Partial Sacrectomy




Indications




  • •

    Primary sacral tumors, many of which benefit from en bloc removal


  • •

    Locally advanced rectal cancer with sacral involvement, for which pelvic exenteration is indicated


  • •

    Nonunion of symptomatic sacral fracture





Contraindications




  • •

    Patients with rectal cancer involving the sacrum must have the fat plane medial to the internal obturator preserved to be candidates for resection.


  • •

    Involvement of the S1 pedicles requires a total sacrectomy with extensive instrumented reconstruction.





Planning and positioning




  • •

    We prefer the prone position, but a lateral position can be used when simultaneous anterior and posterior approaches are performed.


  • •

    For the prone position, legs should be flexed at the hip and thighs should be abducted to allow for maximum exposure.





Procedure





Figure 79-1:


Sacrectomies are often performed for pelvic tumors that extend into the sacrum. Frequently, the initial step in these operations is to use an anterior approach to dissect the tumor and associated viscera away from anterior and lateral margins. The anterior approach allows identification and ligation of the internal iliac arteries that supply the gluteal vessels, which can cause significant bleeding during dissection of the lateral sacral margin.



Figure 79-2:


Incision type is dictated by the need for margins. For cancer operations in which a margin is desirable, an incision that splits into a fork around the region of the interest is used. Alternatively, a midline incision can be used when margins are not required.

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Jun 15, 2019 | Posted by in NEUROSURGERY | Comments Off on Partial Sacrectomy

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