The pineapple technique for excision of large plexiform neurofibromas

Plexiform neurofibromas (PNF) occur in up to 30% of patients with neurofibromatosis type 1 (NF1). To date, management of this tumors remains medically challenging. Surgical approach represents the only viable treatment option of progressive growing plexiform neurofibromas but surgical complications may be relatively common. Intraoperative tumor bleeding was found to occur as one of the most frequent complications. We report the case of a 28-year-old male patient presented with a large back-pack shaped plexiform neurofibroma. The tumor was successfully excised using the pineapple technique, with minimal intraoperative blood loss. To our opinion, this is the first reported case of excision of a plexiform neurofibroma combined with multi-layered hemostatic suture technique. This novel application proves the efficacy and the potential of the technique, extending its feasibility to the excision of any type of vascular tumor or extensive cancerous masses. Level of Evidence: Level V, therapeutic study