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

• Park MS
• Chung WC
• Yoon SJ
• Song JH
• Kim SJ

• KMID: 1851960
• DOI: http://doi.org/10.4055/jkoa.2015.50.3.255

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

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  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.

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  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.

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  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.

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  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.

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

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

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