Abstract
Background and Study Aims Schwannomas are benign tumors derived from the Schwann cells of the peripheral nerve
sheath that rarely affect the retroperitoneum. When symptomatic, surgical resection
is usually recommended via open surgery or the laparoscopic transperitoneal approach.
We discuss the retroperitoneoscopic resection of lumbosacral plexus schwannomas through
an illustrative case and literature review. A new management classification is also
proposed.
Patients A 61-year-old woman affected by schwannomatosis presented with neuropathic pain in
her right inguinocrural area for the past 4 years before admission. Preoperative imaging
revealed a 2-cm right retroperitoneal tumor lateral to the psoas muscle. The diagnosis
of a schwannoma of the ilioinguinal nerve was then suggested. The patient underwent
complete tumor resection through retroperitoneoscopy, and no recurrence was observed
over the long term. A review of the relevant literature revealed that surgical strategy
depends on tumor location, and therefore patients are divided into three groups by
tumor position to guide trocar placement: type 1 (paravertebral or over the psoas
muscle), type 2 (lateral to the psoas muscle), and type 3 (sacral or pelvic).
Results Four patients were classified as type 1, one as type 2, and three as type 3, thereby
guiding trocar placement to a lateral, anterior, or inferior montage, respectively.
Conclusions Retroperitoneoscopy is a minimally invasive technique that offers some potential
advantages in approaching retroperitoneal masses. This new classification is useful
to group patients and thus provide guidance on the best retroperitoneoscopic surgical
strategy.
Keywords
lumbosacral - retroperitoneoscopy - schwannoma - tumor
