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We recently had the opportunity to treat a patient who had a large presacral mass. The mass, a 13-cm neurilemmoma, was removed through a combined abdominosacral approach. Mostly benign, these presacral masses cause symptoms by compression of adjacent pelvic structures. Digital rectal examination generally provides the diagnosis. Although most such lesions may be removed by a Kraske procedure, large lesions may be best treated using a combined abdominosacral approach.

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