Combined anterior‐posterior approach with enlarged sciatic foramen to remove sciatic notch dumbbell‐shaped tumors

Li, Mi; Li, Hao; Du, Yu; Cai, Zhuo; Liao, Hui; Guo, Fengjing; Chen, Anmin; Li, Feng; Yang, Chun

doi:10.1002/jso.24552

Cited by 10 publications

(9 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although not required in our cases, marginal osteotomies may be used to enlarge the sciatic foramen. Li and colleagues (2017) performed a C-shaped osteotomy during the posterior approach with a piezoelectric bone cutter preventing damage to the hip and sacroiliac joint [15]. We support this technique as it protects the soft tissues while the bone is resected.…”

Section: Discussionmentioning

confidence: 85%

“…After ligature of the vessels, dissection towards the sacrum exposed the greater sciatic notch. In patient 2, it was necessary to incise the sacrospinous and sacrotuberous ligaments to enlarge the sciatic foramen to achieve delivery of the tumour through the notch [15]. Osteotomies of the sciatic notch margins were not required in these cases.…”

Section: Surgical Techniquementioning

confidence: 99%

See 1 more Smart Citation

Simultaneous combined anterior and posterior approach for en bloc resection of sciatic notch sarcomas

et al. 2019

View full text Add to dashboard Cite

Background Monobloc resection of soft tissue sarcomas (STSs) has a major impact on overall survival and local recurrence. Anatomical boundaries, such as the sciatic notch, increase the risk of fragmentation of the lesion. To date there are few papers describing the optimal surgical technique to remove such STSs. The objective of this study is to describe a simultaneous anterior and posterior approach for resection of sciatic notch dumbbell tumours. Case presentation We present the surgical management of two patients diagnosed with well-differentiated liposarcomas of the sciatic notch with a retroperitoneal and gluteal extension in the two cases. Pre-operative diagnosis was made with a percutaneous biopsy including molecular analysis which demonstrated MDM2 amplification. We describe a simultaneous anterior and posterior approach, including the ligation of the posterior trunk of the internal iliac artery, to reduce intra-operative blood loss and devascularise the tumour. The anterior approach allows the evaluation of the tumour’s retroperitoneal extension, release from its pelvic attachments and control of the surrounding neurovascular structures. During the posterior approach, bleeding is reduced by the devascularisation of the gluteal musculature achieved with internal iliac artery ligation. Clear margins were achieved in both cases. No vascular, skeletal or soft tissue reconstructions were required. Conclusions Simultaneous combined anterior and posterior approaches to remove a malignant sciatic notch tumour optimises the chance of complete en bloc resection. This surgical strategy allows oncologic en bloc resection with minimal blood loss.

show abstract

Section: Discussionmentioning

confidence: 85%

Section: Surgical Techniquementioning

confidence: 99%

Simultaneous combined anterior and posterior approach for en bloc resection of sciatic notch sarcomas

et al. 2019

View full text Add to dashboard Cite

show abstract

“…It is characterized by pain radiating downward from the lumbar region to the posterior thigh. Lumbar disc herniation, spinal stenosis, and pyriformis syndrome are among the most common causes; however less common extraspinal pathologies are of infective, inflammatory, tumoral and vascular origin which include soft tissue and bone tumors, hematomas, presacral abscesses, aneurysms, sacroiliitis, and gynecological conditions such as endometriosis and tubal-ovarian abscesses [3,4,5].…”

Section: Introductionmentioning

confidence: 99%

The clinical outcomes after surgical treatment of mass lesions causing sciatica - a single-center retrospective study

et al. 2021

View full text Add to dashboard Cite

Introduction/Objective Sciatica is a disabling pathology with variable etiologies. The most common pathologies arise from discogenic or non-discogenic causes. Mass lesions are a rare cause of extraspinal sciatica, which have been commonly overlooked, leading to unnecessary spinal surgeries, delay in diagnosis or inadequate treatment. There is no standard surgical approach and functional outcomes after surgical treatment of these lesions are not well-known. The aim of this study is to evaluate clinical outcomes after surgical treatment of mass lesions causing sciatica in different locations. Methods Data were obtained by a retrospective review from 2015-2020. The mean duration of symptoms at the time of surgery was 10.3 months (3-48 months). The mean age of patients at the time of surgery was 43.8 years (14-73 years). The mean follow-up was 19.5 months (4-50 months). In total, 14 cases had an extrapelvic localization distal to sciatic notch. The other three cases had lesions in the intrapelvic area, including left sciatic notch (1), right acetabulum (1), sacroiliac and lumbosacral region (1). None of the patients had palpable masses. Transgluteal, infragluteal, lateral, and posteromedial approach were used depending on location and size of the lesion. Results At the final follow-up, all patients recovered pain relief. The median musculoskeletal tumor society score was 90% (70-100). There was no recurrence at the latest follow-up. Conclusion Our study demonstrated that early detection by neurological examination and radiological work-up can avoid unnecessary surgeries, enable early surgical treatment of tumoral mass with satisfactory clinical outcomes. The surgical approach should be individualized according to location and size of the lesion.

show abstract

“…Furthermore, because of the wide variety of characteristics, surgery for RPTs is not only carried out by gastroenterological surgeons, but also by urologists, orthopedic surgeons, gynecologists, plastic surgeons and other specialists. [6][7][8][9][10] In addition, sarcoma is an orphan disease with a low incidence (number of cases per 100 000 population/year). 3,11 It is necessary to have treatment for RPTs at some integrated facilities to ensure appropriate treatment strategies and improved OS.…”

Section: Introductionmentioning

confidence: 99%

“…However, RPTs including RPS are areas of overlap for many physicians and surgeons. Furthermore, because of the wide variety of characteristics, surgery for RPTs is not only carried out by gastroenterological surgeons, but also by urologists, orthopedic surgeons, gynecologists, plastic surgeons and other specialists 6–10 …”

Section: Introductionmentioning

confidence: 99%

Retroperitoneal tumors: Review of diagnosis and management

Sassa

2020

Int J of Urology

View full text Add to dashboard Cite

Retroperitoneal tumors are extremely rare tumors occurring in the retroperitoneum. Retroperitoneal tumors are divided into benign tumors and malignant tumors, including retroperitoneal sarcoma. Approximately 70-80% of primary retroperitoneal soft-tissue tumors are malignant; however, these only account for 0.1-0.2% of all malignancies. Retroperitoneal sarcoma is an orphan malignant disease with a low incidence. The information on benign retroperitoneal tumors is limited. The American Joint Committee on Cancer/TNM classification updated to the 8th edition in 2017. In 2010, three new drugs for soft tissue sarcoma were approved based on the results of phase III trials, but the histological subtypes of the patients enrolled in the trials of each drug differed. Recently, in addition to surgery for retroperitoneal sarcoma, the effectiveness of perioperative radiation therapy has become interesting. For malignant retroperitoneal tumors and retroperitoneal sarcoma, survival improvement and locoregional recurrence prevention can be undertaken by carrying out surgery to secure negative margins with wide and combined resection of some adjacent organs, and cooperation with a trained medical team comprising of radiologists, pathologists and medical oncologists in centralized hospitals. Some clinical trials aimed at further improving treatment results by adding preoperative chemotherapy and radiation therapy based on histological confirmation using a correct needle biopsy are in progress. In recent years, molecular profiling has been used to select eligible patients for chemotherapy. In the future, precision medicine with next-generation sequencing technology will be expected among the diverse and potential future treatments for retroperitoneal sarcoma. In this review, we summarized the current state of retroperitoneal tumors and retroperitoneal sarcoma.

show abstract

Combined anterior‐posterior approach with enlarged sciatic foramen to remove sciatic notch dumbbell‐shaped tumors

Abstract: The combined anterior-posterior approach with an enlarged sciatic notch is an effective method to remove sciatic notch dumbbell-shaped tumors. Compared to the reported study, it is a new method probably helpful for selected patients.

Cited by 10 publications

References 14 publications

Simultaneous combined anterior and posterior approach for en bloc resection of sciatic notch sarcomas

Simultaneous combined anterior and posterior approach for en bloc resection of sciatic notch sarcomas

The clinical outcomes after surgical treatment of mass lesions causing sciatica - a single-center retrospective study

Retroperitoneal tumors: Review of diagnosis and management

Contact Info

Product

Resources

About