{
    "abstract": "Extradural spinal nerve sheath tumors with foraminal involvement are rare, and the gold standard for surgical resection is not established yet. Traditionally, lumbar intra-extraforaminal schwannomas have been resected through a posterior midline or paraspinal open approach. The lateral transpsoas approach represents a suitable, minimally invasive approach which can provide direct access to the extraforaminal and lumbar plexus region avoiding bone removal, hence the necessity of lumbar fusion. The aim of this study is to share our experience of extraforaminal lumbar schwannomas approached through a minimally invasive lateral transpsoas technique with intraoperative neurophysiological monitoring. This is a single-center retrospective case series study. Seven adult patients who underwent extraforaminal lumbar schwannoma removal through a lateral retroperitoneal approach were enrolled. A detailed description of the surgical technique is reported. The outcomes measures included: mean surgical duration, mean blood loss, postoperative mobilization, day of discharge, complication, postoperative symptoms, extent of removal. All patients had a minimum follow-up of 1 year. The average age was 51 years. Surgery lasted 225 minutes on average, with minimal blood loss. One patient had a CSF leak, which was successfully repaired. Most patients were mobilized the day after surgery, and 6 were discharged within 2-4 days. At a 12-month follow-up, 6 patients showed symptom improvement and MRIs confirmed complete tumor resection in all cases. Retroperitoneal transpsoas approach represents a safe tool in the neurosurgeon's armamentarium, particularly suitable for this subset of tumors representing a short and direct way to approach them. Surgeon confidence of working inside the psoas and close to the lumbar plexus is increased using continue EMG monitoring. At the end, the retroperitoneal transpsoas approach for extraforaminal lumbar schwannoma can provide minimal soft tissue damage, better pain control, decreased blood loss, and short hospitalization.",
    "authors": [
        {
            "affiliation": "Neurosurgery Unit, Department of Neuroscience \"Rita Levi Montalcini\", \"Citt\u00e0 della Salute e della Scienza\" University Hospital, University of Turin, Turin, Italy.",
            "firstname": "Marco",
            "initials": "M",
            "lastname": "Ajello"
        },
        {
            "affiliation": "Neurosurgery Unit, Department of Neuroscience \"Rita Levi Montalcini\", \"Citt\u00e0 della Salute e della Scienza\" University Hospital, University of Turin, Turin, Italy.",
            "firstname": "Enrico",
            "initials": "E",
            "lastname": "Lo Bue"
        },
        {
            "affiliation": "Neurosurgery Unit, Department of Neuroscience \"Rita Levi Montalcini\", \"Citt\u00e0 della Salute e della Scienza\" University Hospital, University of Turin, Turin, Italy.",
            "firstname": "Stefano",
            "initials": "S",
            "lastname": "Colonna"
        },
        {
            "affiliation": "Neurosurgery Unit, Department of Neuroscience \"Rita Levi Montalcini\", \"Citt\u00e0 della Salute e della Scienza\" University Hospital, University of Turin, Turin, Italy.",
            "firstname": "Raffaele",
            "initials": "R",
            "lastname": "De Marco"
        },
        {
            "affiliation": "Neurosurgery Unit, Department of Neuroscience \"Rita Levi Montalcini\", \"Citt\u00e0 della Salute e della Scienza\" University Hospital, University of Turin, Turin, Italy.",
            "firstname": "Flavio",
            "initials": "F",
            "lastname": "Panico"
        },
        {
            "affiliation": "Neurosurgery Unit, Department of Neuroscience \"Rita Levi Montalcini\", \"Citt\u00e0 della Salute e della Scienza\" University Hospital, University of Turin, Turin, Italy. Electronic address: alberto.morello@unito.it.",
            "firstname": "Alberto",
            "initials": "A",
            "lastname": "Morello"
        },
        {
            "affiliation": "Neurosurgery Unit, Department of Neuroscience \"Rita Levi Montalcini\", \"Citt\u00e0 della Salute e della Scienza\" University Hospital, University of Turin, Turin, Italy.",
            "firstname": "Margherita",
            "initials": "M",
            "lastname": "Castaldo"
        },
        {
            "affiliation": "Neurosurgery Unit, Department of Neuroscience \"Rita Levi Montalcini\", \"Citt\u00e0 della Salute e della Scienza\" University Hospital, University of Turin, Turin, Italy.",
            "firstname": "Giuseppe",
            "initials": "G",
            "lastname": "Palmieri"
        },
        {
            "affiliation": "Neurosurgery Unit, Department of Neuroscience \"Rita Levi Montalcini\", \"Citt\u00e0 della Salute e della Scienza\" University Hospital, University of Turin, Turin, Italy.",
            "firstname": "Nicola",
            "initials": "N",
            "lastname": "Marengo"
        },
        {
            "affiliation": "Neurosurgery Unit, Department of Neuroscience \"Rita Levi Montalcini\", \"Citt\u00e0 della Salute e della Scienza\" University Hospital, University of Turin, Turin, Italy.",
            "firstname": "Diego",
            "initials": "D",
            "lastname": "Garbossa"
        },
        {
            "affiliation": "Neurosurgery Unit, Department of Neuroscience \"Rita Levi Montalcini\", \"Citt\u00e0 della Salute e della Scienza\" University Hospital, University of Turin, Turin, Italy.",
            "firstname": "Fabio",
            "initials": "F",
            "lastname": "Cofano"
        }
    ],
    "conclusions": null,
    "copyrights": "Copyright \u00a9 2025 The Author(s). Published by Elsevier Inc. All rights reserved.",
    "doi": "10.1016/j.wneu.2025.124004",
    "journal": "World neurosurgery",
    "keywords": [
        "extraforaminal tumor",
        "lateral retroperitoneal approach",
        "lumbar schwannoma",
        "minimally invasive spine surgery"
    ],
    "methods": null,
    "publication_date": "2025-04-28",
    "pubmed_id": "40288530",
    "results": null,
    "title": "Minimally invasive lateral retroperitoneal approach for resection of extraforaminal lumbar schwannomas: results after 1-year follow-up.",
    "xml": "<Element 'PubmedArticle' at 0x788503914b30>"
}