Microsurgical treatment of lumbar paravertebral tumors via lateral retroperitoneal approach: operative technique and a series of 6 patients

Abstract

Objective: To investigate the surgical techniques and postoperative therapeutic effectiveness of microsurgical treatment of lumbar paravertebral tumors via lateral retroperitoneal approach.

Methods: The clinical data of 6 cases with lumbar paravertebral tumors treated by lateral retroperitoneal approach in the Neurosurgery department of Xuanwu Hospital, Capital Medical University were analyzed retrospectively. The mean operation time, blood loss, incision length, length of hospital stay, and the resection rate of paravertebral tumors were collected, and the score of The Ability to Perform Activities of Daily Living (ADL) and incidence of postoperative complications was recorded.

Results: The operation time ranged from 56 to 181 min, with an average of (94.8 ± 48.3) minutes. The blood loss was between 5 and 100 ml, with an average of (31.7 ± 37.5) ml. The incision length was 6-7 cm, with an average of (6.7 ± 0.5) cm. The hospitalization length was between 5 and 11 days, with an average of (8.7 ± 2.6) days. The resection rate of paravertebral tumors was 100%. Postoperative pathological diagnosis results revealed 4 cases of schwannoma, 1 case of ganglioneuroma, and 1 case of malignant small round cell tumor. During the 3-month follow-up, there were no tumor recurrence, abdominal infection, incision infection, incisional hernia, or death, and there was no significant decrease in the ADL score compared with that before the operation.

Conclusion: The surgical treatment of lumbar paravertebral tumors via the lateral retroperitoneal approach has the advantages of the short operation time, minimally invasive procedures, quick postoperative recovery, and fewer complications.

Keywords: Lateral retroperitoneal approach; Lumbar paravertebral tumors; Microsurgical treatment.

Fig. 1

Microsurgical treatment of lumbar paravertebral tumors via lateral retroperitoneal approach. A MRI T1-weighted: a round-like paravertebral tumor (white arrow)at the posterior side of the kidney in the retroperitoneum, low signal. B MRI T2-weighted: small amount of mixed and uneven high signal, round-like tumor (white arrow). C MRI Gad-enhanced T1-weighted: axial view, a round-like tumor (white arrow) posterior to the kidney can be observed, significantly enhanced. D MRI Gad-enhanced T1-weighted: coronal view, a round-like tumor (white arrow) can be observed at L1–2 vertebral body level. E Intraoperative image: a 14 cm deep retractor fully exposes the tumor after retraction. F Postoperative image: The tumor was completely resected along the inner surface of the capsule, about 4 cm in diameter. G Postoperative image: the surgical incision length is about 7 cm. H, I Postoperative MRI image: image of retroperitoneal space, complete removal of the tumor (white arrow) located posterior to the kidney