gms | German Medical Science

Objective: Nerve or nerve associated tumours of the retroperitoneal space are rare. Histological findings vary significantly and each entity requires different strategies reaching from open biopsy, function sparing tumour enucleation to radical resection. The tumors are frequently situated in- or in the vicinity the lumbosacral plexus. Depending on tumour extent and location appropriate treatment sometimes necessitates pluriportal approaches. A considerable portion are peripheral nerve sheath tumors (PNST). However, the majority of PNST are benign, and can be microsurgically removed without functional deficit. If they are treated like conventional soft-tissue tumours pain and functional loss are the consequences. If situated in the lumbosacral plexus results can be disastrous. Therefore, nerve surgical expertise is crucial. We present our series of patients with different types of tumours, treatment strategies and results.

Methods: Retrospectively our patients with retroperitoneal nerve-associated tumours were evaluated. We followed an interdisciplinary approach for assessment and surgery. Clinical and imaging findings, treatment strategies, surgical approaches, histological findings and outcome are presented.

Results: From January 2012 to September 2015 n= 12 patients were operated on. Of these n= 9 were female, n= 3 male. Histological findings included n= 5 schwannoma, n= 2 malignant peripheral nerve sheath tumours (MPNST), n= 1 sarcoma of unknown origin, n=1 perineurioma, n=1 intraneural ganglion cyst, n= 1 lymphoma, n= 1 paraganglioma. In n= 5 a monoportal retroperitoneal, in n= 2 patients a biportal (transabdominal+transgluteal), in n=3 a monoportal transabdomial and in n= 2 a dorsal approach was used. In n= 2 we performed an open biopsy (perineurioma/ paraganglioma), in n= 2 a tumour enucleation (schwannoma), in n= 3 a subtotal function-sparing resection (MPNST/ sarcomas/ lymphoma), in n= 1 intraneural decompression (intraneural ganglion cyst) and in n= 1 removal of remaining schwannoma after previous surgery ex domo and autologous nerve reconstruction. Both macroscopic and microscopic techniques were applied in all cases. We generally do not perform CT-guided needle biopsies. In n=1 patient motor weakness occurred. N= 4 patients required further radio-oncological treatment.

Conclusion: Retroperitoneal nerve or nerve associated tumours encompass a large variety of different entities. Each requires different treatment strategies, but any one of them benefits from nerve surgical expertise. Aside from tumour removal preservation of function should be one goal of surgery. In our experience, working in an interdisciplinary team patient’s safety can be improved significantly.