title: Combined anterior-posterior approach with enlarged sciatic foramen to remove sciatic notch dumbbell-shaped tumors.
abstract: OBJECTIVE
  To explore a new method for resecting huge sciatic notch dumbbell-shaped tumors.
  
  
  METHODS
  Preoperative thin-slide scanning magnetic resonance images (MRI) and computerized tomography angiography (CTA) scans were conducted. The images were processed to reconstruct a 3-dimensional (3D) model. The relationship between the tumor and surrounding anatomical structures was accurately identified. By combining an anterior-posterior approach, about 1.0 × 5.0 cm2c-shaped bone around the greater sciatic foramen was removed using piezosurgery osteotomy to enlarge the sciatic notch, after which retroperitoneal dumbbell-shaped tumors in the four patients were excised.
  
  
  RESULTS
  Tumors in four patients were completely removed. Two patients obtain a total en bloc tumor resection; one patient was clinically determined to be a benign nerve-sheath tumor which was removed within the sciatic nerve sheath, and one patient had an extremely asymmetric tumor shape. The tumor unexpectedly split at the dumbbell isthmus across the greater sciatic foramen during blunt dissection, while both sections were completely removed.
  
  
  CONCLUSIONS
  The combined anterior-posterior approach with an enlarged sciatic notch is an effective method to remove sciatic notch dumbbell-shaped tumors. Compared to the reported study, it is a new method probably helpful for selected patients.
authors.affiliation: Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China.
authors.forename: Mi
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China.
authors.forename: Hao
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China.|Department of Orthopedic Surgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, P.R. China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Du
authors.affiliation: Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China.
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Cai
authors.affiliation: Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China.
authors.forename: Hui
authors.initials: H
authors.lastname: Liao
authors.affiliation: Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China.
authors.forename: Fengjing
authors.initials: F
authors.lastname: Guo
authors.affiliation: Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China.
authors.forename: Anmin
authors.initials: A
authors.lastname: Chen
authors.affiliation: Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China.
authors.forename: Feng
authors.initials: F
authors.lastname: Li
authors.affiliation: Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China.
authors.forename: Caihong
authors.initials: C
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D007085:Ilium / Q000601:surgery; D021621:Imaging, Three-Dimensional; D008080:Liposarcoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018317:Nerve Sheath Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D010027:Osteotomy / Q000379:methods; D059745:Piezosurgery; D011300:Preoperative Care; D012186:Retroperitoneal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D012509:Sarcoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D012983:Soft Tissue Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D054364:Solitary Fibrous Tumors / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery
keywords: dumbbell-shaped tumor; retroperitoneal space; sciatic notch