Spinopelvic Reconstruction with Femoral Allograft and Vertical Rectus Abdominis Myocutaneous Flap after Total Sacrectomy in Recurrent Sacral Chordoma: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: To report a case of recurrent sacral chordoma treated with total sacrectomy and spinopelvic reconstruction. SUMMARY OF LITERATURE REVIEW: Sacral chordoma is a musculoskeletal tumor reported to have a low incidence. Surgical treatment is considered difficult due to the complicated sacropelvic structure, so the prognosis for patients with sacral chordoma has been considered poor. MATERIALS AND METHODS: We report a surgical technique and outcomes from spinopelvic reconstruction with femoral allograft and vertical rectus abdominis myocutaneous flap after total sacrectomy. RESULTS: We report no tumor recurrence at 43 months postoperatively. CONCLUSIONS: Spinopelvic reconstruction with thorough surgical planning after total sacrectomy was found to be a safe and effective treatment method.

Comparison of Treatment Effects between Targeting Arterial Embolization before Sacral Chordoma Excision and Temporary Balloon Occlusion of Abdominal Aorta during Sacral Chordoma Surgery / 中国医科大学学报

Objective To compare the clinical efficacy of targeting arterial embolization before sacral chordoma excision and temporary balloon oc-clusion of abdominal aorta during sacral tumors surgery. Methods A total of 34 patients with sacral chordoma were recruited for this study and fol-lowed up. Totally 18 patients received bi-iliac artery,sacrococcygeal artery and other target arteryl embolization before excision(target arterial emboli-zation group),and the other 16 received temporary balloon occlusion of abdominal aorta during surgery(balloon occlusion group). The blood loss during operation,drained blood after operation,operation time and wound healing were recorded. Results The blood loss during operation,drained blood after operation and operation time in targeting arterial embolization group were less than balloon occlusion group. There was no statistical differ-ence in wound healing between the two groups. Conclusion Targeting arterial embolization can be more effective than temporary balloon occlusion of abdominal aorta in the control of blood loss.

Image-Guided Percutaneous Lipiodol-Pingyangmycin Suspension Injection Therapy for Sacral Chordoma

A 74-year-old man presented with a progressively worsening pain in sacrum and was diagnosed to have a sacral chordoma by biopsy in May, 2004. Percutaneous intratumoral injection with lipiodol-pingyangmycin suspension (LPS) was carried out under image guidance and repeated when the pain in sacrum recurred and the tumor increased. During a 6-year follow-up period, three sessions of this treatment were executed. CT imaging and Karnofsky Performance Score were used to evaluate the size of tumor and quality of life, respectively. The patient was free of pain after each procedure and had a high quality of life with a Karnofsky Performance Score above 80 points. The tumor lesion in sacral area was effectively controlled. No complications were observed. Percutaneous intratumoral injection with LPS under image guidance may be an effective and safe alternative for the patients with sacral chordoma.

Computer-Assisted Modified Mid-Sacrectomy for En Bloc Resection of Chordoma and Preservation of Bladder Function

A 67-year-old woman presented for evaluation of severe coccygeal pain. The computed tomography scans and magnetic resonance imaging showed an asymmetric midline sacral tumor invading the right lower portion of S2. To preserve both S2 nerve roots and to obtain negative surgical margins, a modified mid-sacrectomy with an aid of a computed navigation system was performed. The sacral tumor was excised en bloc with negative tumor margins. Both S2 nerve roots were preserved and additional reconstruction was not necessary because of minimal resection of the sacroiliac joint. We report a case of a sacral chordoma which was excised en bloc with adequate surgical margins by a computer-assisted modified mid-sacrectomy. The computed navigation system may be a useful tool for tumor targeting and safe osteotomies in sacral tumor surgery via the posterior only approach.

A Case of Giant Sacral Chordoma

PURPOSE: Chordoma is a rare primary osseous tumor arising from the remnants of the primitive notochord. It occurs once in 2,000,000. It is characterized by its slow growth, high frequency to invade destroy bone by direct extension. We experienced giant sacral chordoma and reconstructed with gluteal advancement flap. METHODS: A 52-year-old woman presented with a 2-years history of gluteal pain. In the biopsy study revealed sacral chordoma. MRI study showed 13 x 12 x 10 cm sized m0cs. We approached anterior and posterior resection and reconstructed with bilateral gluteus maximus advancement flap. RESULTS: After the operation, blader and anal function were slightly decreased. But, 4 months later those were almost fully recovered. There was no significant complication and recurrence after 2-years follow-up. CONCLUSION: Chordoma is characterized by its slow growth, high frequency to invade and destroy bone by direct extension. Wide surgical resection is the only curative procedure. We report a ase of giant sacral chordoma which was successfully treated by anterior and posterior approach and reconstructed with bilateral gluteal advancement flap.

A Case of Giant Sacral Chordoma

PURPOSE: Chordoma is a rare primary osseous tumor arising from the remnants of the primitive notochord. It occurs once in 2,000,000. It is characterized by its slow growth, high frequency to invade destroy bone by direct extension. We experienced giant sacral chordoma and reconstructed with gluteal advancement flap. METHODS: A 52-year-old woman presented with a 2-years history of gluteal pain. In the biopsy study revealed sacral chordoma. MRI study showed 13 x 12 x 10 cm sized m0cs. We approached anterior and posterior resection and reconstructed with bilateral gluteus maximus advancement flap. RESULTS: After the operation, blader and anal function were slightly decreased. But, 4 months later those were almost fully recovered. There was no significant complication and recurrence after 2-years follow-up. CONCLUSION: Chordoma is characterized by its slow growth, high frequency to invade and destroy bone by direct extension. Wide surgical resection is the only curative procedure. We report a ase of giant sacral chordoma which was successfully treated by anterior and posterior approach and reconstructed with bilateral gluteal advancement flap.