Inferior vena cava division with venous-venous bypass during en bloc lumbar spondylectomy for malignant peripheral nerve sheath tumor: illustrative case.

Background: Malignant peripheral nerve sheath tumors are a rare, aggressive form of soft tissue sarcoma with a dismal prognosis. Little progression has been made in understanding their pathogenesis, natural history, clinical management, and outcomes over the last few decades. The cornerstone of treatment is cytoreduction in the form of surgery. However, when in the lumbar region, the inferior vena cava poses a limitation for executing anterior approaches. Although performed in other operations, elective caval division for access purposes has not been described as an approach to anterior column resection in spinal operations.

Observations: The authors present the first documented case of planned division and mobilization of the vena cava supported by venous-venous bypass in order to achieve gross-total resection of a lower lumbar malignant peripheral nerve sheathe tumor as part of a two-stage procedure.

Lessons: Inferior vena cava division and reanastomosis is a novel technique that can be used to widen surgical corridors in anterior approaches to the lumbar spine, and one that proves useful in en bloc resections. Venous-venous bypass can minimize impact on right heart filling during prolonged surgery. https://thejns.org/doi/10.3171/CASE25151.