title: Image-guided resection of aggressive sacral tumors.
abstract: OBJECTIVE The aim of this study was to identify and discuss operative nuances utilizing image guidance in the surgical management of aggressive sacral tumors. METHODS The authors report on their single-institution, multi-surgeon, retrospective case series involving patients with pathology-proven aggressive sacral tumors treated between 2009 and 2016. They also reviewed the literature to identify articles related to aggressive sacral tumors, their diagnosis, and their surgical treatment and discuss the results together with their own experience. Information, including background, imaging, treatment, and surgical pearls, is organized by tumor type. RESULTS Review of the institutional records identified 6 patients with sacral tumors who underwent surgery between 2009 and 2016. All 6 patients were treated with image-guided surgery using cone-beam CT technology (O-arm). The surgical technique used is described in detail, and 2 illustrative cases are presented. From the literature, the authors compiled information about chordomas, chondrosarcomas, giant cell tumors, and osteosarcomas and organized it by tumor type, providing a detailed discussion of background, imaging, and treatment as well as surgical pearls for each tumor type. CONCLUSIONS Aggressive sacral tumors can be an extremely difficult challenge for both the patient and the treating physician. The selected surgical intervention varies depending on the type of tumor, size, and location. Surgery can have profound risks including neural compression, lumbopelvic instability, and suboptimal oncological resection. Focusing on the operative nuances for each type can help prevent many of these complications. Anecdotal evidence is provided that utilization of image-guided surgery to aid in tumor resection at our institution has helped reduce blood loss and the local recurrence rate while preserving function in both malignant and aggressive benign tumors affecting the sacrum.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Doniel
authors.initials: D
authors.lastname: Drazin
authors.affiliation: Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Neil
authors.initials: N
authors.lastname: Bhamb
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Lutfi T
authors.initials: LT
authors.lastname: Al-Khouja
authors.affiliation: Department of Neurosurgery, Stony Brook University Medical Center, Stony Brook, New York; and.
authors.forename: Ari D
authors.initials: AD
authors.lastname: Kappel
authors.affiliation: Departments of 1 Neurosurgery and.|Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Terrence T
authors.initials: TT
authors.lastname: Kim
authors.affiliation: Departments of 1 Neurosurgery and.|Department of Neurosurgery, University of California, Davis, Sacramento, California.
authors.forename: J Patrick
authors.initials: JP
authors.lastname: Johnson
authors.affiliation: Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Earl
authors.initials: E
authors.lastname: Brien
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000379:methods; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery*; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D015898:Tomography Scanners, X-Ray Computed
keywords: ABC = aneurysmal bone cyst; GCT = giant cell tumor; IGS = image-guided surgery; WBB = Weinstein-Boriani-Biagini; aggressive sacral tumors; chondrosarcoma; chordoma; giant cell tumor; image-guided surgery; spine malignancy