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Eur J Nucl Med Mol Imaging 2022 May 4. Epub 2022 May 4.

Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium.

Acta Neurochir (Wien) 2022 06 21;164(6):1509-1519. Epub 2022 Apr 21.

Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.

Background: Perineural spread (PNS) of tumors from pelvic malignancies is a rare phenomenon but constitutes an important differential diagnosis of lumbosacral plexopathy (LSP). Herein, we describe the clinical and imaging features of patients with LSP due to PNS of pelvic malignancies along with a literature review.

Methods: We retrospectively reviewed 9 cases of LSP caused by PNS of pelvic malignancy between January 2006 and August 2021, and all clinical and imaging parameters were recorded in detail. Read More

Neurol Sci 2022 May 23;43(5):3019-3038. Epub 2022 Feb 23.

Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA.

Though metastasis and malignant infiltration of the peripheral nervous system is relatively rare, physicians should have a familiarity with their presentations to allow for prompt diagnosis and initiation of treatment. This article will review the clinical presentations, diagnostic evaluation, and treatment of neoplastic involvement of the cranial nerves, nerve roots, peripheral nerves, and muscle. Due to the proximity of the neural structure traversing the skull base, metastasis to this region results in distinctive syndromes, most often associated with breast, lung, and prostate cancer. Read More

Clin Neurophysiol Pract 2020 13;5:173-193. Epub 2020 Aug 13.

Electromyography Laboratory, Mayo Clinic, Jacksonville, FL, USA.

Diseases of the brachial and lumbosacral plexus are uncommon and complex. The diagnosis of plexopathies is often challenging for the clinician, both in terms of localizing a patient's symptoms to the plexus as well as determining the etiology. The non-specific clinical features and similar presentations to other root, nerve, and non-neurologic disorders emphasize the importance of a high clinical index of suspicion for a plexopathy and comprehensive clinical evaluation. Read More

World Neurosurg 2020 09 24;141:323-326. Epub 2020 Jun 24.

Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA. Electronic address:

Background: Adenocarcinomas of müllerian origin are malignancies derived from tissues of the proximal third of the vagina, cervix, uterus, and fallopian tubes. These organs develop from the embryologic müllerian ducts. While reports of perineural spread of certain uterine and cervical carcinomas exist in the literature, to our knowledge, no reports of clear cell-type müllerian adenocarcinoma presenting with neural invasion of the lumbosacral plexus exist in the literature. Read More

Acta Neurochir (Wien) 2018 03 21;160(3):655-661. Epub 2017 Dec 21.

Department of Neurosurgery, Mayo Clinic, Scottsdale, AZ, USA.

Background: Perineural spread (PNS) of pelvic cancer along the lumbosacral plexus is an emerging explanation for neoplastic lumbosacral plexopathy (nLSP) and an underestimated source of patient morbidity and mortality. Despite the increased incidence of PNS, these patients are often times a clinical conundrum-to diagnose and to treat. Building on previous results in modeling glioblastoma multiforme (GBM), we present a mathematical model for predicting the course and extent of the PNS of recurrent tumors. Read More

Neurosurg Focus 2015 Sep;39(3):E14

Departments of 1 Neurosurgery and.

OBJECT Perineural spread along pelvic autonomie nerves has emerged as a logical, anatomical explanation for selected cases of neoplastic lumbosacral plexopathy (LSP) in patients with prostate, bladder, rectal, and cervical cancer. The authors wondered whether common radiological and clinical patterns shared by various types of pelvic cancer exist. METHODS The authors retrospectively reviewed their institutional series of 17 cases concluded as perineural tumor spread. Read More

Acta Orthop Traumatol Turc 2015 ;49(1):97-102

Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.

Postoperative radiculopathy has previously been reported as a common complication of transforaminal lumbar interbody fusion (TLIF). However, no data has been published on lumbar plexopathy following TLIF. We present a rare case of lumbar plexopathy occurring following TLIF (L5-S1) in a patient with spondylolisthesis. Read More

J Neurosurg 2015 Apr 6;122(4):778-83. Epub 2015 Feb 6.

Departments of 1 Neurosurgery.

Perineural tumor spread in prostate cancer is emerging as a mechanism to explain select cases of neurological dysfunction and as a cause of morbidity and tumor recurrence. Perineural spread has been shown to extend from the prostate bed to the lumbosacral plexus and then distally to the sciatic nerve or proximally to the sacral and lumbar nerves and even intradurally. The authors present a case of a bilateral neoplastic lumbosacral plexopathy that can be explained anatomically as an extension of the same process: from one lumbosacral plexus to the contralateral one utilizing the dural sac as a bridge between the opposite sacral nerve roots. Read More

Acta Neurochir (Wien) 2014 Dec 22;156(12):2331-6. Epub 2014 Oct 22.

Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI, USA.

We present two cases of biopsy-proven neoplastic lumbosacral plexopathy from perineural spread of bladder cancer: one patient presented with predominantly sciatic nerve involvement and the second predominantly with obturator nerve involvement. These two patterns of perineural spread from bladder cancer were supported by imaging in our cases and solidified by review of the literature. Based on the innervation of the bladder, we provide an anatomic explanation for this observation. Read More

Continuum (Minneap Minn) 2014 Oct;20(5 Peripheral Nervous System Disorders):1343-58

Purpose Of Review: This article provides an up-to-date review of the clinical features and pathogenesis of different types of lumbosacral plexopathy and a clinical approach to their evaluation and management. Often, the pathologic involvement is not limited to the plexus and also involves the root and nerve levels. These conditions are called lumbosacral radiculoplexus neuropathies. Read More

Stereotact Funct Neurosurg 2014 15;92(2):109-16. Epub 2014 Apr 15.

Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea.

Background: Pain from neoplastic lumbosacral plexopathy is resistant to conventional pain treatment. According to a recent review of destructive procedures for cancer pain, only cordotomy has been reported to play an important role in the treatment of cancer pain. To date, the effectiveness of dorsal rhizotomy, which selectively interrupts pain transmission, has not been shown in neoplastic lumbosacral plexopathy. Read More

Radiographics 2013 Jul-Aug;33(4):967-87

Russell H. Morgan Department of Radiology and Radiological Science and Department of Plastic Surgery, Johns Hopkins Hospital, 601 N Caroline St, Baltimore, MD 21287, USA.

The lumbosacral plexus comprises a network of nerves that provide motor and sensory innervation to most structures of the pelvis and lower extremities. It is susceptible to various traumatic, inflammatory, metabolic, and neoplastic processes that may lead to lumbrosacral plexopathy, a serious and often disabling condition whose course and prognosis largely depend on the identification and cure of the causative condition. Whereas diagnosis of lumbrosacral plexopathy has traditionally relied on patients' medical history, clinical examination, and electrodiagnostic tests, magnetic resonance (MR) neurography plays an increasingly prominent role in noninvasive characterization of the type, location, and extent of lumbrosacral plexus involvement and is developing into a useful diagnostic tool that substantially affects disease management. Read More

Ann Rehabil Med 2011 Dec 30;35(6):807-15. Epub 2011 Dec 30.

Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.

Objective: To ascertain the etiology of non-traumatic plexopathy and clarify the clinical, electrophysiological characteristics according to its etiology.

Method: We performed a retrospective analysis of 63 non-traumatic plexopathy patients that had been diagnosed by nerve conduction studies (NCS) and needle electromyography (EMG). Clinical, electrophysiological, imaging findings were obtained from medical records. Read More

Semin Neurol 2010 Jul 24;30(3):254-62. Epub 2010 Jun 24.

Department of Neurology and Oncology, Mayo Clinic Florida, Jacksonville, Florida 32224, USA.

Metastatic plexopathy is often a disabling accompaniment of advanced systemic cancer, and may involve any of the peripheral nerve plexuses. Brachial plexopathy most commonly occurs in carcinoma of the breast and lung; lumbosacral plexopathy is most common with colorectal and gynecologic tumors, sarcomas, and lymphomas. Neoplastic plexopathy is often characterized initially by severe, unrelenting pain followed by development of weakness and focal sensory disturbances. Read More

Acta Neurochir (Wien) 2010 Sep 15;152(9):1567-76. Epub 2010 May 15.

Department of Neurologic Surgery, Mayo Clinic, Gonda 8S-214, 200 First Street SW, Rochester, MN 55905, USA.

Background: Prostate adenocarcinoma, which may recur despite aggressive treatment, has the potential to spread to the lumbosacral plexus. This intraneural involvement is not widely known and is thought to be from direct perineural spread. We hypothesized that high-resolution imaging could provide supportive evidence for this mechanism. Read More

Muscle Nerve 2006 Nov;34(5):659-65

Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA.

Neoplastic lumbosacral plexopathy occurs with some abdominal and pelvic malignancies. Patients present with severe pain radiating from the low back down to the lower extremities, and this progresses to weakness. Neoplastic lumbosacral plexopathy is virtually always associated with known malignancy or obvious pelvic metastatic disease. Read More

Semin Neurol 2004 Dec;24(4):385-93

Department of Neurology and Oncology, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224, USA.

Metastatic plexopathy is often a disabling accompaniment of advanced systemic cancer and may involve any of the peripheral nerve plexuses. Brachial plexopathy most commonly occurs in carcinoma of the breast and lung; lumbosacral plexopathy is most common with colorectal and gynecologic tumors, sarcomas, and lymphomas. Regardless of the location, neoplastic plexopathy is often characterized by severe, unrelenting pain. Read More

Neurologia 1993 Oct;8(8):271-3

Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla.

Neoplastic lumbosacral plexopathy is a frequent and disabling complication in subjects with cancer. Its clinical presentation is characterized by pain, muscle weakness, sensory complaints in one or occasionally both limbs associated with the tumoral symptoms. The presence of autonomic symptoms is less frequent; one of these is the "hot and dry foot". Read More

J Back Musculoskelet Rehabil 1993 Jan;3(2):35-43

Memorial Sloan-Kettering Cancer Center, New York, NY.

Traditionally, the regions of brachial and lumbosacral plexi have been difficult to evaluate, both by physical examination and conventional radiography. Presenting symptoms of plexus involvement may include pain, paresthesia, focal weakness, sensory deficits, and muscle atrophy. The symptomatology as well as electrodiagnostic studies are nonspecific and many conditions, such as mechanical compromise of the pathway by a benign process, inflammation, and infiltration by a neoplasm originating or metastatic to the region of plexi share similar features and cannot be differentiated. Read More

Minerva Anestesiol 1991 Oct;57(10):1088-9

Servizio-Anestesia, Rianimazione e Terapia del Dolore, XVIII USL Liguria, Universitá degli Studi di Genova.

Neurology 1989 Jun;39(6):871-2

Department of Neurology, Hospital de Sabadell, Spain.

Radiographics 1986 May;6(3):401-25

Department of Radiology, University of Michigan Hospitals, Ann Arbor.

Before high resolution computed tomography (CT), the lumbosacral plexus was nearly impossible to image. While individual elements of the plexus are not consistently resolved using CT, the regional anatomy is reproducible and allows accurate evaluation. Normal regional anatomy was established by axial cadaver dissection and review of 233 normal computed tomographic examinations. Read More