Laparoscopic management of obturator nerve schwannomas: Experiences with 6 cases and review of the literature

摘要

OBJECTIVES: To present our experiences in management of obturator nerve schwannomas by laparoscopy. PATIENTS AND METHODS: Six patients who were diagnosed preoperatively with pelvic tumors and histologically with obturator nerve schwannomas were treated by laparoscopy in our hospital between 1998 and 2009. Clinical data were obtained by a retrospective review of all the patients' medical records, radiologic reports, pathologic reports, and operation videos. RESULTS: A total of 6 tumors were found in 6 patients, none of which was correctly, preoperatively diagnosed as a schwannoma. In 5 of them, obturator nerve roots were identified to be associated with the tumors during the operation. All of the tumors were resected successfully by laparoscopy, including 2 resected by enucleation. Postoperatively, 2 patients developed a permanent neurological deficit, 2 patients developed transient nerve neuropathy but complete resolution within 8 weeks, and the other 2 developed no neurological deficit. Pathologic examination showed that all the tumors were benign schwannoma. At a mean follow-up of 24 months (range, 12 to 48 mo) postresection, all the patients remained free from recurrence. CONCLUSIONS: Pelvic schwannomas are rare and difficult to diagnose preoperatively. The intraoperative observation of the nerve running through the tumor may aid the diagnosis. Although obturator nerve injury does not seem to be associated with severe impairments, efforts should be made to preserve the integrity of the nerve. Laparoscopic surgery is a safe and feasible method for approaching benign schwannoma in the obturator fossa.