gms | German Medical Science

Objective: Deep-seated retroperitoneal neurinomas are very rare lesions causing a variety of symptoms. Because of their slow growth and deep-seated location with soft surrounding structures some can gain large size before initial diagnosis. This report presents an interdisciplinary treatment regime needed for successful surgery of these complex lesions.

Methods: In 2016, three patients with large retroperitoneal neurinomas were treated interdisciplinarily in our institution. Two patients with deeply located neurinomas of the lumbosacral plexus and one patient with a small intraspinal and a large extraspinal neurinoma of the L2/L3 segment are included in this report. All patients underwent preoperative enhanced and non-enhanced magnetic resonance imaging (MRI). The surgical approach and operative strategy was decided in an interdisciplinary case discussion (neurosurgery/general surgery) and the surgical procedure was scheduled accordingly. All patients underwent clinical and MRI follow-up three months after the treatment.

Results: A general surgeon performed the retroperitoneal approach in all three cases and microsurgical tumor resection was carried out by a neurosurgeon under permanent electrophysiological monitoring. Both deep seated intrapelvine neurinomas were microsurgically resected over a lateral retroperitoneal approach in supine position in an interdisciplinary procedure. Both patients were mobilized one day after surgery and could be discharged home on the fifth and sixth postoperative day, respectively. Both patients had no early or late postoperative deficit and 3 months MRI follow-up showed complete tumor removal without tumor recurrence. They could fully return back to work as an IT-specialist and a ballet teacher, respectively. The intra- and extraspinal neurinoma was treated in a two-portal-technique over a hemi-laminectomy of L3 and a retroperitoneal approach in lateral position. The patient could be mobilized on the first postoperative day and was discharged home five days after the procedure without deficits. At three months follow-up she was without deficits and fully back to work as a teacher. MRI showed complete tumor removal without signs for tumor recurrence.

Conclusion: An interdisciplinary team of neurosurgeons and general surgeons allows treatment of large deep-seated neurinomas with complete tumor removal and excellent clinical outcome. An interdisciplinary surgical team is mandatory for treatment of these complex lesions.