Sacral Lesion

Presentation

A 38-year-old man was troubled by lower extremity radiculopathies. Although he did not have incontinence, urinary frequency with decreased sensation in a right L5 to S3 distribution developed. An urgent workup was completed.

Radiologic Findings

A large, soft tissue density presacral lesion was seen on magnetic resonance imaging (MRI), displacing his pelvic structures (Figs. 68-1 and 68-2).

FIGURE 68-1 Sagittal MRI of the lumbosacral spine with a large presacral lesion.

Diagnosis

The results of pathology tests indicated a ganglioneuroma

Treatment

Through a combined transabdominal and transperianal approach, the tumor was resected. Electrophysiologic monitoring was utilized intraoperatively.

Discussion

Solid presacral tumors are usually malignant, and most frequently include primitive neuroectodermal tumors (PNET) and sacrococcygeal teratomas. Enteric cysts and anterior sacral meningoceles are among cystic presacral lesions. Congenital lesions usually involve a bony defect and urologic abnormalities.