258 Minimally Invasive Robotic Assisted Resection of a Pelvic Sacral Nerve Root Schwannoma

INTRODUCTION: Sacral schwannomas are rare and, encompass 1%-5% of spinal schwannomas but, are typically benign. They usually arise from the sacral nerves and present with a variety of symptoms. We present a 50-year-old woman with a history of radicular right posterior thigh pain and abnormal uterine bleeding. Pelvic Magnetic Resonance Imaging revealed leiomyomas and an enlarging presacral mass, consistent with a Schwannoma, which had doubled in size over a five-year period. She underwent a robotic total hysterectomy and presacral mass excision for definitive management of her symptoms. METHODS: Robotic-assisted excision of the mass with intraoperative use of three-dimensional stereotactic Imaging and electromyography were utilized to help map out the schwannoma borders and identify nerve roots. Surgery was performed in conjunction with the Gynecological surgery team. RESULTS: Patient underwent minimally invasive laparoscopic total hysterectomy as well as robotic-assisted nerve root schwannoma excision for definitive management of her symptoms. The sacral mass was removed through patient’s vagina prior to closure of the vaginal cuff. Post-operatively she had mild residual posterior thigh pain due to manipulation of the proximal lumbar sacral plexus causing nerve root irritation. CONCLUSIONS: This case highlights the utilization of minimally invasive techniques, such as robotic-assisted surgery, and the deep knowledge of anatomy to safely excise a sacral mass in a multidisciplinary work environment.