gms | German Medical Science

Objective: PNSTs rarely have their origin from lumbosacral roots or plexus and can occur in the retroperitoneum. The tumours can be asymptomatic until they reach an appreciable size. There are only few studies to this topic available. Aim of this study is to show the relevance of a nerve-sparing resection of PNST with analysis of surgical management, pathologies of the neurinoma and the postsurgical progress.

Methods: N=21 patients who were treated surgically at the Heidelberg Universitätsklinikum from 2009 until 2018 have been included in the study. Surgeries were performed in multidisciplinary manner. Abdominal approach, transperitoneal or retroperitoneal, was chosen depending on tumour localization. Intraneural tumours were dissected and resected after incision of the epineurium and microsurgical preparation was performed to save the non-involved fascicles. Clinical data were reviewed and analysed retrospectively. The suspected diagnosis was retroperitoneal PNST or unclear mass with direct contact to the nerval structures.

Results: Post-surgical histopathology showed n=16 benign PNSTs (76.2%) (n=12 schwannoma, n=3 neurofibroma, n=1 ganglioneuroma), n=3 peripheral non-neural sheath tumours (14.3%) and n=2 malignant PNSTs (9.5%). M:F ratio was 10:11 and age ranged from 20 to 67 years (median 52a). 13 patients (61.9%) presented with presurgical pain symptoms (47.6% ischialgia, 14.3% back pain). The tumour size ranged from 4-645cm³ (median 53cm³). Eight out of ten patients (80%) with a tumour size below 50cm³ did not show any symptom alteration in the follow-up. There were no postsurgical neurological deficits. Intraoperatively, 17 patients (81%) could be treated with complete tumour resection. Of these patients, only one patient had a tumour relapse

Conclusion: With our surgical management, the nerve-sparing resection, we were able to achieve only few or even no postsurgical nerval dysfunction as well as one non-surgical complication. Regardless of its etiology, we could also show a very small recurrence rate. The small pain relief in tumours smaller than 50cm³ could indicate the incoherence between pain symptoms and small tumours. For a better significance, a bigger study population and a prospective study design is required.