Brachial- and lumbosacral plexus tumours zone system for surgery

Introduction: Operating on plexus related neoplasia involves a higher risk for morbidity and functional deterioration. For neck-and intrapelvic plexus tumours (tu) a variety of approaches exist, with fluent transition to standard spine, abdominal and thoracic surgery. We described a systematic approach selection for complex multi compartmental lumbosacral plexus tumours before. Based on this decision pathway we now suggest a unifying classification system, applicable for both brachial- and lumbosacral plexus. Objective: To introduce a unifying zone system for brachial- and lumbosacral plexus to ease adequate approach selection for simple and complex nerve associated plexus tumours. The system further refines our approach selection process for these patients. Method: Based on MRI, localisation, tumour boundaries and their correlation to landmarks define core zones that facilitate the choice of one or the combination of different appropriate approach/es: in brachial plexus tumour BP Zone I-IV with spinal (Spi), foraminal (For), lateral thoracic wall (Ltw) extension; in lumbosacral tumour LSP Zone I-III with spinal (Spi), foraminal (For), femoral (Fem), Sci (sciatic) extension. Result: The system works to easily classify plexus tumours in groups and suggests appropriate approach choices, even involving combinations of surgical accesses not described previously. Conclusion: We propose the "Zone plus extension Plexus tu classification system" derived from tumour imaging to classify brachial- and lumbosacral plexus tumours prior to surgery. The necessary decision making inherently suggests approach combinations for tu removal. The classification thus aids to secure adequate exposure to prevent untoward surgical compromises.