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Surgical Treatment of Sacral Tumors.
The surgical goals in the management of sacral tumors are to remove the tumor completely with clear margins and to maximize postoperative function.
A radical surgical approach such as partial or total sacrectomy, with sacrifice of sacral roots, is often warranted to achieve total resection with clear margins.
7 Various sacrectomies have been described depending on the tumor location, extent, and histology.
In general, sacrectomies can be categorized either as partial or total. Decision regarding partial or total sacrectomy for en bloc resection can be made after radiological evaluation and bone biopsy.
Total sacrectomy is indicated when a malignant or aggressive benign lesion involves the proximal sacrum.
53,54,67,68 Partial sacrectomy includes transverse, sagittal, or combination.
Lateral sacral tumors that lie entirely to one side of the sacrum are treated by sagittal partial sacrectomy.
According to the transverse axis and sacroiliac joint involvement, sacral tumors are distinguished into high midline lesions above S3 without lateral invasion of a sacroiliac joint, high lateral lesions above S3 with sacroiliac joint invasion, and low midline lesions below S3.
Lateral lesions with sacroiliac joint involvement are treated by sagittal sacrectomy.
High or low midline tumors without sacroiliac joint involvement are treated by transverse sacrectomy (Figure 5).
14 Sagittal partial sacrectomies also are frequently done as part of an extended hemipelvectomy for tumors of the medial iliac wing that involve the sacroiliac joint or sacrum.54,69
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