Intrapelvic sciatic notch schwannoma: microsurgical excision using the infragluteal approach

Abstract

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.

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

“…Intraoperative plastic bags were used to wrap the tumor to provide a strong cystic capsule and reduce the risk of tumor rupture. For benign sciatic notch tumor, Montano reported it can be resected through a purely posterior approach in 2013 . But the tumor was not resected total en bloc, so it cannot be proposed for malignant tumors.…”

“…Considering the complex anatomical situations in the retroperitoneal space, this type of tumor is very difficult to resect, often thought to be unresectable by many surgeons. Although there have been several reports in recent years on this type of tumor, most are case reports . A standard surgical procedure has not been created.…”

“…Pelvic retroperitoneal dumbbell-shaped soft tissue tumor has a very rare incidence and is hard to treat. [1][2][3][4][5][6][7][8][9] Because of the large potential retroperitoneal space, the tumor often grows without any initial symptoms. When a magnetic resonance imaging (MRI) examination reveals the tumor only after the patient feels discomfort, the tumor has generally already become very large, sometimes large enough to penetrate the greater sciatic foramen, thus a dumbbell-shaped tumor is formed.…”

Case Report: Sciatic nerve schwannoma - a rare cause of sciatica

“…The sciatic nerve invariably lies midway between the ischial tuberosity, medially, and the greater trochanter, laterally. A subgluteal approach may lead to prolonged discomfort due to retraction of the soft tissues and the gluteal muscles 9 . A transgluteal approach may sometimes lead to disastrous consequences due to retraction of the muscle arteries within the pelvis.…”

“…A transgluteal approach may sometimes lead to disastrous consequences due to retraction of the muscle arteries within the pelvis. However it provides a wider surgical corridor up to the sciatic notch 9 .…”