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Go for the Gold: A "Plane" and Simple Technique for Resecting Benign Peripheral Nerve Sheath Tumors
Jonathan J Stone1, Robert J Spinner1
1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
Background:
Intraneural dissection is a useful technique for achieving gross total resection and preserving functional fascicles for peripheral nerve tumors. Finding the correct tissue plane is the critical step for safe successful enucleation. The authors hypothesized that the yellow color of benign nerve tumors can be used to identify surgical planes.
Objective:
To describe a technique to find the correct intraneural dissection plane based on a quantified yellow appearance during resection of benign peripheral nerve sheath tumors.
Methods:
Intraoperative photographs were reviewed to determine the percentage of yellow that tumors appeared at different phases of surgery. A technique was developed to quantitatively measure the amount of yellow using Photoshop. Previously published journal articles containing color images of peripheral nerve tumor resections were also analyzed for yellow tumor color.
Results:
There were 24 patients with suitable images to permit measurement of color for 3 steps of the procedure. The average percentages of yellow for tumor exposure, tumor resection, and removed specimen were 36.5%, 59.1%, and 80.4%, respectively (P < .001). Three publications were found that contained high-quality images of at least 2 phases of the surgery with average yellow content of 47.4% and 84% (P < .01).
Conclusion:
The simple observation that a benign nerve sheath tumor is yellow in color can be used to guide surgical resection and achieve excellent outcomes. Intraneural dissection through the pseudocapsule should be pursued layer by layer until a yellow true capsule is found. By sparing functional nervous tissue within the pseudocapsule, this technique may lead to improved neurological outcomes.
Insights
The yellow color of benign nerve tumors can guide surgeons to the correct plane for intraneural dissection. This technique aids in preserving functional fascicles during peripheral nerve tumor resection.
Area of Science:
- Neurosurgery
- Surgical Oncology
- Pathology
Background:
- Intraneural dissection is crucial for peripheral nerve tumor resection, aiming for gross total resection while preserving functional fascicles.
- Identifying the correct surgical plane is critical for safe and successful enucleation of these tumors.
- The study hypothesizes that the inherent yellow coloration of benign nerve tumors can serve as a visual landmark for surgical plane identification.
Purpose of the Study:
- To present and validate a technique for identifying the optimal intraneural dissection plane.
- The technique relies on the quantified yellow appearance of benign peripheral nerve sheath tumors during surgical resection.
- To improve outcomes in peripheral nerve tumor surgery through enhanced surgical plane identification.
Main Methods:
- Analysis of intraoperative photographs from 24 patients to quantify tumor yellow percentage at different surgical stages.
- Development of a quantitative method using Adobe Photoshop to measure the degree of yellow coloration.
- Systematic review of published literature for color images of peripheral nerve tumor resections to compare yellow content.
Main Results:
- Quantifiable yellow percentages for tumor exposure, resection, and specimen were 36.5%, 59.1%, and 80.4% respectively (P < .001).
- Analysis of three publications revealed average yellow content of 47.4% and 84% in relevant surgical phases (P < .01).
- Consistent yellow coloration was observed across patient data and published literature, supporting its utility.
Conclusions:
- The yellow hue of benign nerve sheath tumors is a reliable indicator for guiding surgical resection.
- Intraneural dissection should proceed layer-by-layer towards the yellow "true capsule" for optimal enucleation.
- This visually guided technique enhances the preservation of functional nervous tissue, potentially improving neurological outcomes.