Surgical Management of Lumbar Neurofibroma
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- Category: Vol. 88, December 2020
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Surgical Management of Lumbar Neurofibroma, AHMED A. MOHAMED and MOHAMMED F. ADEL ALI
Abstract
Background: Neurofibroma is a benign nerve sheath tumor in the peripheral nervous system. In 90% of cases they're found as stand-alone tumors, while the remainder are found with neurofibromatosis type I (NF1). Lumbar neurofibroma often encountered in the surgical practice, presenting with sciatic pain, tingling and numbness, or even foot drop. Aim of Study: The aim of this study is to evaluate the role of surgery and defining the prognostic factors that affect the outcome of microscopic resection and how to avoid the possible complications especially those related to spinal instability and CSF leak. Patients and Methods: This is a retrospective study of sixteen cases of lumbar neurofibroma operated in the depart-ments of the authors by gross total resection, the surgery was microscopic assisted to secure the lumbar roots, and improve the outcome. Results: In this study, the male-to-female ratio of patients was 3 to 1 (75% to 25%). The mean age at the time of operation was 29 years. The initial symptoms were pain whether back or leg pain, gait disturbance resulting from leg motor weakness in 12% of our patients, tingling and numbness was found in 10 patients. Total removal of the tumor was achieved in 14 cases. Post-operative complications included CSFpseudo meningocele in onecase (6%), wound infection (including superficial and deep) in 3 cases (19%). One patient did not experience an improvement of the presenting motor power deficit. Conclusion: Excision of the lumbar neurofibroma totally can be achieved safely without complication if proper micro-scopic surgery principles were followed with special concerns directed towards the dissection of the tumor from adherent nerve roots especially the hidden ones. Midline posterior approach is a convenient approach that can guarantee spinal stability. Extreme attention should be applied towards closure steps of the surgery especially those related to the dural seal.