Primary Tumors of the Sacrum

Llauger, Jaume; Palmer, J.; Amores, S; Bague, Sylvia; Camins, Àngels

doi:10.2214/ajr.174.2.1740417

Cited by 153 publications

(104 citation statements)

References 8 publications

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“…Intralesional curettage is the mainstay of treatment in long bones and is often combined with local adjuvants such as cryotherapy, peroxide, ethanol, phenol, and bone cement to reduce recurrence. [61][62][63]77,78 However, due to the proximity of critical neurological structures, such adjuvants may not be appropriate or must be used only with care in the sacrum. Intralesional resection in the sacrum may potentially preserve neurological and other critical structures but present a greater risk of local recurrence, whereas wide excision may sacrifice neurological function to reduce recurrence.…”

Section: Surgical Pearlsmentioning

confidence: 99%

Image-guided resection of aggressive sacral tumors

Drazin¹,

Bhamb

Al-Khouja³

et al. 2017

FOC

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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.

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Section: Surgical Pearlsmentioning

confidence: 99%

Image-guided resection of aggressive sacral tumors

Drazin¹,

Bhamb

Al-Khouja³

et al. 2017

FOC

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“…The remaining 15% occur in the spine above the sacrum. Men are affected twice as frequently as women, and patients' mean age is 50 years (2). Typical chordomas contain clear cells with intracytoplasmic vacuoles and abundant mucin; in atypical chordomas, the mucinous matrix is replaced by chondroid or osteoid elements.…”

Section: Chordomamentioning

confidence: 99%

“…The presence of fluid-fluid levels is diagnostically useful but is not pathognomonic, since fluid-fluid levels have also been reported in giant cell tumors, telangiectatic osteosarcomas, osteoblastomas, and chondroblastomas (1, 7). The most common radiographic appearance is an osteolytic expansile lesion surrounded by a thin bony shell (2) (Fig. 2).…”

mentioning

confidence: 99%

Imaging Findings of Sacral Tumors

Kim

Hong

Choi

et al. 2003

J Korean Radiol Soc

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Sacral tumors include primary bone tumors, sacral canal tumors and, most commonly, metastases. The most common primary malignant bone tumor is chordoma, and the second most common is giant cell tumor. The presence of multiple lesions involving the sacrum and other bones suggests metastasis or multiple myeloma. Although the imaging findings of sacral tumors are nonspecific, a patient's age and sex, and specific findings such as calcification or fluid-fluid levels, can help radiologists determine the differential diagnosis. The imaging findings may overlap, however, in which case the final diagnosis can be determined by biopsy. We illustrate the imaging findings of primary sacral tumors, emphasizing the MRI findings. Benign Bone Tumors Giant Cell TumorGiant cell tumor is the second most common primary sacral tumor. Its peak incidence is during the 2 nd-4th decades of life, and there is female predominance (1 4). Sacral giant cell tumors are frequently eccentric and originate in anterior spinal elements. They are generally found in a subchondral location in both long and flat bones, and this may lead to transarticular spread (3, 5). Typically, the tumor is a purely lytic lesion without marginal sclerosis or tumor matrix calcification. Due to the presence of necrosis and hemorrhage, heterogeneous intermediate signal intensity is seen at both T1-and T2-weighted MR imaging (3) (Fig. 1). Aneurysmal Bone CystAneurysmal bone cysts are expansile lesions with multiloculated blood-filled sacs. Their incidence peaks during the second decade of life, and there is slight female predominance (4). They may result from trauma or coexist with other bone lesions, both benign and ma- The various pathologic conditions detected at CT and MRI and subsumed by the term "sacral tumor" include primary bone tumors, sacral canal tumors and metastases. Among these, metastases are much more common than primary bone tumors, of which chordoma is the most common. Although the imaging findings of sacral tumors are nonspecific, a patient's age and sex, and specific findings such as calcification or fluid-fluid levels, can help radiologists in their differential diagnosis. We describe the imaging findings of primary sacral tumors, emphasizing the MRI findings.

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“…Spinal metastatic infiltrations predominantly occur in the thoracic region, followed by the lumbar spine and the lumbosacral junction [4]. Breast, lung, renal, thyroid and prostate tumours form the predominant primary sources, less common primary lesions include lymphoma, melanoma and tumours of unknown origin [4][5][6][7][8]. Spread is mainly by haematogenic dissemination, although direct invasion through locally recurrent pelvic tumours is not uncommon [2].…”

Section: Introductionmentioning

confidence: 99%

Management of metastatic sacral tumours

et al. 2012

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Purpose Metastatic involvement of the sacrum is rare and there is a paucity of studies which deal with the management of these tumours since most papers refer to primary sacral tumours. This study aims to review the available literature in the management of sacral metastatic tumours as reflected in the current literature. Methods A systematic review of the English language literature was undertaken for relevant articles published over the last 11 years (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). The PubMed electronic database and reference lists of key articles were searched to identify relevant studies using the terms ''sacral metastases'' and ''metastatic sacral tumours''. Studies involving primary sacral tumours only were excluded. For the assessment of the level of evidence quality, the CEBM (Oxford Centre of Evidence Based Medicine) grading system was utilised. Results The initial search revealed 479 articles. After screening, 16 articles identified meeting our inclusion criteria [1 prospective cohort study on radiosurgery (level II); 2 case series (level III); 4 retrospective case series (level IV) and 9 case reports (level IV)]. Conclusion The mainstay of management for sacral metastatic tumours is palliation. Preoperative angioembolisation is shown to be of value in cases of highly vascularised tumours. Radiotherapy is used as the primary treatment in cases of inoperable tumours without spinal instability where pain relief and neurological improvement are attainable. Minimal invasive procedures such as sacroplasties were shown to offer immediate pain relief and improvement with ambulation, whereas more aggressive surgery, involving decompression and sacral reconstruction, is utilised mainly for the treatment of local advanced tumours which compromise the stability of the spine or threaten neurological status. Adjuvant cryosurgery and radiosurgery have demonstrated promising results (if no neurological compromise or instability) with local disease control.

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Primary Tumors of the Sacrum

Cited by 153 publications

References 8 publications

Image-guided resection of aggressive sacral tumors

Image-guided resection of aggressive sacral tumors

Imaging Findings of Sacral Tumors

Management of metastatic sacral tumours

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