Resection of benign sciatic notch dumbbell-shaped tumors

Area of Science:

• Neurosurgery
• Oncology
• Radiology

Background:

• Management of intrapelvic and extrapelvic sciatic notch dumbbell-shaped tumors presents surgical challenges due to rarity and varied disease extent.
• Predicting surgical outcomes and indications based on preoperative imaging is difficult.

Purpose of the Study:

• To evaluate the efficacy of a combined surgical approach for extensive sciatic notch tumors.
• To assess the role of high-resolution magnetic resonance (MR) imaging in surgical planning.

Main Methods:

• Five patients with benign sciatic notch dumbbell-shaped tumors were treated.
• Three patients with unilateral symptoms underwent a one-stage transabdominal and transgluteal resection after MR imaging confirmed tumor separation from the sciatic nerve.
• Two patients with bilateral symptoms and extensive tumor involvement underwent conservative management.

Main Results:

• Complete tumor resection was achieved in three patients, with preserved neurological function and no recurrence after 1 year.
• No surgery was performed in two patients due to extensive tumor involvement of the sciatic nerve and lumbosacral plexus, with pharmacological treatment initiated.
• High-resolution MR imaging accurately delineated tumor-nerve relationships, guiding surgical decisions.

Conclusions:

• A combined one-stage transabdominal and transgluteal approach enables safe resection of selected benign sciatic notch tumors.
• High-resolution MR imaging is crucial for visualizing anatomical relationships and predicting tumor resectability.
• Advancements in imaging may further refine surgical indications for sciatic notch tumors.