. Emergent surgery revealed an epidural tumor involving largely the L3 vertebral body. Histology found schwannoma with positive protein S100 on the immunohistochemical study. Metastasis screening revealed bilateral nodular lesions of the lungs and a trochanter high scintigraphic signal. It was a malignant schwannoma. The patient underwent radiotherapy in addition to the total tumor resection.
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