Brian P Curry1,2, Reinier Alvarez2,3,4, Brigitte C Widemann5, Matthew Johnson6, Piyush K Agarwal7, Tanya Lehky6, Vladimir Valera8, Prashant Chittiboina3,4. 1. Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA. 2. Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA. 3. Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Diseases and Stroke, Bethesda, Maryland, USA. 4. Florida International University Herbert Wertheim College of Medicine, Miami, Florida, USA. 5. Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA. 6. Electromyography Section, National Institute of Neurological Diseases and Stroke, Bethesda, Maryland, USA. 7. Department of Surgery, Urology Section, Comprehensive Cancer Center, The University of Chicago, Chicago, Illinois, USA. 8. Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
Abstract
BACKGROUND: Retroperitoneal nerve sheath tumors present a surgical challenge. Despite potential advantages, robotic surgery for these tumors has been limited. Identifying and sparing functional nerve fascicles during resection can be difficult, increasing the risk of neurological morbidity. OBJECTIVE: To review the literature regarding robotic resection of retroperitoneal nerve sheath tumors and retrospectively analyze our experience with robotic resection of these tumors using a manual electromyographic probe to identify and preserve functional nerve fascicles. METHODS: We retrospectively analyzed the clinical courses of 3 patients with retroperitoneal tumors treated at the National Institutes of Health by a multidisciplinary team using the da Vinci Xi system. Parent motor nerve fascicles were identified intraoperatively with a bipolar neurostimulation probe inserted through a manual port, permitting tumor resection with motor fascicle preservation. RESULTS: Two patients with neurofibromatosis type 1 underwent surgery for retroperitoneal neurofibromas located within the iliopsoas muscle, and 1 patient underwent surgery for a pelvic sporadic schwannoma. All tumors were successfully resected, with no complications or postoperative neurological deficits. Preoperative symptoms were improved or resolved in all patients. CONCLUSION: Resection of retroperitoneal nerve sheath tumors confers an excellent prognosis, although their deep location and proximity to vital structures present unique challenges. Robotic surgery with intraoperative neurostimulation mapping is safe and effective for marginal resection of histologically benign or atypical retroperitoneal nerve sheath tumors, providing excellent visibility, increased dexterity and precision, and reduced risk of neurological morbidity.
BACKGROUND: Retroperitoneal nerve sheath tumors present a surgical challenge. Despite potential advantages, robotic surgery for these tumors has been limited. Identifying and sparing functional nerve fascicles during resection can be difficult, increasing the risk of neurological morbidity. OBJECTIVE: To review the literature regarding robotic resection of retroperitoneal nerve sheath tumors and retrospectively analyze our experience with robotic resection of these tumors using a manual electromyographic probe to identify and preserve functional nerve fascicles. METHODS: We retrospectively analyzed the clinical courses of 3 patients with retroperitoneal tumors treated at the National Institutes of Health by a multidisciplinary team using the da Vinci Xi system. Parent motor nerve fascicles were identified intraoperatively with a bipolar neurostimulation probe inserted through a manual port, permitting tumor resection with motor fascicle preservation. RESULTS: Two patients with neurofibromatosis type 1 underwent surgery for retroperitoneal neurofibromas located within the iliopsoas muscle, and 1 patient underwent surgery for a pelvic sporadic schwannoma. All tumors were successfully resected, with no complications or postoperative neurological deficits. Preoperative symptoms were improved or resolved in all patients. CONCLUSION: Resection of retroperitoneal nerve sheath tumors confers an excellent prognosis, although their deep location and proximity to vital structures present unique challenges. Robotic surgery with intraoperative neurostimulation mapping is safe and effective for marginal resection of histologically benign or atypical retroperitoneal nerve sheath tumors, providing excellent visibility, increased dexterity and precision, and reduced risk of neurological morbidity.
Authors: Christine S Higham; Eva Dombi; Aljosja Rogiers; Sucharita Bhaumik; Steven Pans; Steve E J Connor; Markku Miettinen; Raf Sciot; Roberto Tirabosco; Hilde Brems; Andrea Baldwin; Eric Legius; Brigitte C Widemann; Rosalie E Ferner Journal: Neuro Oncol Date: 2018-05-18 Impact factor: 12.300
Authors: Karlyne M Reilly; AeRang Kim; Jaishri Blakely; Rosalie E Ferner; David H Gutmann; Eric Legius; Markku M Miettinen; R Lor Randall; Nancy Ratner; N L Jumbé; Annette Bakker; David Viskochil; Brigitte C Widemann; Douglas R Stewart Journal: J Natl Cancer Inst Date: 2017-08-01 Impact factor: 13.506