title: Surgical excision of extensive sacrococcygeal chordomas assisted by occlusion of the abdominal aorta.
abstract: OBJECTIVE
  An extensive sacrococcygeal chordoma is considered a challenge for neurosurgeons. Because of the complex anatomy of the sacral region, the risk of uncontrollable intraoperative hemorrhage, and the typically large tumor size at presentation, complete resections are technically difficult and the tumor recurrence rate is high. The aim of this study was to assess the value of using occlusion of the abdominal aorta by means of a balloon dilation catheter and electrophysiological monitoring when an extensive sacrococcygeal chordoma is removed.
  
  
  METHODS
  Between 2004 and 2008, 9 patients underwent resection of extensive sacrococcygeal chordomas in the authors' department with the aid of occlusion of the abdominal aorta and electrophysiological monitoring. All of these operations were performed via the posterior approach. The records of the 9 patients were reviewed retrospectively.
  
  
  RESULTS
  Wide resections were performed in 6 cases and marginal excisions in the other 3. Five patients underwent postoperative radiotherapy. Intraoperative hemorrhage was controlled at 100-400 ml. Postoperatively, none of the patients had any new neurological dysfunction, and 2 patients regained normal urinary and bowel function. The mean follow-up period was 31.4 months (range 10-57 months). No patient developed local recurrence or had metastatic spread of tumor during follow-up.
  
  
  CONCLUSIONS
  Occlusion of the abdominal aorta and electrophysiological monitoring are useful methods for assisting in resection of sacrococcygeal chordoma. They can reduce intraoperative hemorrhage and entail little chance of tumor cell contamination. They can also help surgeons to protect the organs in the pelvic cavity and neurological function. Use of these methods could give patients better quality of life.
authors.affiliation: Department of Neurosurgery, West China Hospital, Sichuan University, Sichuan Province, China.
authors.forename: Liu
authors.initials: L
authors.lastname: Xue-Song
authors.forename: You
authors.initials: Y
authors.lastname: Chao
authors.forename: Yang
authors.initials: Y
authors.lastname: Kai-Yong
authors.forename: Huang
authors.initials: H
authors.lastname: Si-Qing
authors.forename: Zhang
authors.initials: Z
authors.lastname: Heng
mesh_terms: D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal; D002404:Catheterization; D002817:Chordoma / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012189:Retrospective Studies; D012445:Sacrococcygeal Region; D013125:Spinal Neoplasms / Q000601:surgery*