Anterior retroperitoneal approach for removal of L5-S1 foraminal nerve sheath tumor-case report.

Abstract

Extradural lumbar schwannomas are a rare form of nerve sheath tumors (NSTs). The typical management approach for extradural foraminal NSTs is total gross resection, which involves a midline incision and muscle exposure, followed by laminectomy and facetectomy to access the tumor for resection. Following tumor removal, spinal fusion is often indicated to reduce postoperative deformity, pain, and neurologic deficits. We report the case of a 34-year-old woman who presented with a 2-year history of progressive dysesthesia and left foot drop. Magnetic resonance imaging revealed a lesion in the lateral L5/S1 foramen. A novel anterior-retroperitoneal approach was used to access the tumor, via muscle splitting, retraction of peritoneum medially and psoas muscle or iliac vessels laterally. This study is a case report of a novel approach for extradural lumbar schwannomas. The methods involve a description of the approach and reporting of clinical findings. The schwannoma was successfully resected without requiring additional fusion surgery. The patient recovered uneventfully and was discharged on day 2 post operation. We propose that the anterior-retroperitoneal approach is a viable technique for resection of lumbar foraminal NSTs without the need for fusion surgery.