• Christian Heinen, Thomas Schmidt, and Thomas Kretschmer.
• Department of Neurosurgery, Evangelisches Krankenhaus, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany.
• Neurosurgery. 2020 Sep 1; 87 (3): E359-E369.

BackgroundSurgical treatment of retroperitoneal nerve and nerve-associated tumors is challenging, especially in cases with large extent. A single surgical access may have limitations and jeopardize patients.ObjectiveTo present a series of patients to illustrate our individually tailored treatment concept and decision pathway.MethodsRetrospectively, clinical findings and imaging were related to surgical features and outcome. An algorithm for choice of approach was established.ResultsFrom 2012 to 2017, we operated on n = 13 patients with retroperitoneal tumors, of these n = 9 were included (n = 6 female, n = 3 male). Histological findings included n = 2 schwannomas, n = 2 malignant peripheral nerve sheath tumors, n = 1 non-origin sarcoma, n = 1 perineurioma, n = 1 intraneural ganglion cyst, n = 1 lymphoma, and n = 1 paraganglioma. In n = 6 patients, we used a monoportal (retroperitoneal/transperitoneal) approach; in n = 2 patients, a biportal retroperitoneal to inguinal/transperitoneal to dorsal approach; and in n = 1 patient, a triportal transperitoneal to dorsal to gluteal approach. In n = 2 patients, we performed an open biopsy only; in n = 2 patients, a tumor enucleation; in n = 3 patients, a subtotal function-sparing resection; in n = 1 patient, a complete resection; and in n = 1 patient, intraneural decompression. In n = 1 patient, a new motor deficit appeared. n = 4 patients required further radio-oncological treatment. n = 8/9 patients are alive without tumor progress or recurrence.ConclusionRetroperitoneal nerve or nerve-associated tumors encompass multiple entities. Depending on suspected histology and tumor extension, extensile or combined surgical approaches may be necessary. We present our algorithm for assessment and decision-making regarding surgical access ports and pathways.Copyright © 2020 by the Congress of Neurological Surgeons.

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