J Korean Orthop Assoc.  2015 Jun;50(3):255-259. 10.4055/jkoa.2015.50.3.255.

Endoscopic Excision of Schwannoma of Sciatic Nerve Using Hip Arthroscopy

Affiliations
  • 1Department of Orthopaedic Surgery, Chonbuk National University Medical School, Jeonju, Korea.
  • 2Department of Orthopaedic Surgery, St. Carollo Hospital, Suncheon, Korea. wctoilets@hanmail.net

Abstract

As the expertise of the surgeon improves in arthroscopic surgery of the hip, the number of conditions treated by it also increases. In this case, an arthroscopic treatment was performed on a patient with piriformis syndrome due to schwannoma on the sciatic nerve. Meticulous excision of the cystic lesion on the sciatic nerve was completely performed and neither recurrence nor complication of the surgery was observed. Endoscopic excision using arthroscopy is useful for reducing postoperative pain and achieving early return to activities for the patient.

Keyword

piriformis syndrome; sciatic nerve; schwannoma; hip arthroscopy

MeSH Terms

Arthroscopy*
Hip*
Humans
Neurilemmoma*
Pain, Postoperative
Piriformis Muscle Syndrome
Recurrence
Sciatic Nerve*

Figure

  • Figure 1 (A) Whole spine T2-weighted sagittal magnetic resonance imaging (MRI) shows multiple intradural masses on lower thoracic and lumbar spine. (B) Lumbar and sacrum MRI with enhancement reveal small enhancing lesions on the left quadratus lumborum muscle and psoas muscle.

  • Figure 2 T2-weighted hip magnetic resonance imaging. (A) In axial view, image showed a well capsulized, regular margin and a 2.5×1.8 cm sized mass. It showed low signal intensity in the central lesion, and high signal intensity in the peripheral lesion. (B) In coronal view, neurilemmoma originated from the sciatic nerve between piriformis and gluteus maximus. The mass was highly estimated to be a neurilemmoma.

  • Figure 3 The anterolateral portal is placed approximately 1 cm anterior and 1 cm superior to the greater trochanter (GT) on 60° internal rotation of lower extremity ①. The posterolateral portal is placed 5 cm posterior to the GT and in line with the anterolateral portal ②.

  • Figure 4 (A) The huge mass was located in the fibrous sheath of the sciatic nerve and adhered to the epineural vessel and the branch of the inferior gluteal artery. (B) The vessels were carefully dissected from the mass and ligated with an absorbable vascular clip. (C) The fibrous sheath was incised and the mass was excised from the sciatic nerve.

  • Figure 5 A 2.7×2.2×1.6 cm sized yellowish mass was removed.

  • Figure 6 The photomicrograph shows Antoni type A and Antoni type B tissue, indicating benign schwannoma (H&E, ×100).


Cited by  1 articles

Surgical Outcomes of Schwannoma Occurring at Major Peripheral Nerves of Extremity: A Single Institution Analysis
Kap Jung Kim, Sang Ki Lee, Jae Yeon Hwang, Young Sub Chun, Yong Ho Kim
J Korean Orthop Assoc. 2017;52(3):225-231.    doi: 10.4055/jkoa.2017.52.3.225.


Reference

1. Benzon HT, Katz JA, Benzon HA, Iqbal MS. Piriformis syndrome: anatomic considerations, a new injection technique, and a review of the literature. Anesthesiology. 2003; 98:1442–1448.
2. Parziale JR, Hudgins TH, Fishman LM. The piriformis syndrome. Am J Orthop (Belle Mead NJ). 1996; 25:819–823.
3. Papadopoulos EC, Khan SN. Piriformis syndrome and low back pain: a new classification and review of the literature. Orthop Clin North Am. 2004; 35:65–71.
4. Reich MS, Shannon C, Tsai E, Salata MJ. Hip arthroscopy for extra-articular hip disease. Curr Rev Musculoskelet Med. 2013; 6:250–257.
5. Cassidy L, Walters A, Bubb K, Shoja MM, Tubbs RS, Loukas M. Piriformis syndrome: implications of anatomical variations, diagnostic techniques, and treatment options. Surg Radiol Anat. 2012; 34:479–486.
6. Foster MR. Piriformis syndrome. Orthopedics. 2002; 25:821–825.
7. Dezawa A, Kusano S, Miki H. Arthroscopic release of the piriformis muscle under local anesthesia for piriformis syndrome. Arthroscopy. 2003; 19:554–557.
8. Siqueira MG, Socolovsky M, Martins RS, et al. Surgical treatment of typical peripheral schwannomas: the risk of new postoperative deficits. Acta Neurochir (Wien). 2013; 155:1745–1749.
9. Levi AD, Ross AL, Cuartas E, Qadir R, Temple HT. The surgical management of symptomatic peripheral nerve sheath tumors. Neurosurgery. 2010; 66:833–840.
10. Hwang DS, Kang C, Lee JB, Cha SM, Yeon KW. Arthroscopic treatment of piriformis syndrome by perineural cyst on the sciatic nerve: a case report. Knee Surg Sports Traumatol Arthrosc. 2010; 18:681–684.
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