Surgical treatment of primary sacral tumor

English Keywords:Primary sacral tumors  Surgical treatment  Complications  Prognosis

English Abstract:

  【Abstract】 Objective：To summarize the surgical outcome for primary sacral tumors.Method：26 cases （including 17 males and 9 females） with sacral tumor from January 1991 to Ａｕｇｕｓｔ 2009，underwent surgical protocol.The mean age at admission was 50 years（range，17-71 years）.The clinical presentation，imaging and needle biopsy were used to determine the diagnoses.Combined anterior-posterior approach（APA） was used in 15 patients with tumors involving S2 and above.Among them，balloon dilation catheter（BDC） was used in 9 cases with huge malignant tumors.Single posterior approach（PA） was used in 11 patients with tumors involving vertebrae below S2.Bilateral S1 and S2 nerve roots and at least unilateral S3 nerve root were preserved in the surgery.Lumboiliac fixation was performed in 9 patients due to the removal of S1.Result：All patients underwent the operations successfully with no perioperative death or serious complications.The blood loss in PA group ranged from 200ml to 5000ml（mean，1995±2076ml），whereas that in APA group ranged from 400ml to 6300ml（mean，2400±1678ml），and the mean blood loss for BDC was 2333ml.Skin incision complications were noted in 11 cases including non-healing in 6 cases，infection in 4 cases，skin necrosis in 2 cases and sinus formation in 1 case.Two of them healed after skin flap transplantation and the others healed through debridement and dressing change.11 cases presented with neurological deterioration at the early following up，including weakness and numbness of lower extremity，saddle numbness and bladder and bowel dysfunction.Of them，8 cases recovered completely and 3 cases recovered incompletely after an average of 27 months follow up.One patient with malignant peripheral nerve sheath tumors died of multiple organ failure 11 months later.9 cases were noted to have local recurrence including 5 chordoma，3 malignant peripheral nerve sheath tumors and 1 nerve sheath tumors.The primary local recurrence was dated at 12.2 months on average.At final follow-up，17 patients recovered routine life and normal cauda equina function.Conclusion：CT-guided biopsy is valuable.We recommend single posterior approach for tumors involving vertebrae below S2 and combined anterior-posterior approach for tumors involving S2 and above，BDC is helpful to blood control.Bilateral S1 and S2 nerve roots and at least unilateral S3 nerve root should be preserved to improve life quality.