Intrapelvic sciatic notch schwannoma: microsurgical excision using the infragluteal approach

2013 ◽  
Vol 119 (3) ◽  
pp. 751-755 ◽  
Author(s):  
Nicola Montano ◽  
Mariangela Novello ◽  
Quintino Giorgio D'Alessandris ◽  
Nicola Magarelli ◽  
Roberto Pallini ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Total Resection ◽  
Surgical Risk ◽  
Postoperative Course ◽  
Transabdominal Approach ◽  
Neurogenic Tumors ◽  
Sciatic Notch

Benign neurogenic tumors at the sciatic notch that are purely intrapelvic have rarely been reported. Because of this tumor's particular position, a transabdominal or combined transabdominal-gluteal approach is usually used to achieve total resection. However, the transabdominal approach carries a remarkable surgical risk because of the manipulation of intraperitoneal organs. Here, the authors describe a 59-year-old woman harboring a purely intrapelvic sciatic notch schwannoma extrinsic to the sciatic nerve, which was totally removed via the infragluteal approach preserving sciatic function. The postoperative course was uneventful. The infragluteal approach can be safely used for the effective resection of intrapelvic benign neurogenic tumors at the sciatic notch that are extrinsic to the sciatic nerve, avoiding the more invasive and risky transabdominal approach.

scholarly journals Sciatica due to Schwannoma at the Sciatic Notch

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Yavuz Haspolat ◽  
Feyza Unlu Ozkan ◽  
Ismail Turkmen ◽  
Bahattin Kemah ◽  
Yalcin Turhan ◽  
...  
Keyword(s):  
Case Report ◽  
Sciatic Nerve ◽  
Solitary Lesion ◽  
Unusual Location ◽  
Sciatic Notch

Schwannomas are rarely seen on the sciatic nerve and can cause sciatica. In this case report we aimed to present an unusual location of schwannoma along sciatic nerve that causes sciatica. A 60-years-old-man was admitted to us with complaints of pain on his thigh and paresthesia on his foot. Radiography of the patient revealed a solitary lesion on the sciatic nerve. The lesion was excised and the symptoms resolved after surgery.

Structure-Activity Relation of N-alkyl Tetracaine Derivatives as Neurolytic Agents for Sciatic Nerve Lesions 

1998 ◽  
Vol 88 (2) ◽  
pp. 417-428 ◽  
Author(s):  
Ging Kuo Wang ◽  
Marina Vladimirov ◽  
Hao Shi ◽  
Wai Man Mok ◽  
Johann G. Thalhammer ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Nerve Block ◽  
Local Anesthetic ◽  
Drug Application ◽  
Rapid Onset ◽  
Na Channel ◽  
Channel Blockers ◽  
Sciatic Notch ◽  
Structure Activity

Background N-butyl tetracaine has local anesthetic and neurolytic properties. An injection of this drug at the rat sciatic notch produces rapid onset and nerve impairment lasting > 1 week. This study aimed to elucidate the structure-activity relation of various tetracaine derivatives to design better neurolytic agents. Methods N-alkyl tetracaine salts (n = 2-6) were synthesized, and their ability to elicit sciatic nerve impairment of sensory and motor functions in vivo was tested in rats. A single dose (0.1 ml at 37 mM) was administered close to the sciatic nerve at the sciatic notch. Regeneration was assessed morphologically in transverse sections of treated nerves. Finally, the drug potency in blocking Na+ currents was studied under voltage-clamp conditions. Results N-ethyl and N-propyl tetracaine derivatives were non-neurolytic and elicited complete sciatic nerve block lasting 3-7 h. In contrast, N-butyl, N-pentyl, and N-hexyl tetracaine derivatives were strong neurolytic agents and elicited functional impairment of sciatic nerve for > 1 week. All derivatives were strong Na+ channel blockers, more potent than tetracaine if applied intracellularly. External drug application showed marked differences in their wash-in rate: tetracaine > N-hexyl > N-butyl > N-ethyl tetracaine. All derivatives were trapped within the cytoplasm and showed little washout within 7 min. Conclusions When n-alkylation is 4-6, n-alkyl tetracaine appeared as a strong neurolytic agent. Neurolytic derivatives retained their local anesthetic activity and elicited rapid onset of nerve block after injection. Such derivatives are potential local anesthetic-neurolytic dual agents for chemical lesions of the sciatic nerve.

scholarly journals Thoracoscopic surgical resection of thoracic neurogenic tumors

1999 ◽  
Vol 7 (5) ◽  
pp. E3 ◽  
Author(s):  
Patrick P. Han ◽  
Curtis A. Dickman
Keyword(s):  
Tumor Resection ◽  
Open Thoracotomy ◽  
Total Resection ◽  
Thoracic Sympathectomy ◽  
Neurogenic Tumors ◽  
Normal Tissues ◽  
Intercostal Neuralgia ◽  
The Mean ◽  
Intraspinal Extension

Five patients who harbored large intrathoracic paraspinal neurogenic tumors were treated using thoracoscopic techniques to achieve gross-total tumor resection. All tumors were entirely intrathoracic except one that had an intraspinal extension, and all tumors were treated entirely thoracoscopically except for this one. Gross-total resection was achieved in all cases. The mean clinical follow-up period was 6.8 months. Postoperatively, one patient developed Horner's syndrome. The only other complication was transient intercostal neuralgia (two patients), which has resolved in both patient. No evidence of disease was demonstrated clinically or on follow-up imaging in any patient. Thoracoscopy is an excellent modality with which to treat these tumors, in part because it is associated with significantly less morbidity than open thoracotomy and costotransversectomy procedures. Endoscopic transthoracic approaches reduce the approach-related soft-tissue morbidity by preserving the normal tissues of the chest wall, avoiding rib retraction and muscle transection, reducing postoperative pain, and facilitating recovery. This technique has become the senior author's (C.A.D.'s) surgical approach of choice for the removal of intrathoracic benign paraspinal neurogenic tumors. It has also become the preferred method by which to perform thoracic sympathectomy and remove central, herniated thoracic discs.

scholarly journals Microsurgical resection of a large cavernous malformation of the medulla oblongata

2019 ◽  
Vol 1 (1) ◽  
pp. V25
Author(s):  
Sima Sayyahmelli ◽  
Mustafa K. Başkaya
Keyword(s):  
Surgical Resection ◽  
Medulla Oblongata ◽  
Cavernous Malformation ◽  
Foramen Magnum ◽  
Total Resection ◽  
Postoperative Course ◽  
Suboccipital Craniotomy ◽  
Postoperative Mri ◽  
Microsurgical Resection

In this surgical video, we present a 57-year-old man with neck pain, dizziness, and imbalance. MRI showed a heterogeneously enhancing mass lesion within the posterior medulla at the level of the foramen magnum. Because the patient was symptomatic from this cavernous malformation, the decision was made to proceed with surgical resection. The patient underwent a midline suboccipital craniotomy with C1 laminectomy for surgical resection of the cavernous malformation in the medulla oblongata, with concurrent monitoring of motor and somatosensory evoked potentials.The surgery and postoperative course were uneventful. The postoperative MRI showed gross-total resection of the mass with histopathology indicating a cavernous malformation. The patient continues to do well without recurrence at 7 years of follow-up. In this video, we demonstrate important microsurgical steps for the resection of this challenging and rare vascular malformation.The video can be found here: https://youtu.be/gbGleLowzxo.

scholarly journals Retrocondylar Far-Lateral Approach for Resection of a Craniocervical Junction Hemangioblastoma

2019 ◽  
Vol 80 (S 04) ◽  
pp. S349-S351
Author(s):  
Alexander X. Tai ◽  
Kathleen Knudson ◽  
Walter C. Jean
Keyword(s):  
Cystic Lesion ◽  
Craniocervical Junction ◽  
Lateral Approach ◽  
Total Resection ◽  
Operative Strategy ◽  
Postoperative Course ◽  
Suboccipital Craniectomy ◽  
Far Lateral Approach ◽  
Far Lateral ◽  
Neurologically Intact

AbstractWe present a case in which a retrocondylar far-lateral approach was utilized to resect a hemangioblastoma at the craniocervical junction. The patient was a 33-year-old man presenting with 2 months of symptoms referable to compression at the craniocervical junction (i.e., dizziness and gait instability). Though neurologically intact on exam, his imaging demonstrated a highly vascular cystic lesion dorsolateral to the medulla on the left consistent with a hemangioblastoma. Virtual reality software was critical to visualize the patient's lesion in relationship to the vertebral artery and draining vein (Fig. 1). A far-lateral retrocondylar suboccipital craniectomy with a C1 hemilamiectomy permitted resection of this lesion. The operative strategy was to address the lesion similar to an arteriovenous malformation by detaching the lesion from its arterial feeders first, and then addressing the lesion's draining vein (Fig. 2). Postoperative imaging demonstrated a gross-total resection and the patient had an uncomplicated postoperative course. This case demonstrates not only the lateral reach of a retrocondylar far-lateral approach; but also, clearly demonstrates an effective dissection strategy when approaching a hemangioblastoma.The link to the video can be found at: https://youtu.be/M0szMOdhjfE.

scholarly journals A unique case of a double intra-conal cavernous hemangioma

2021 ◽  
Vol 36 (1) ◽  
Author(s):  
Simone Ulivieri ◽  
Davide Luglietto ◽  
Matteo Ulivieri ◽  
Antonio Giorgio
Keyword(s):  
Vascular Malformations ◽  
Adult Population ◽  
Lateral Approach ◽  
Unique Case ◽  
Total Resection ◽  
Case Presentation ◽  
Postoperative Course ◽  
First Case ◽  
Cavernous Hemangiomas ◽  
Extended Lateral Approach

Abstract Background Cavernous hemangiomas are benign vascular malformations, probably representing the most common intraorbital and intraconal tumors in the adult population. Case presentation We report the case of a 49-year-old female with two intra-conal lesions. We performed a total resection using Ulivieri's extended lateral approach. The postoperative course was uneventful and the patient was discharged three days after surgery. Conclusions To the best of our knowledge, we report here the first case in the literature of a double intra-conal lesion.

Resection of benign sciatic notch dumbbell-shaped tumors

2006 ◽  
Vol 105 (6) ◽  
pp. 873-880 ◽  
Author(s):  
Robert J. Spinner ◽  
Toshiki Endo ◽  
Kimberly K. Amrami ◽  
Eric J. Dozois ◽  
Dusica Babovic-Vuksanovic ◽  
...  
Keyword(s):  
High Resolution ◽  
Sciatic Nerve ◽  
Mr Imaging ◽  
Neurological Deficits ◽  
Leg Pain ◽  
Preoperative Imaging ◽  
Imaging Data ◽  
Cross Sectional ◽  
Sciatic Notch ◽  
One Stage

Object The operative management of combined intrapelvic and extrapelvic sciatic notch dumbbell-shaped tumors is challenging. The relatively rare occurrence of these tumors and the varied extent of disease have made it difficult for surgeons to establish definitive surgical indications or predict favorable neurological outcomes based on preoperative imaging data. Methods In the past 3 years, the authors treated five patients presenting with radiating leg pain as a result of benign sciatic notch dumbbell-shaped tumors. These tumors in three patients with unilateral leg symptoms were considered unresectable by other neurosurgeons because of presumed direct intrinsic neural involvement. After high-resolution magnetic resonance (MR) imaging demonstrated that the extensive tumors were separate from the sciatic nerve and the lumbosacral plexus, however, these patients underwent a combined one-stage transabdominal and posterior transgluteal complete resection. Normal neurological status was maintained postoperatively in these three patients, and after more than 1 year of postoperative follow up, there were no tumor recurrences. In two patients with bilateral symptoms and extensive tumor burden, serial MR images showed that innumerable tumors directly involved the entire cross-sectional area of the sciatic nerves and extended longitudinally to the lumbosacral plexuses. Tumor debulking or resection in these patients would have resulted in neurological deficits and would not have addressed their neuropathic pain, and therefore no surgery was performed. These two patients were treated pharmacologically and advised to monitor their tumor status over the course of their lifetimes in case of malignant transformation of the tumor. Conclusions A combined one-stage transabdominal and transgluteal approach allows safe resection of selected benign but extensive sciatic notch tumors. High-resolution MR imaging is a useful tool in the management of these tumors because it allows the surgeon to visualize the anatomical relationships of the tumor to the sciatic nerve. The authors believe that as this imaging technology advances, it will provide surgeons with a method to predict definitively which sciatic notch tumors displace rather than directly involve the sciatic nerve, and therefore indicate which tumors can be resected safely and completely.

scholarly journals Microsurgical Gross Total Resection of Foramen Magnum Meningioma via Far Lateral Approach

2019 ◽  
Vol 80 (S 04) ◽  
pp. S360-S362
Author(s):  
Sima Sayyahmelli ◽  
Mustafa K. Başkaya
Keyword(s):  
Skull Base ◽  
Foramen Magnum ◽  
Lateral Approach ◽  
World Health ◽  
Gross Total Resection ◽  
Fine Motor ◽  
Total Resection ◽  
Postoperative Course ◽  
Far Lateral Approach ◽  
Far Lateral

Foramen magnum meningiomas are one of the most challenging tumors for skull base neurosurgeons due to their proximity to critical neurovascular structures. The far-lateral approach demonstrated here facilitates access to lesions involving the anterior portion of the foramen magnum.In this video, we present a 62-year-old woman with hand numbness and weakness. The patient had significant difficulty in fine motor movements of both hands. In the neurological examination, she had a significant right-hand intrinsic muscle weakness and mild quadriparesis.Magnetic resonance imaging (MRI) showed a dural-based homogeneously enhancing extra-axial mass in the anterior foramen magnum with a significant mass effect on the brain stem and the upper cervical cord. The decision was made to proceed with a far lateral transcondylar skull base approach including partial C1 laminectomy.The surgery and postoperative course were uneventful. The postoperative MRI showed gross total resection of the mass. The histopathology indicated a WHO (World health Organization) grade-I meningioma. The patient's postoperative course was uneventful. She improved to normal neurological function within several weeks and continues to do well without recurrence at 20 months' follow-up.In this video, we demonstrated important steps for the microsurgical resection of these challenging lesions.The link to the video can be found at: https://youtu.be/_nuX2Y7YU9w.

Thoracoscopic resection of thoracic neurogenic tumors

2002 ◽  
Vol 96 (3) ◽  
pp. 304-308 ◽  
Author(s):  
Patrick P. Han ◽  
Curtis A. Dickman
Keyword(s):  
Gross Total Resection ◽  
Total Resection ◽  
Thoracoscopic Resection ◽  
Content Type ◽  
Neurogenic Tumors ◽  
Normal Tissues ◽  
Intercostal Neuralgia ◽  
Intraspinal Extension ◽  
Fine Print

Object. The authors describe the treatment and results of thoracoscopic resection performed in patients with neurogenic tumors. Methods. Seven patients with large intrathoracic paraspinal neurogenic tumors underwent a thoracoscopic procedure to achieve gross-total resection. All tumors were entirely intrathoracic and treated thoracoscopically except in one patient whose tumor had an intraspinal extension. Gross-total resection was achieved in all cases. Postoperatively, one patient developed Horner syndrome. The only other complication, transient intercostal neuralgia, resolved in all patients. Clinical examination and magnetic resonance imaging follow-up examination in all patients demonstrated no evidence of recurrent disease (mean follow up 12.5 months). Conclusions. Endoscopic transthoracic approaches can reduce approach-related soft-tissue morbidity and facilitate a patient's recovery by preserving the normal tissues of the chest wall, by avoiding rib retraction and muscle transection, and by reducing postoperative pain.

scholarly journals Transcondylar fossa approach for the large, high-flow, and diffuse arteriovenous malformation of the posterior fossa

2021 ◽  
Vol 4 (1) ◽  
pp. V5
Author(s):  
Koichi Torihashi ◽  
Takafumi Ogura ◽  
Mitsutoshi Kadowaki ◽  
Makoto Sakamoto ◽  
Masamichi Kurosaki
Keyword(s):  
Conservative Treatment ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Cerebellopontine Angle ◽  
Endovascular Embolization ◽  
High Flow ◽  
High Grade ◽  
Total Resection ◽  
Cerebellar Hemorrhage ◽  
Postoperative Course

Posterior fossa high-grade arteriovenous malformations (AVMs) are challenging diseases. This video presents the treatment of a patient with a diffuse, high-flow AVM of the posterior fossa on the tonsil and cerebellopontine angle (4 cm in diameter) and deep draining veins. The patient had an intraventricular and cerebellar hemorrhage. After conservative treatment, total resection of the AVM was performed with embolization and surgery. The authors resected the nidus after the endovascular embolization, on the same day. The postoperative course was uneventful, and the patient was discharged with almost full recovery.The video can be found here: https://youtu.be/logCCn3uKUc

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