Laparoscopic-Assisted Resection for Retroperitoneal Dumbbell-Shaped Lumbar Spinal Schwannomas: Operative Technique and Surgical Results

Background: Retroperitoneal dumbbell lumbar spinal schwannomas (RDLSSs) classified as the Eden type 4 are composed of small intervertebral foramen components and large paravertebral components extending into the retroperitoneal cavity. The surgical management of RDLSSs s remains a great challenge for all neurosurgeons because of the features of tumor.

Objective: To present our experience in the laparoscopic resection of RDLSSs and to evaluate endoscopy surgery by an anterior approach for the treatment of RDLSSs.

Methods: We performed a retrospective review of 3 patients with RDLSSs who underwent laparoscopic surgery by an anterior approach between June 2013 and July 2014. Patient demographics, operative reports, and pre- and postoperative images were reviewed.

Results: All tumors were removed completely with retroperitoneal laparoscopy by the anterior approach. There were no major morbidities related to the surgical procedure in this series, and all patients recovered from surgery. The preoperative symptoms either improved or resolved in 2 patients, whereas they remained unchanged in 1 patient. Postoperative follow-up ranged from 12 to 24 months, and none of the patients showed signs of tumor recurrence or spinal deformity.

Conclusions: The operative plan should be tailored to the features of the RDLSS. Retroperitoneal laparoscopy surgery by the anterior approach can produce safe and effective resection of RDLSSs with minimal postoperative complications. This procedure may be preferred for RDLSSs mainly located in the retroperitoneum without spinal canal extension.