gms | German Medical Science

Background: 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 of 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. Therefore nerve surgical expertise is crucial. We present our series of patients with different types of tumours, treatment strategies and results.

Materials and methods: Retrospectively, patients presenting with and treated with interdisciplinary team due to retroperitoneal nerve sheath tumours were assessed.Clinical and imaging findings, treatment strategies, surgical approaches, histolopathological findings and outcome are presented.

Results: From January 2012 to September 2015 n= 9 patients were operated on. Of these n= 6 were female, n= 3 male. Histological findings included n= 2 schwannoma, n= 1 malignant peripheral nerve sheath tumour (MPNST), n= 1 sarcoma of unknown origin, n=1 perineurioma, n= 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=2 a monoportal transabdomial and in n= 1 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. We experienced no complications and no new neurological deficits occurred. N= 3 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.