Laparoscopic-assisted Resection of a Retroperitoneal Lumbar Nerve Root Neurofibroma: A Case Report

We present a case of a 59-year-old patient with chronic low back pain, caused by a retroperitoneal intraneural tumour. Laparoscopic excision was performed and histology revealed a spinal nerve root neurofibroma. Post-operatively, the patient developed partial motor and sensitive deficits due to tumoral nerve entrapment, with progressive recovery with rehabilitation. This report reviews the literature on this sparsely reported condition, highlighting the utility of laparoscopy in its management.

Keywords
laparoscopy; low back pain; neurofibroma; retroperitoneal neoplasms; spinal nerve roots

Authorship

Miguel Relvas-Silva Address for correspondence Miguel Relvas-Silva, Hospital de São João, Ortopedics and Traumatology, Rua Santa Justa 228G, 6° CDF, Porto, Porto, 4200–319, Portugal (e-mail: mrelvas.silva@gmail.com).

Department of Orthopedics and Traumatology, São João University Hospital Center, Porto, PortugalSão João University Hospital CenterPortugalPorto, PortugalDepartment of Orthopedics and Traumatology, São João University Hospital Center, Porto, Portugal

https://orcid.org/0000-0003-1018-0810

Estevão Rodrigues Lima

Department of Urology, CUF Porto Hospital, Porto, PortugalCUF Porto HospitalPortugalPorto, PortugalDepartment of Urology, CUF Porto Hospital, Porto, Portugal

https://orcid.org/0000-0002-1962-7968

Manuel Ribeiro Silva

Department of Orthopedics, CUF Porto Hospital, Porto, PortugalCUF Porto HospitalPortugalPorto, PortugalDepartment of Orthopedics, CUF Porto Hospital, Porto, Portugal

i3S - Institute for Research and Innovation in Health, University of Porto, Porto, PortugalUniversity of PortoPortugalPorto, Portugali3S - Institute for Research and Innovation in Health, University of Porto, Porto, Portugal

https://orcid.org/0000-0001-7520-2385

Nuno Neves

Department of Orthopedics, CUF Porto Hospital, Porto, PortugalCUF Porto HospitalPortugalPorto, PortugalDepartment of Orthopedics, CUF Porto Hospital, Porto, Portugal

INEB - National Institute of Biomedical Engineering, University of Porto, Porto, PortugalUniversity of PortoPortugalPorto, PortugalINEB - National Institute of Biomedical Engineering, University of Porto, Porto, Portugal

https://orcid.org/0000-0002-5413-435X

Address for correspondence Miguel Relvas-Silva, Hospital de São João, Ortopedics and Traumatology, Rua Santa Justa 228G, 6° CDF, Porto, Porto, 4200–319, Portugal (e-mail: mrelvas.silva@gmail.com).

Conflict of Interest

The authors stated that there is no conflict of interest in writing this article.

SCIMAGO INSTITUTIONS RANKINGS

Department of Urology, CUF Porto Hospital, Porto, PortugalCUF Porto HospitalPortugalPorto, PortugalDepartment of Urology, CUF Porto Hospital, Porto, Portugal

Department of Orthopedics, CUF Porto Hospital, Porto, PortugalCUF Porto HospitalPortugalPorto, PortugalDepartment of Orthopedics, CUF Porto Hospital, Porto, Portugal

Figures

Figures (6)

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Fig. 1
MRI (coronal plane) – T1- weighted sequence: hypointense ovoid, nodular paraspinal mass, closely related to the left L4 nerve root and located between the psoas and iliacus muscles.

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Fig. 2
MRI (axial plane) – T2- weighted sequence: heterogeneously hyperintense lesion, with few cystic areas, suggestive of neurogenic lumbar plexus tumour.

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Fig. 3
MRI (sagittal plane) – T2- weighted sequence: heterogeneously hyperintense lesion, with few cystic areas, suggestive of neurogenic lumbar plexus tumour.

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Fig. 4
L4 nerve root neurofibroma, intermingled with the nerve fascicles. (arrow: neurofibroma; arrowhead: distal portion of the L4 nerve root).

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Fig. 5
After total lesion resection with partial neurectomy, direct end-to-end epineural repair was performed.

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Fig. 6
Histopathological and imunochemistry examination (5x magnification). Hematoxylin-eosin staining revealing neoplastic fusiform cells and collagenous myxoid stroma (A), with positive CD34 (B), S100 (C) and SOX10 (D) immunoreactivity.

Thumbnail

Fig. 4
L4 nerve root neurofibroma, intermingled with the nerve fascicles. (arrow: neurofibroma; arrowhead: distal portion of the L4 nerve root).

Thumbnail

Fig. 5
After total lesion resection with partial neurectomy, direct end-to-end epineural repair was performed.

Thumbnail

Fig. 1 MRI (coronal plane) – T1- weighted sequence: hypointense ovoid, nodular paraspinal mass, closely related to the left L4 nerve root and located between the psoas and iliacus muscles.

Fig. 2 MRI (axial plane) – T2- weighted sequence: heterogeneously hyperintense lesion, with few cystic areas, suggestive of neurogenic lumbar plexus tumour.

Fig. 3 MRI (sagittal plane) – T2- weighted sequence: heterogeneously hyperintense lesion, with few cystic areas, suggestive of neurogenic lumbar plexus tumour.

Fig. 4 L4 nerve root neurofibroma, intermingled with the nerve fascicles. (arrow: neurofibroma; arrowhead: distal portion of the L4 nerve root).

Fig. 5 After total lesion resection with partial neurectomy, direct end-to-end epineural repair was performed.

Fig. 6 Histopathological and imunochemistry examination (5x magnification). Hematoxylin-eosin staining revealing neoplastic fusiform cells and collagenous myxoid stroma (A), with positive CD34 (B), S100 (C) and SOX10 (D) immunoreactivity.

Fig. 4 L4 nerve root neurofibroma, intermingled with the nerve fascicles. (arrow: neurofibroma; arrowhead: distal portion of the L4 nerve root).

Fig. 5 After total lesion resection with partial neurectomy, direct end-to-end epineural repair was performed.

Fig. 6 Histopathological and imunochemistry examination (5x magnification). Hematoxylin-eosin staining revealing neoplastic fusiform cells and collagenous myxoid stroma (A), with positive CD34 (B), S100 (C) and SOX10 (D) immunoreactivity.

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Laparoscopic-assisted Resection of a Retroperitoneal Lumbar Nerve Root Neurofibroma: A Case Report

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[1] Address for correspondence Miguel Relvas-Silva, Hospital de São João, Ortopedics and Traumatology, Rua Santa Justa 228G, 6° CDF, Porto, Porto, 4200–319, Portugal (e-mail: mrelvas.silva@gmail.com).