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Surgical Management of Symptomatic Lumbar, Sacral, and Lumbosacral Plexus Tumors: a Peripheral Nerve Unit Experience

  • Original Article - Peripheral Nerves
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A Correction to this article was published on 29 March 2021

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Abstract

Objective

Data concerning the surgical treatment of lumbosacral plexus tumors (LSPTs) is scarce. This study aims to present our experience with a series of 19 patients surgically treated for symptomatic LSPTs at our institution.

Methods

This is a retrospective study of 19 patients surgically treated for symptomatic LSPTs from 2011 to 2019. Clinical data were retrieved from medical records and consisted of age, gender, clinical presentation, location of the lesion, surgical approach, final histopathologic diagnosis, follow-up time, outcomes, and complications.

Results

Nineteen surgical procedures were conducted. Thirteen patients were female and six, male. The median age of patients was 45 years (range 20 to 63 years). No patients harbored genetic syndromes. Surgical treatment appears to be correlated to the reduction of pain in patients with peripheral nerve sheath tumors (PNSTs), as assessed by visual analog scale (VAS). Sixteen patients did not present with new-onset deficits during follow-up (84.2%), two of whom recovered from their preoperative deficit. Four patients presented with postoperative weakness. The histopathological diagnoses were 11 schwannomas, four neurofibromas, three metastases, and one lymphoma.

Conclusions

LSPTs are rare. When surgical treatment is indicated, it usually requires multidisciplinary management. Surgery appears to be effective concerning the reduction of pain in PNSTs and may also recover neurological deficits. Iatrogenic neurological deficits are an evident risk, such that intraoperative multimodal monitoring should always be performed if available. In lesions involving the sacral plexus, we found it to be indispensable.

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Acknowledgements

We would like to thank Maria Sanches for the drawing presented in Fig. 1.

Author information

Authors and Affiliations

  1. Department of Surgery, Division of Neurosurgery, Gaffrée e Guinle University Hospital, School of Medicine, Federal University of Rio de Janeiro State (UNIRIO), 775 Mariz e Barros Street, Rio de Janeiro, RJ, 20270-901, Brazil

    Fernando Guedes, Gabriel Elias Sanches, Rosana Siqueira Brown & Rodrigo Salvador Vivas Cardoso

  2. Department of Pathology, Antônio Pedro University Hospital, Fluminense Federal University (UFF), Niterói, RJ, Brazil

    Ana Caroline Siquara-de-Sousa

  3. Department of Surgery, Gaffrée e Guinle University Hospital, School of Medicine, Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, RJ, Brazil

    Agostinho Ascenção & Antônio Carlos Iglesias

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  1. Fernando Guedes
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  4. Rodrigo Salvador Vivas Cardoso
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Corresponding author

Correspondence to Fernando Guedes.

Ethics declarations

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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The authors declare no competing interests.

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Comments

This paper describes a series of 19 patients with lumbar, sacral and lumbosacral plexus tumors treated at one peripheral nerve unit. These tumors in these locations are relatively rare and the heterogeneity is to be expected; thus, a large experience, successful application of the protocol, and the consequent analysis are not possible. This paper has several strengths which need to be highlighted for general neurosurgeons who have little familiarity with the evaluation and/or management of these lesions.

The authors present an anatomical classification for these tumors and proposes surgical approaches to each of the anatomical regions described. They also offer a useful algorithm that allows standardization for the management and surgery for these patients. We believe that these approaches should be incorporated in our care of these patients with these regional tumors (and potentially extrapolated to those with dumbbell tumors) to optimize surgical techniques, benchmark data and share knowledge.

The well known phrase "location, location, location" describes the most important aspects of property values. Similarly, the location of tumors is critical, and the care of our patients is priceless. In unusual locations, many neurosurgeons not only use access surgeons, but rely on them, to bring their expertise and dedicated teams to the multidisciplinary care of our patients. In our practice, we employ specific access surgeons specialized in the surgery at each of these locations.

The authors should be congratulated on their paper and their anatomical contributions to our surgical specialty.

Evelina Llorian,

Robert J. Spinner,

Rochester, Minnesota,USA

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Guedes, F., Sanches, G.E., Brown, R.S. et al. Surgical Management of Symptomatic Lumbar, Sacral, and Lumbosacral Plexus Tumors: a Peripheral Nerve Unit Experience. Acta Neurochir 163, 2063–2074 (2021). https://doi.org/10.1007/s00701-021-04789-0

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