Surgical management of sacrococcygeal region giant tumors by use of balloon occlusion abdominal aorta

Abstract

Controlling intraoperative hemorrhage is a very troublesome problem for these giant tumors, but it is of vital significance. When blood loss exceeds the maximum permissive level, it becomes life threatening. The purpose of this study is to report on our successful experience in controlling blood loss through using balloon catheters to occlude the abdominal aorta. Surgical management of large sacral tumors is challenging for surgeons and anesthesiologists, in particular due to extensive hemorrhage, which is often refractory to control strategies (8,10,17,20). Several studies (7,9,12,15,16,18) have reported that occluding the abdominal aorta with a balloon catheter is an effective method to control intraoperative blood loss while also gaining better outcomes and fewer complications.The sacrococcygeal region is a complex anatomical area. The pelvic cavity provides many spaces for tumors to grow to quite a large size before symptoms become obvious (19). RESUlTS: Thirty patients underwent surgery via a posterior approach; these cases included 21 chordomas, 5 schwannomas, and 4 giant cell tumors of bone. Wide resections were performed in 26 patients (86.7%) and margin resections were performed in 4 (13.3%) patients. Most patients' symptoms were relieved through surgery and only nine patients (30%) experienced recurrence of the tumors during follow-up.CONClUSION: Sacrococcygeal region giant tumors are still difficult to treat, especially for malignant tumors. Balloon catheter occlusions of the lower abdominal aorta can notably decreased intraoperative hemorrhage, shorten operation time, and decrease postoperative complications. This method is a good choice for neurosurgeons to manage these giant tumors in the sacral region.