Neurosurgical Management of Sacral Tumors: Review of the Literature and Operative Nuances

Stephens, Marcus L.; Gunasekaran, Arunprasad; Elswick, Clay M; Laryea, Jonathan A.; Pait, T. Glenn; Kazemi, Noojan

doi:10.1016/j.wneu.2018.05.212

Cited by 8 publications

(4 citation statements)

References 17 publications

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“…Moreover, using the posterior approach in exposing the anterior sacrum increases the incidence of rectal injury due to the limited space and exposed field available [ 19 ]. To achieve complete tumour resection, most scholars use the combined antero-posterior approach, which can safely separate the rectum and blood vessels in front of the sacrum and allows closure of the posterior incision with a rectus or omental flap [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…The sacrum and its surrounding tissues are mainly supplied by the internal iliac artery and the middle sacral artery [ 22 ]. The accompanying veins and the sacral vertebral veins form a venous plexus in front of the sacrum with abundant collateral circulation [ 22 ]; this provides the tumours with a rich blood supply and abundant anastomosis, thereby predisposing them to bleed rapidly on injury [ 20 ]. Compression of the common iliac vein, internal iliac vein, and anterior sacral venous plexus by the tumour creates venous stasis, which also predisposes them to intra-operative rupture and bleeding [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

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Total sacrectomy with a combined antero-posterior surgical approach for malignant sacral tumours

Zhang

Wang

et al. 2021

International Orthopaedics (SICOT)

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Purpose To investigate the indications, approaches, resection methods, and complications of total sacrectomy with a combined antero-posterior approach for malignant sacral tumours. Methods Fourteen cases of primary malignant sacral tumours treated with total sacrectomy between January 2012 and 2018 were retrospectively analysed. All patients presented with pre-operative lumbosacral pain or constipation. A combined antero-posterior approach was used for tumour resection, and the spinal pedicle screw rod system was used to achieve ilio-lumbar stability. The visual analogue scale (VAS) and Musculoskeletal Tumor Society (MSTS) scores were used to assess pain and lower limb function, respectively. The mean operative time and intra-operative blood loss were 6.54 hours and 2935 mL, respectively. The mean follow-up period was 62 months. Results None of the patients died peri-operatively. At the last follow-up, ten patients were continuously disease-free, three were alive with disease, and one died of disease from lung metastasis. Tumour recurrence occurred in three patients. The MSTS scores ranged from 6 to 28 (20.00–93.33%, 6/30–28/30) with an average of 20 (66.67%, 20/30). Seven patients could walk independently in public, five could only walk at home using a walking aid, and two could only lie down and stand for a short time. Thirteen patients developed post-operative complications such as skin necrosis, screw loosening, connecting rod fracture, neuropathic pain, sciatic nerve injury, dysuria, and urinary incontinence. Conclusion Total sacrectomy can effectively treat malignant sacral tumours with good resection boundaries and prognosis. However, the high incidence of post-operative complications may impact post-operative neurological function.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Total sacrectomy with a combined antero-posterior surgical approach for malignant sacral tumours

Zhang

Wang

et al. 2021

International Orthopaedics (SICOT)

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“…Sacral tumors are account for approximately 1-7% of all spinal tumors. 20 Chordoma is the most common among the primary malignant bone tumors, and GCT is one of the most frequently seen benign lesions arising from the sacrum. Although GCT is a benign tumor, it is very vulnerable to local recurrence.…”

Section: Discussionmentioning

confidence: 99%

Surgical Strategy for Sacral Tumor Resection

Kim

Park

et al. 2021

Yonsei Med J

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“…Moreover, the sacrum may be excluded from initial radiographic studies as these lesions can lie below the sacral 2 (S2) vertebrae or are obscured by bowel gas or stool. [ 12 , 27 , 36 ] This combination of nonspecific symptoms, inadequate diagnostic imaging, and clinical rarity contributes to frequent delay in diagnosis and advanced tumor size at time of eventual diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Clinical manifestations, classification, and surgical management of sacral tumors and the need for personalized approach to sacrectomy

Runnels

Rose

Kondilis

et al. 2021

Surgical Neurology International

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Background: Although comprising 7% of all spinal tumors, sacral tumors present with a litany of issues due to their slow growth and difficulty in detection. As a result, sacral tumors can grow unperturbed for years until a patient presents for an incidental workup of an unassociated minor trauma or an offending primary tumor source that has metastasized to the sacrum; in most cases, this includes primary tumors of the breast, prostate, and lung. The goal of this review is to outline the pathophysiology underlying sacral tumors including the various tissues and structures that can be targeted for treatment, along with a discussion of the surgical approach to sacrectomy. Methods: An extensive review of the published literature was conducted through PubMed database with articles simultaneously containing both search terms “sacral tumors” and “sacrectomy.” No date restrictions were used. Results: The search yielded 245 related articles. Cross-checking of articles was conducted to exclude of duplicate articles. The articles were screened for their full text and English language availability. We finalized those articles pertaining to the topic. Conclusion: Once a sacral tumor has reached the point of diagnostic detection, invasive sacrectomy is typically utilized (through an anterior, posterior, or combination approach) to locally isolate and resect the tumor and minimize risk of future tumor growth and additional bone loss. While institutions have varying criteria for surgical approaches, a combination of anterior and posterior approach has traditionally been used in total and high sacrectomies due to the control it provides surgeons toward the rectum and vasculature anterior to the sacrum. A posterior-only approach can be performed for tumors that failed to invade pelvic organs or extend past the lumbosacral junction. Early detection with screenings can help avoid invasive sacrectomy by identifying the onset of tumor formation in the sacrum, particularly for highly metastatic cancers.

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Neurosurgical Management of Sacral Tumors: Review of the Literature and Operative Nuances

Cited by 8 publications

References 17 publications

Total sacrectomy with a combined antero-posterior surgical approach for malignant sacral tumours

Total sacrectomy with a combined antero-posterior surgical approach for malignant sacral tumours

Surgical Strategy for Sacral Tumor Resection

Clinical manifestations, classification, and surgical management of sacral tumors and the need for personalized approach to sacrectomy

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