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Peyre M, Gaudric J, Bernat I, André A, Couture T, Kalamarides M. Surgical management of sporadic and schwannomatosis-associated pelvic schwannomas. Neurosurg Rev 2023; 46:275. [PMID: 37857782 DOI: 10.1007/s10143-023-02186-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/06/2023] [Accepted: 10/14/2023] [Indexed: 10/21/2023]
Abstract
Pelvic schwannomas are rare tumors that may occur either sporadically or in the context of schwannomatosis. We retrospectively reviewed the charts of patients harboring a pelvic schwannoma under conservative management or operated at our reference center between 2016 and 2023. All patients were operated by a multidisciplinary team, combining a vascular surgeon and a neurosurgeon. Twenty-four patients harboring 33 pelvic tumors were included in the cohort, including 12 patients with sporadic lesions, 2 patients with NF2-related schwannomatosis, and 10 patients with NF2-independent schwannomatosis. Multi-nodular tumors were more frequent in schwannomatosis compared to sporadic cases (p = 0.005). The mean age at diagnosis was 41 years old. Schwannomas were located on branches of the sciatic nerve (23/33, 70%), the femoral nerve (6/33, 18%), and the obturator nerve (4/33, 12%). Over the course of the study, 16 patients were operated, including 11 sporadic cases. The indication for surgery was pain (12/16, 75%) or tumor growth (4/16, 25%). Complete resection was achieved in 14 of 16 patients (87%). The mean post-operative follow-up was 37 months (range: 2-168 months). At last-follow-up, complete pain relief was achieved in all 12 patients with pre-operative pain. Post-operative morbidity included 3 long-term localized numbness and one MRC class 4 motor deficit in a multi-nodular tumor in a schwannomatosis patient. Despite its limited size, our series suggests that nerve-sparing resection of pelvic schwannomas offers satisfying rates of functional outcome both in sporadic and schwannomatosis cases, except for multi-nodular tumors.
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Affiliation(s)
- Matthieu Peyre
- Department of Neurosurgery, Bâtiment Babinski, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Universités, 47-83 boulevard de l'Hôpital, 75013, Paris, France.
- Genetics and Development of Brain Tumors, CRICM INSERM U1127 CNRS UMR 7225, Hôpital de la Pitié-Salpêtrière, Brain Institute, Paris, France.
| | - Julien Gaudric
- Department of Vascular Surgery, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Universités, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Isabelle Bernat
- Department of Neurophysiology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Universités, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Arthur André
- Department of Neurosurgery, Bâtiment Babinski, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Universités, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Thibault Couture
- Department of Vascular Surgery, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Universités, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Michel Kalamarides
- Department of Neurosurgery, Bâtiment Babinski, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Universités, 47-83 boulevard de l'Hôpital, 75013, Paris, France
- Genetics and Development of Brain Tumors, CRICM INSERM U1127 CNRS UMR 7225, Hôpital de la Pitié-Salpêtrière, Brain Institute, Paris, France
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Nayab A, Malik MH, Madhavan AA, Glockner J, Collins DA, Wenger DE. Incidental diagnosis of presacral ganglioneuroma in a patient with hematuria. Radiol Case Rep 2023; 18:1324-1328. [PMID: 36704366 PMCID: PMC9870923 DOI: 10.1016/j.radcr.2022.11.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/26/2022] [Accepted: 11/29/2022] [Indexed: 01/20/2023] Open
Abstract
Ganglioneuromas are benign neuroblastic tumors seen most in pediatric population. The most common locations are mediastinal, retroperitoneal and adrenal regions. Ganglioneuromas rarely occur in presacral space. We present one such case of an incidentally diagnosed presacral ganglioneuroma in an asymptomatic 71-year-old male who initially presented with hematuria.
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Affiliation(s)
- Asra Nayab
- Corresponding author at: Mayo Clinic, Department of Radiology, 200 1st St SW Rochester MN 55905.
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3
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Tos SM, Jobran AW, Alasafrah A, Bakri I, Jubran F. A report of presacral epidermoid cyst in perimenopausal women: An extremely rare site and an unusual cause of chronic constipation. Int J Surg Case Rep 2023; 103:107880. [PMID: 36634501 PMCID: PMC9843274 DOI: 10.1016/j.ijscr.2023.107880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Epidermoid cyst is rare congenital lesion of ectodermal origin that arises from the remnants of the embryonic tissues. Although epidermal cysts are frequently observed throughout the body, they are rarely found in the presacral regions. It more commonly occurs in women of reproductive age as an asymptomatic, incidental finding during routine physical examination or imaging studies, or during obstetric and gynecologic events. CASE PRESENTATION A 48-year-old female patient presented with intermittent constipation, lower abdominal and pelvic pain that had developed progressively during the previous six months, which was temporarily relieved with regular laxatives. Magnetic resonance imaging showed a presacral cystic tumor with a high signal intensity on T1-weighted images and, low signal on T2-weighted images with no significant enhancement post-contrast administration. The mass pushed the rectum laterally by external compression. This tumor was diagnosed as a developmental cyst, and total mass resection with negative margins was performed. After that, tumor was histopathologically diagnosed as an epidermoid cyst. DISCUSSION AND CONCLUSION Epidermoid cyst is a common entity but is rare at presacral space. Also, an epidermoid cyst is an uncommon entity among cystic pathologies found in the presacral region, which includes benign and malignant pathologies. Due to the potential of subsequent infection or cancer, a meticulous clinical examination with correlated radiographic imaging, followed by total mass excision and histopathological evaluation are crucial.
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Affiliation(s)
- Salem M. Tos
- Faculty of Medicine, Al Quds University, Jerusalem, Palestine,Corresponding author at: Al-Quds University, Main Campus, Abu Dis, P.O. Box 89, Palestine.
| | | | | | - Izzeddin Bakri
- Pathology department, Al Ahli hospital, Hebron, Palestine
| | - Fahmi Jubran
- Faculty of Medicine, Al Quds University, Jerusalem, Palestine,Al Ahli Hospital, Hebron, Palestine
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Mualem W, Ghaith AK, Rush D, Jarrah R, Alexander Y, Zamanian C, Atkinson JLD, Yaszemski MJ, Krauss WE, Spinner RJ, Bydon M. Surgical management of sacral schwannomas: a 21-year mayo clinic experience and comparative literature analysis. J Neurooncol 2022. [PMID: 35752722 DOI: 10.1007/s11060-022-03986-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/14/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Sacral and presacral schwannomas are rare, accounting for a minority of spinal schwannomas. We present our institution's experience surgically treating spinal schwannomas and compare it to the literature. METHODS Data were collected for 27 patients treated surgically for sacral or presacral schwannoma between 1997 and 2018 at all Mayo Clinic locations and 93 patients in the literature. Kaplan-Meier disease-free survival analysis was conducted. Unpaired two-sample t tests and Fisher's exact tests assessed statistical significance between groups. RESULTS Our patients and those in the literature experienced a similar age at diagnosis (49.9 y/o. vs 43.4 y/o., respectively). Most of our patients (59.3%) reported full recovery from symptoms, while a minority reported partial recovery (33.3%) and no recovery (11.1%). A smaller percentage in the literature experienced full recovery (31.9%) and partial recovery (29.8%) but also no recovery (1.1%). Our patients experienced fewer complications (14.8% versus 25.5%). Disease-free survival curves for all patients showed no significant variation in progression by extent of resection of schwannoma (log-rank P = 0.26). No lesion progression was associated with full or partial symptom improvement (p = 0.044), and female patients were more likely to undergo resection via a posterior approach (p = 0.042). CONCLUSION Outcomes of patients with sacral or presacral schwannomas vary based on patient demographics, tumor characteristics, symptoms, and surgical treatment. Among the range of symptoms experienced by these patients, the most common is pain. Prognosis improves and overall survival is high when the surgical approach towards sacral schwannomas is prepared and executed appropriately.
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Poudel D, Shrestha S, Poddar E, Pacchai P, Kandel BP, Lakhey PJ. Retrorectal schwannoma in a middle-aged female: A case report. Int J Surg Case Rep 2022; 96:107270. [PMID: 35696818 PMCID: PMC9194842 DOI: 10.1016/j.ijscr.2022.107270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/29/2022] [Accepted: 05/29/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary sacral and presacral lesions are uncommon and pose a significant diagnostic dilemma. Retrorectal schwannoma is a benign primary presacral lesion that is extremely rare and presents with non-specific symptoms. CASE PRESENTATION A 42-years-old, female patient was admitted for lower-back pain for seven days. The retrorectal mass was detected on imaging, and she underwent laparoscopic excision. Pathological examination revealed a rare retrorectal schwannoma. CLINICAL DISCUSSION Retrorectal location of schwannomas is rare and the preoperative diagnosis is very difficult as the clinical features and the radiological features are non-specific. In addition, these tumors can be found incidentally on routine rectal or pelvic examinations. As these tumors are benign, encapsulated, and non-invasive, this entity has an excellent prognosis. Despite the tumors' rarity and variety, we concur with the literature that surgical management is required to obtain a clear diagnosis and avoid consequences such as malignant transformation. CONCLUSION Retrorectal Schwannoma presents a diagnostic and therapeutic challenge. Identification is important because surgical excision, either open or laparoscopic, is curative.
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Affiliation(s)
- Diptee Poudel
- Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Nepal
| | - Suraj Shrestha
- Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Nepal
| | - Elisha Poddar
- Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Nepal
| | - Prarthana Pacchai
- Department of Surgical Gastroenterology, Tribhuvan University Teaching Hospital, Maharajgunj, Nepal
| | - Bishnu Prasad Kandel
- Department of Surgical Gastroenterology, Tribhuvan University Teaching Hospital, Maharajgunj, Nepal,Corresponding author at: Department of Surgical Gastroenterology, Tribhuvan University Teaching Hospital, P.O. Box: 1524, Maharajgunj, Nepal.
| | - Paleswan Joshi Lakhey
- Department of Surgical Gastroenterology, Tribhuvan University Teaching Hospital, Maharajgunj, Nepal
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Leclerc A, Lebreton G, Huet A, Alves A, Emery E. Management of giant presacral schwannoma. Clinical series and literature review. Clin Neurol Neurosurg 2020; 200:106409. [PMID: 33341090 DOI: 10.1016/j.clineuro.2020.106409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/01/2020] [Accepted: 11/28/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Presacral schwannomas are rare tumors. Due to their benign nature and slow growth, these tumors are often giant and become difficult to treat. Their removal is a surgical challenge with different strategies reported in the literature. This study presents the consecutives cases of presacral schwannomas operated on in our institution, our surgical strategy and literature review. METHODS This retrospective study includes all consecutive patients operated on for a pre-sacral schwannoma in our department between 2006 and 2019, i.e. 6 patients. We report clinical features, pre and post-operative imaging, surgical data and post-operative outcomes. RESULTS All patients had symptoms before surgery (constipation, dysuria, radicular or lower back pain) with an average duration of 7.4 months. All patients underwent an MRI and a CT scan before the surgery. Five patients had type III schwannoma according to Klimo classification and one patient had a type II. The average size was 504,9 cm3 (range 53,1-1495,4). All the patients were operated on by an anterior approach in a double team with an mean duration of 246 min. Intraoperative bleeding was less than 500 ml for 4 patients, 2 patients had significant bleeding (2700 and 2900 mL). Excision was total or subtotal in all cases. One patient had an intraoperative complication (air embolism). Follow up at 3 months was excellent with a disappearance of symptoms for all patients except one patient who retained constipation. One patient had a late complication (bowel obstruction due to tissue adhesions). At last follow-up after phone interview, no patient had clinical symptoms that could suggest a recurrence. CONCLUSION The anterior approach with a double surgical team is a great option for the treatment of presacral schwannoma. Combined with adequate preoperative imaging and intraoperative stimulation, it reduces the risk of intra and postoperative complications.
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Affiliation(s)
- Arthur Leclerc
- CHU Caen, Department of Neurosurgery, Caen, F-14000, France; Université Caen Normandie, Medical School, Caen, F-14000, France.
| | - Gil Lebreton
- CHU Caen, Department of Digestive Surgery, Caen, F-14000, France
| | - Augustin Huet
- CHU Caen, Department of Imaging, Caen, F-14000, France; Université Caen Normandie, Medical School, Caen, F-14000, France
| | - Arnaud Alves
- CHU Caen, Department of Digestive Surgery, Caen, F-14000, France; INSERM, U1086 ANTICIPE Centre François Baclesse, 3 Avenue du Général Harris, 14000 Caen, France; Université Caen Normandie, Medical School, Caen, F-14000, France
| | - Evelyne Emery
- CHU Caen, Department of Neurosurgery, Caen, F-14000, France; INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, Caen, F-14000, France; Université Caen Normandie, Medical School, Caen, F-14000, France
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Huang M, Qian H, Wang J, Zhao Q, Jiang T. Giant Presacral Schwannoma in Man: Report of a Case with Emphasis on Imaging Findings. World Neurosurg 2019; 133:14-16. [PMID: 31557553 DOI: 10.1016/j.wneu.2019.09.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Schwannoma is a tumor arising from peripheral nerve sheaths and commonly occurs in the head, neck, and upper and lower extremities. Schwannoma in the presacral space is relatively rare and is often misdiagnosed before pathologic diagnosis is made. CASE DESCRIPTION Here we discuss a case of giant presacral schwannoma in a 34-year-old man with an emphasis on imaging findings. CONCLUSIONS Solid and encapsulated, round or oval, with rich blood supply may be the characteristic imaging findings of presacral schwannoma, which may narrow the differential diagnosis of hypervascular pelvic lesions.
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Affiliation(s)
- Min Huang
- Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongrong Qian
- Department of Ultrasound, Shengzhou People's Hospital, Shengzhou Branch of The First Affiliated Hospital of Zhejiang University, Shengzhou, Zhejiang Province, China
| | - Junsen Wang
- Department of Pathology, Shengzhou People's Hospital, Shengzhou Branch of The First Affiliated Hospital of Zhejiang University, Shengzhou, Zhejiang Province, China
| | - Qiyu Zhao
- Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tian'an Jiang
- Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Zhang R, Zhu Y, Huang XB, Deng C, Li M, Shen GS, Huang SL, Huangfu SH, Liu YN, Zhou CG, Wang L, Zhang Q, Deng Y, Jiang B. Primary neuroendocrine tumor in the presacral region: A case report. World J Clin Cases 2019; 7:1884-1891. [PMID: 31417935 PMCID: PMC6692270 DOI: 10.12998/wjcc.v7.i14.1884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/15/2019] [Accepted: 05/23/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Primary neuroendocrine tumors (NETs) in the presacral region are extremely rare, some of which are caused by other primary tumors or metastatic rectal carcinoids. Nevertheless, cases of NETs have been increasing in recent years. This report describes the first primary neuroendocrine tumor in the presacral region that was found at our hospital within the last five years.
CASE SUMMARY The patient was identified as a 36-year-old woman with a presacral mass and pelvic floor pain. A digital rectal examination revealed a presacral mass with unclear margins and obvious tenderness. Magnetic resonance imaging (MRI) demonstrated a 57 mm × 29 mm presacral lump. An ultrasound-guided needle biopsy confirmed a well-differentiated neuroendocrine tumor. No other primary or metastatic tumors were found.
CONCLUSION Comprehensive consideration of our case report and literature reported by others suggests that a conclusive diagnosis of NETs should be based on computed tomography/MRI and pathological examinations. The treatment of primary NETs in the presacral region mainly relies on surgical procedures with follow-up.
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Affiliation(s)
- Rui Zhang
- Department of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Yong Zhu
- Department of Colorectal Surgery, the Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 2100022, Jiangsu Province, China
| | - Xiao-Bo Huang
- Department of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Chris Deng
- Bioinformatics Core, Department of Complementary and Integrative Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, HI 96813, United States
| | - Min Li
- Department of Medical Oncology, the Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 2100022, Jiangsu Province, China
| | - Guang-Shu Shen
- Department of Medical Imaging, the Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 2100022, Jiangsu Province, China
| | - Shu-Liang Huang
- Department of Pathology, the Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 2100022, Jiangsu Province, China
| | - Shao-Hua Huangfu
- Department of Colorectal Surgery, the Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 2100022, Jiangsu Province, China
| | - Yan-Ni Liu
- Department of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Chun-Gen Zhou
- Department of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Ling Wang
- Department of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Qi Zhang
- Department of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Youping Deng
- Bioinformatics Core, Department of Complementary and Integrative Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, HI 96813, United States
| | - Bin Jiang
- Department of Colorectal Surgery, the Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 2100022, Jiangsu Province, China
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Rege S, Tadghare J, Jatav G, Pounikar M. An Unusual Presentation as Recurrent Abortions in a Case of Giant Presacral Epidermoid Cyst Mimicking an Anterior Sacral Meningocele. World Neurosurg 2018; 122:77-80. [PMID: 31108068 DOI: 10.1016/j.wneu.2018.10.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/16/2018] [Accepted: 10/19/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND An epidermoid cyst is a congenital benign tumor and is extremely rare at the presacral region. Only a few cases have been reported in the literature. CASE DESCRIPTION We herein report a case of a 40-year-old woman with a giant presacral epidermoid cyst mimicking an anterior sacral meningocele who presented with recurrent abortions. This increases risk to the mother and fetus. Magnetic resonance imaging is the investigation of choice. CONCLUSIONS The diagnosis and surgical management of this case are discussed.
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Affiliation(s)
- Shrikant Rege
- Department of Neurosurgery, Sri Aurobindo Medical College and P.G. Institute, Indore, India
| | - Jitendra Tadghare
- Department of Neurosurgery, Sri Aurobindo Medical College and P.G. Institute, Indore, India.
| | - Gourav Jatav
- Department of Neurosurgery, Sri Aurobindo Medical College and P.G. Institute, Indore, India
| | - Minakshi Pounikar
- Department of Obstetrics and Gynaecology, Lokmanya Tilak Municipal Medical College, Mumbai, India
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Abstract
Presacral ganglioneuromas are extremely rare benign tumors and fewer than 20 cases have been reported in the literature. Ganglioneuromas are difficult to be differentiated preoperatively from tumors such as schwannomas, meningiomas, and neurofibromas with imaging modalities. The retroperitoneal approach for resection of presacral ganglioneuroma was performed for gross total resection of the tumor. Recurrence and malignant transformation of these tumors is rare. Adjuvant chemotherapy or radiation therapy is not indicated because of their benign nature. We report a case of a 47-year-old woman with a presacral ganglioneuroma.
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Affiliation(s)
- Donguk Lee
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Woo Jin Choe
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - So Dug Lim
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Uçar AD, Erkan N, Yıldırım M. Surgical treatment of retrorectal ( presacral) tumors. World J Surg Proced 2015; 5:127-136. [DOI: 10.5412/wjsp.v5.i1.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 12/05/2014] [Accepted: 12/19/2014] [Indexed: 02/07/2023] Open
Abstract
Retrorectal (also known as presacral) tumor (RT) is a rare disease of retrorectal space. They can be classified as congenital, inflammatory, neurogenic, osseous, or miscellaneous. The most common presentation is an asymptomatic mass discovered on routine rectal examination, but certain nonspecific symptoms can be elicited by careful history and physical examination. The primary and only satisfactory treatment is surgery for RTs. Three approaches commonly used for resection are abdominal, transsacral, or a combined abdominosacral approach. Prognosis is directly related primary local control, which is often difficult to achieve for malignant lesions.
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Melgar MA, Tobler WD, Ernst RJ, Raley TJ, Anand N, Miller LE, Nasca RJ. Segmental and global lordosis changes with two-level axial lumbar interbody fusion and posterior instrumentation. Int J Spine Surg 2014; 8:14444-1010. [PMID: 25694920 PMCID: PMC4325488 DOI: 10.14444/1010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Loss of lumbar lordosis has been reported after lumbar interbody fusion surgery and may portend poor clinical and radiographic outcome. The objective of this research was to measure changes in segmental and global lumbar lordosis in patients treated with presacral axial L4-S1 interbody fusion and posterior instrumentation and to determine if these changes influenced patient outcomes. Methods We performed a retrospective, multi-center review of prospectively collected data in 58 consecutive patients with disabling lumbar pain and radiculopathy unresponsive to nonsurgical treatment who underwent L4-S1 interbody fusion with the AxiaLIF two-level system (Baxano Surgical, Raleigh NC). Main outcomes included back pain severity, Oswestry Disability Index (ODI), Odom's outcome criteria, and fusion status using flexion and extension radiographs and computed tomography scans. Segmental (L4-S1) and global (L1-S1) lumbar lordosis measurements were made using standing lateral radiographs. All patients were followed for at least 24 months (mean: 29 months, range 24-56 months). Results There was no bowel injury, vascular injury, deep infection, neurologic complication or implant failure. Mean back pain severity improved from 7.8±1.7 at baseline to 3.3±2.6 at 2 years (p < 0.001). Mean ODI scores improved from 60±15% at baseline to 34±27% at 2 years (p < 0.001). At final follow-up, 83% of patients were rated as good or excellent using Odom's criteria. Interbody fusion was observed in 111 (96%) of 116 treated interspaces. Maintenance of lordosis, defined as a change in Cobb angle ≤ 5°, was identified in 84% of patients at L4-S1 and 81% of patients at L1-S1. Patients with loss or gain in segmental or global lordosis experienced similar 2-year outcomes versus those with less than a 5° change. Conclusions/Clinical Relevance Two-level axial interbody fusion supplemented with posterior fixation does not alter segmental or global lordosis in most patients. Patients with postoperative change in lordosis greater than 5° have similarly favorable long-term clinical outcomes and fusion rates compared to patients with less than 5° lordosis change.
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Affiliation(s)
| | - William D Tobler
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH
| | | | | | - Neel Anand
- Spine Trauma, Minimally Invasive Spine Surgery Spine Center, Cedars-Sinai Medical Center, Los Angeles, CA
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van der Meer JG, Moerman E, van de Kar AL, Vermaas M, Gerhards MF. Lotus petal perforator flap for reconstruction of an extended chronic presacral defect after radiotherapy and rectal cancer resection. Colorectal Dis 2014; 16:O220-2. [PMID: 24308419 DOI: 10.1111/codi.12511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 10/15/2013] [Indexed: 02/08/2023]
Abstract
AIM As a result of their extent and complexity, pelvic wounds after surgery for anorectal malignancy often require a multidisciplinary approach to accomplish closure. This report describes a successful reconstruction using the lotus petal perforator flap. METHOD This flap is based on perforators of the internal pudendal artery and was partially depithelialized for plugging the defect. RESULTS Wound healing was achieved after 12 days. CONCLUSION The lotus petal flap is a relatively simple and successful choice for reconstruction of an extended chronic presacral defect after radiotherapy and rectal cancer resection.
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Affiliation(s)
- J G van der Meer
- Department of Plastic, Reconstructive and Hand Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Macki M, Bydon M, Papademetriou K, Gokaslan Z, Bydon A. Presacral extramedullary hematopoiesis: an alternative hypothesis. J Clin Neurosci 2013; 20:1664-8. [PMID: 24139732 DOI: 10.1016/j.jocn.2013.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 06/10/2013] [Indexed: 12/19/2022]
Abstract
Idiopathic extramedullary hematopoiesis (EMH) is the production of blood cells outside of the bone marrow without an underlying hematological pathology. This article examines the rare case of idiopathic EMH in the presacral area. A 65-year-old woman with a past medical history of a total abdominal hysterectomy and a negative hematological history presented with back and leg pain. MRI revealed a presacral mass. Fine needle aspiration revealed a diagnosis of EMH. The patient was managed conservatively with serial imaging. We present this patient with rare idiopathic, presacral EMH and review the literature on this topic. The current pathophysiology suggests that sacral fractures release hematopoietic stem cells, which in turn replicate to form an EMH mass. This review suggests a second mechanism in which surgical manipulation of the uterine tissue releases mesenchymal stem cells. These cells differentiate into stromal tissue that interacts with multipotent hematopoietic stem cells in order to form an EMH mass. Thus, idiopathic, presacral EMH may develop from either bone fractures or surgical manipulation of the uterus. Management of these patients should include watchful waiting unless intractable pain, new-onset weakness, or bowel/bladder dysfunction develops.
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Affiliation(s)
- Mohamed Macki
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Meyer Building, Room 5-109, 600 N. Wolfe Street, Baltimore, MD 21287, USA; Johns Hopkins Biomechanics and Surgical Outcomes Laboratory, Baltimore, MD, USA
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15
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Lynch NP, Neary PM, Fitzgibbon JF, Andrews EJ. Successful management of presacral ganglioneuroma: A case report and a review of the literature. Int J Surg Case Rep 2013; 4:933-5. [PMID: 24012577 DOI: 10.1016/j.ijscr.2013.07.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 07/17/2013] [Accepted: 07/31/2013] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Presacral ganglioneuromas are rare, usually benign lesions. Patients typically present when the mass is very large and becomes symptomatic. PRESENTATION OF CASE This report describes the case of a 42 year old lady presenting with back pain who was subsequently diagnosed with a presacral ganglioneuroma based on MR imaging and a CT guided biopsy of the lesion. DISCUSSION After counselling regarding nonoperative management, the patient opted for surgical resection. Open resection was performed with preservation of the neurovascular pelvic anatomy and an uneventful postoperative recovery. A review of the relevant literature was also performed using a search strategy in the online literature databases PUBMED and EMBASE. CONCLUSION Surgical resection of a presacral ganglioneuroma is reasonable given their propensity for local effects and reported potential malignant transformation.
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Affiliation(s)
- N P Lynch
- Department of Surgery, Cork University Hospital, University College Cork, Ireland.
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16
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Abstract
Background Open and minimally invasive lumbar fusion procedures have inherent procedural risks, with posterior and transforaminal approaches resulting in significant soft-tissue injury and the anterior approach endangering organs and major blood vessels. An alternative lumbar fusion technique uses a small paracoccygeal incision and a presacral approach to the L5-S1 intervertebral space, which avoids critical structures and may result in a favorable safety profile versus open and other minimally invasive fusion techniques. The purpose of this study was to evaluate complications associated with axial interbody lumbar fusion procedures using the Axial Lumbar Interbody Fusion (AxiaLIF) System (TranS1, Wilmington, North Carolina) in the postmarketing period. Methods Between March 2005 and March 2010, 9,152 patients underwent interbody fusion with the AxiaLIF System through an axial presacral approach. A single-level L5-S1 fusion was performed in 8,034 patients (88%), and a 2-level (L4-S1) fusion was used in 1,118 (12%). A predefined database was designed to record device- or procedure-related complaints via spontaneous reporting. The complications that were recorded included bowel injury, superficial wound and systemic infections, transient intraoperative hypotension, migration, subsidence, presacral hematoma, sacral fracture, vascular injury, nerve injury, and ureter injury. Results Complications were reported in 120 of 9,152 patients (1.3%). The most commonly reported complications were bowel injury (n = 59, 0.6%) and transient intraoperative hypotension (n = 20, 0.2%). The overall complication rate was similar between single-level (n = 102, 1.3%) and 2-level (n = 18, 1.6%) fusion procedures, with no significant differences noted for any single complication. Conclusions The 5-year postmarketing surveillance experience with the AxiaLIF System suggests that axial interbody lumbar fusion through the presacral approach is associated with a low incidence of complications. The overall complication rates observed in our evaluation compare favorably with those reported in trials of open and minimally invasive lumbar fusion surgery.
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Affiliation(s)
| | - Larry E Miller
- Miller Scientific Consulting, Inc, Biltmore Lake, NC ; Jon E. Block, Ph.D., Inc, San Francisco, CA
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