PMC3015890_01
Abdominal CT scan revealing paravertebral mass (black arrow) adjacent to the upper pole of the left kidney, posterior to the inferior left hemidiaphragm (white curve and arrow).
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F1
T12-L1 posterior to the upper pole of the left kidney. MRI scan of the thoracic spine with and without contrast revealed the mass to be arising from a widened neural foramen at T12-L1 with no extension into the spinal canal with the mass projecting laterally behind the left kidney and posteriorly into paraspinal muscles. The mass enhanced uniformly with contrast, consistent with a neurofibroma (Figures 1, 2).
T1-weighted MRI of mass originating at T12-L1 neural foramen.
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T12-L1 posterior to the upper pole of the left kidney. MRI scan of the thoracic spine with and without contrast revealed the mass to be arising from a widened neural foramen at T12-L1 with no extension into the spinal canal with the mass projecting laterally behind the left kidney and posteriorly into paraspinal muscles. The mass enhanced uniformly with contrast, consistent with a neurofibroma (Figures 1, 2).
Docked robot, with 2 working arms, one arm attached to the endoscope, and 2 additional assistant's ports.
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Two 8-mm robotic ports were then placed subcostally, one in the posterior axillary line, and the other in the anterior axillary line (Figure 3). The da Vinci robot was then docked (Figure 3).
Initial view of tumor through robotic endoscope with bipolar serrated graspers in the left robotic hand, monopolar electrosurgical scissors in the right robotic hand, and assistant operated irrigation/suction inferiorly.
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The diaphragm was incised vertically over the mass, and the anterior surface of the mass was dissected until its upper and lower margin could be clearly discerned (Figure 4).
Retraction of tumor anteromedially after resection, showing tumor bed and nerve root.
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After removing one third of the tumor, enough space was made to elevate the posterior aspect of the tumor revealing the tumor attachment to its nerve root of origin (Figure 5).
Neurofibroma histology, showing the presence of stout collagen strands within the tumor. This has been referred to as a "shredded carrot" appearance.
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