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Neurological Outcome Following Resection of Benign Presacral Neurogenic Tumors Using a Nerve-Sparing Technique

Hébert-Blouin, Marie-Noëlle M.D.1; Sullivan, Patrick S. M.D.2; Merchea, Amit M.D.2; Léonard, Daniel M.D.2; Spinner, Robert J. M.D.1; Dozois, Eric J. M.D.2

doi: 10.1097/DCR.0b013e31829e4e4f
Original Contributions: Benign Colorectal Disease

BACKGROUND: Benign presacral nerve sheath tumors represent up to 10% of all presacral tumors. Limited data exist regarding the impact of the surgical technique on neurological outcomes following resection.

OBJECTIVE: The aim of this study was to test our hypothesis that a nerve-sparing resection technique results in the improvement of preoperative neurological dysfunction and minimal postoperative neurological morbidity.

DESIGN: This study is a case series of all patients with benign neurogenic presacral tumors operated on by the same 2 surgeons between 2004 and 2010 at our institution.

SETTINGS: This study was performed at a tertiary care center.

PATIENTS: Adult patients with benign presacral neurogenic tumors who underwent a nerve-sparing resection were included.

MAIN OUTCOME MEASURES: Postoperative urogenital, anorectal, and lower-extremity neurological functions were analyzed.

RESULTS: Seventeen patients were identified with a mean age of 40 years; 14 were women. Preoperatively, 13 patients had symptoms from neurological dysfunction or presumed mass effect of the tumor. The mean tumor size was 7.4 cm. The pathology was a schwannoma in 12 patients and neurofibroma in 5 patients. Mortality was nil, and 30-day morbidity was noted in 3 patients (hemorrhage, ileus, acute respiratory distress syndrome, deep vein thrombosis, and transient foot drop). Mean follow-up was 36 months. Of the 13 symptomatic patients, 7 achieved complete resolution of symptoms and 5 had improved, but persistent symptoms. None of the 4 asymptomatic patients developed postoperative neurological dysfunction.

LIMITATIONS: Small sample size was a limitation of this study.

CONCLUSIONS: With the use of a nerve-sparing technique, function-preserving resection can be safely completed with an overall improvement in symptoms.

1 Mayo Clinic, Department of Neurologic Surgery, Rochester, Minnesota

2 Mayo Clinic, Division of Colon and Rectal Surgery, Rochester, Minnesota

Financial Disclosures: None reported.

Poster presentation at the meeting of the American Society of Colon and Rectal Surgeons, San Antonio, TX, June 2 to 6, 2012.

Correspondence: Eric J. Dozois, M.D., Professor of Surgery, Colon and Rectal Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905. E-mail: dozois.eric@mayo.edu.

© 2013 The American Society of Colon and Rectal Surgeons