Bilateral internal hemipelvectomy for osteosarcoma in a pediatric patient previously treated for rhabdomyosarcoma

Abstract

The surgical treatment of malignant bone tumors involving the pelvis represents a great challenge in terms of local control. Internal hemipelvectomy is a major surgical procedure that involves the resection of the entire hemipelvis or of a portion of the hemipelvis with preservation of the ipsilateral extremity. The need for a bilateral internal hemipelvectomy is an extraordinary situation. We describe the case of an 11-year-old girl with a primary diagnosis of rhabdomyosarcoma of the bladder at the age of two years who subsequently developed a right pelvis osteosarcoma at the age of six years and a left pelvis osteosarcoma at the age of nine years. She ultimately underwent sequential bilateral internal hemipelvectomies and she postoperatively ambulates without an assist device.

Extended anterolateral transiliac approach to the sacral plexus

“…Approaching the lateral part of the sacrum is difficult [1][2][3]. Judet's transiliac approach has the advantage of remaining at a distance from vessels [4], and shows that sectioning the iliac wing is unproblematic [4][5][6]; the drawback is that access is limited by the gluteal muscles reclined downward and forward and by the lateral edge of the plexus barring access to the sacrum [7].…”