• Na Yoon Yoo, Hyoung Seop Kim, Joong Won Yang, and Dougho Park.
• Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, South Korea.
• Medicine (Baltimore). 2024 Feb 16; 103 (7): e37244e37244.

RationaleThe incidence of a schwannoma within the psoas muscle is rare, and only a few cases have been reported. The surgical approach to removing schwannomas present in the psoas muscle is challenging because of its anatomical proximity to the lumbar plexus.Patient ConcernsA 31-year-old man experienced right lower back pain and anterolateral thigh numbness for 2 months.DiagnosisMagnetic resonance imaging of the patient's lumbar spine revealed a mass lesion, which was radiologically diagnosed as a well-demarcated schwannoma.InterventionsThe patient underwent surgery for excision of the schwannoma in the right psoas muscle at the second to fourth lumbar vertebrae levels. During surgery, intraoperative neurophysiological monitoring modalities, free-running and triggered electromyography and evoked potentials, from the target muscles were recorded.OutcomesThere was no neurotonic discharge corresponding to neuronal injury. Compound motor nerve action potential was detected in the triggered electromyography of muscles around the medial margin of the tumor. However, direct integration of the motor nerve was not observed in the intra-tumor region.LessonsWe report that schwannoma removal in the psoas muscle, which is adjacent to the lumbar plexus, can be safely performed using intraoperative neurophysiological monitoring.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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