Modified kraske procedure with mid-sacrectomy and coccygectomy for en bloc excision of sacral giant cell tumors.
Sacral giant cell tumors are rare neoplasms, histologically benign but potentially very aggressive due to the difficulty in achieving a complete resection, their high recurrence rate, and metastization capability. Although many treatment options have been proposed, en bloc excision with tumor-free margins seems to be the most effective, being associated with long term tumor control, improved outcome, and potential cure. An exemplifying case of a 29-year-old female with progressive complaints of pain and paresthesias in the sacral and perianal regions, constipation, and weight loss for 6 months is presented. The surgical technique for en bloc excision of a large sacral giant cell tumor through a modified Kraske procedure with mid-sacrectomy and coccygectomy is described. Complete resection with wide tumor-free margins was achieved. At 5 years of follow-up the patient is neurologically intact, without evidence of local recurrence on imaging studies. A multidisciplinary surgical procedure is mandatory to completely remove sacral tumors. In the particular case of giant cell tumors, it allows minimizing local recurrence preserving neurovascular function, through a single dorsal and definitive approach.
Neurosurgery Department, Garcia de Orta Hospital, Avenida Torrado da Silva, 2801-951 Almada, Portugal.
Vítor M
0000-0002-5432-9595
VM
Gonçalves
Orthopedic Department, Beatriz Ângelo Hospital, Avenida Carlos Teixeira, 2674-514 Loures, Portugal.
Alvaro
A
Lima
General Surgery Department, CUF Infante Santo Hospital, Travessa do Castro, 1350-070 Lisbon, Portugal.
João
J
Gíria
General Surgery Department, Garcia de Orta Hospital, Avenida Torrado da Silva, 2801-951 Almada, Portugal.
Nuno
N
Carvalho
Plastic and Reconstructive Surgery Department, Garcia de Orta Hospital, Avenida Torrado da Silva, 2801-951 Almada, Portugal.
José
J
Parreira
Neurosurgery Department, Garcia de Orta Hospital, Avenida Torrado da Silva, 2801-951 Almada, Portugal.
Manuel
M
Cunha E Sá