Surgical treatment of sacral chordomas combined with transcatheter arterial embolization.
METHODS
A retrospective study, analyzing midterm results of transcatheter arterial embolization (TAE) for removal of a sacral chordoma.


OBJECTIVE
To develop a suitable method to maximally remove the tumor.


BACKGROUND
Although previous reports have reported the use of TAE for removal of tumors, there is currently no data available on using this method to treat sacral chordomas.


METHODS
Thirty patients with sacral chordomas, who underwent surgical treatment from January 1994 to September 2005, were selected. All 30 patients underwent the posterior approach after TAE of the main arteries that supplied the sacral chordoma. The average follow-up was 44.6 months after the operation. The blood lost during the operation, blood transfusion, and the blood drained from the patient after the operation was reviewed. In addition, the sphincter muscle function of the bladder and bowel was observed.


RESULTS
The intraoperative blood loss averaged 1200 mL during the removal of the tumor. The average blood drained from the patient after the operation was 650 mL. The average blood transfusion postoperatively was 1080 mL. Of the 30 patients, 12 had recurrence and 2 died of tumor metastasis. In the 17 patients whose sacral nerve roots had been bilaterally reserved at and above the S3 level, the sphincter muscle function of the bladder and bowel was good, whereas the function of the sphincter muscles was impaired in 2 patients with nerve roots reserved only at and above the S1 level. In 1 case, colostomy and ureterocutaneosomy were used.


CONCLUSIONS
In comparison with historical literature, preoperative TAE for excising the sacral tumor can significantly decrease intraoperative blood loss, make the surgical field clear, possibly eliminate the need for using an anterior approach, and facilitate the maximal removal of the sacral chordoma. It is an encouraging technique for excising the sacral chordomas.
Yang
Huilin
H
The First Affiliated Hospital of Soochow University, Suzhou, China.
Zhu
Lifan
L
Ebraheim
Nabil A
NA
Liu
Jiayong
J
Shapiro
Anna
A
Castillo
Sharmaine
S
Liu
Xiaochen
X
Tang
Tiansi
T
D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal / Q000033:anatomy & histology / Q000601:surgery; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D002817:Chordoma / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000033:anatomy & histology / Q000601:surgery; D017116:Low Back Pain / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D011128:Polyradiculopathy / Q000209:etiology / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D011859:Radiography; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D012447:Sacrum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D013126:Spinal Nerve Roots / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology / Q000517:prevention & control; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods; D055815:Young Adult