By way of interdepartmental collaboration, a younger girl’s high quality of life and skill to stroll have been restored following the laparoscopic elimination of a uncommon, benign tumor of neurological origin within the lesser pelvis, referred to as a schwannoma (additionally known as a neurinoma). Within the Central and Jap European area, solely the Neuropelveology Program of Semmelweis College’s Division of Obstetrics and Gynecology and its joint working group with the Division of Neurosurgery and Neurointervention carry out procedures supported by intraoperative electrophysiological monitoring. The collaboration between the 2 departments can also be facilitated by a newly acquired specialised cellular neuromonitoring gadget. The day after the profitable surgical procedure, the affected person was discharged from the college, totally recovered.
An operation attracting vital worldwide curiosity was carried out on Might 6, 2026, at Semmelweis College’s Division of Obstetrics and Gynecology, an occasion that additionally marked a brand new part within the collaboration between the organizational unit and the Division of Neurosurgery and Neurointervention. A uncommon, benign tumor originating from the sheath of peripheral nerves, referred to as a schwannoma, was faraway from a younger girl’s lesser pelvis by the division’s neuropelveology group, in shut collaboration with the neurosurgical and intraoperative neurophysiology working group led by Dr. Loránd Erőss, Director of the Division of Neurosurgery and Neurointervention, together with electrophysiologist Dr. Boglárka Hajnal and neurology resident Dr. Borbála Damó-Csorba.
“On this case, we encountered a really uncommon variant of schwannoma: A tumor rising within the retroperitoneal area behind the uterus within the lesser pelvis, which accounts for 1–3 p.c of all schwannomas,” stated Dr. Loránd Erőss. As he identified, such instances require notably thorough neurological or spinal surgical analysis, because the extreme ache that happens in these cases – within the sciatic nerve and the sacrum, and radiating to the decrease extremities – is most attribute of degenerative spinal ailments, that are thought of a widespread situation, so the trigger is often sought there.
What’s a neurinoma or schwannoma?
A neurinoma, a slow-growing tumor that develops from the myelin sheath of nerves, is a uncommon situation, with an incidence of 0.3–0.5 instances per 100,000 individuals; nevertheless, it might probably develop wherever within the physique the place there are peripheral nerves: within the limbs, nerve plexuses, nerve roots exiting the backbone, the auditory nerve, and different cranial nerves. The most typical is the vestibular schwannoma, a benign tumor of the Schwann cells of the eighth cranial nerve, accounting for six–10 p.c of all intracranial tumors.
“On this affected person, a five-centimeter tumor developed behind the uterus on the level the place the nerve exits the sacrum, compressing the nerve; the affected person sought examination as a consequence of unrelenting ache radiating into the correct leg,” stated Affiliate Professor Dr. Attila Bokor, Head of the Endometriosis Middle and the laparoscopic surgical procedure unit on the Division of Obstetrics and Gynecology. Recognizing that this was a singular scientific image, and that excessive warning was required in the course of the process because of the location within the lesser pelvis and the necessity to protect the operate of the delicate nerves and organs in that space, he requested the surgeons on the Division of Neurosurgery and Neurointervention to collaborate and to supply electrophysiological monitoring in the course of the operation.
As Dr. Attila Bokor defined, in the course of the roughly five-hour surgical procedure carried out on the Baross Road part of the Division of Obstetrics and Gynecology, the neurosurgeons constantly monitored the surgical web site utilizing a 32-channel electrode and a linked neuromonitor to find out whether or not the world being operated on contained any nerve bundles, or solely the wall of the neurinoma, and whether or not eradicating that tissue would trigger nerve harm or not. “From a neurosurgical perspective, the problem of the surgical procedure was the laparoscopic localization of the tumor, however Dr. Attila Bokor’s laparoscopic expertise managed to beat it,” stated Dr. Loránd Erőss. Utilizing neurostimulation carried out throughout laparoscopic dissection, they exactly localized the nerves operating alongside the floor of the tumor; thus, after dissecting the nerve bundles operating alongside the floor of the tumor, they have been in a position to take away it in a number of items.
This offered quite a lot of security in the course of the surgical procedure, as a tumor roughly 5 centimeters in measurement needed to be faraway from an space that was notably troublesome to entry and vulnerable to bleeding.”
Dr. Attila Bokor
An extra problem of the process was that the tumor was not solely compressing the nerve of origin, but it surely had additionally begun to have an effect on the operate of one other nerve root. Furthermore, the nerves controlling the operate of the rectum, bladder, and vagina additionally run via this space. Preserving these capabilities, in addition to uterine fertility, and avoiding neurological deficits, have been among the many objectives of the surgical procedure, along with eliminating ache and eradicating the tumor, as Dr. Attila Bokor famous.
“To facilitate long-term collaboration and make sure the profitable execution of joint surgical procedures, we’ve additionally acquired a cellular neuromonitoring gadget,” added Dr. Loránd Erőss. That is used, amongst different issues, when eradicating endometriotic lesions that have an effect on nerves within the lesser pelvis, as a fragile steadiness have to be struck between excising the lesions inflicting ache, thus sacrificing among the nerves that regulate varied very important capabilities, and preserving these capabilities. The gadget can even be helpful in treating varied vascular compressions within the lesser pelvis that develop on account of earlier surgical procedures, radiation remedy, or circumstances related to vital fibrosis and irritation.
“These are uncommon circumstances; we carry out 2–3 such deliberate surgical procedures each three months, which makes us the one ones in Hungary and neighboring nations to take action. Even on a European scale, just one French and one Swiss working group carry out the same variety of such neuropelveological procedures,” added Dr. Attila Bokor. For this very purpose, the neurinoma elimination carried out in early Might with intraoperative electrophysiological monitoring attracted curiosity not solely from inside the college; the operation was additionally watched stay by specialists from Slovenia, Turkey, and Portugal, amongst others.
The surgical procedure went based on plan, and the affected person was discharged from the division the following day. Not solely was she relieved of her ache, but additionally of the chance of decrease limb paralysis. “She has now totally recovered; going ahead, she solely must endure follow-up MRI scans at three months and one yr,” added Dr. Loránd Erőss.