Total Sacrectomy for Low-Grade Malignant Peripheral Nerve Sheath Tumour: A Case Report

Abstract

We report on a 58-year-old woman who underwent total sacrectomy and spinopelvic reconstruction for a low-grade malignant peripheral nerve sheath tumour involving the sacrum. One week later, she developed deep wound infection, and the entire spinopelvic reconstruction was removed. At the 36-month followup, the patient had no pain and was able to walk with a walking frame. There was no sign of recurrence or metastasis.

What Are the Functional Outcomes After Total Sacrectomy Without Spinopelvic Reconstruction?

“…Because of lower complication rates, other authors advocate sacrectomy without reconstruction [11,19,21,22]; at least one study suggested little difference between patients who had a reconstruction and those who had not [24]. We previously reported a satisfactory result of ambulatory status of a patient after total sacrectomy without spinopelvic reconstruction and thought that it was an appropriate method in selected patients [17]. Although others have evaluated total sacrectomy without spinopelvic reconstruction [11,19,21,22,24], those reports lacked detail on postoperative functional outcomes, especially with respect to resection location.…”

“…For nine patients with bilateral Type I resection, five were able to walk without walking aids, four needed a walking aid and the mean MSTS score was 20 (range, [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Among the five patients who had a Type I resection on one side and a Type II resection on the contralateral side, four were able to walk with a walking aid, and the mean MSTS score was 18 (range, [15][16][17][18][19][20][21][22]. Radiographic findings in patients who had bilateral Type I resections where part of the anterior sacroiliac joint was remained (Fig.…”

“…Thirteen patients were able to walk, five without walking aids, two with a cane and sometimes without a walking aid, three with a cane, and three with a walker. Thirteen of 14 patients who had bilateral Type I resections or a Type I resection on one side and Type II on the contralateral side were able to walk, five without a walking aid, and had a mean MSTS score of 19 (range, [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Two patients with bilateral Type II resection were only able to Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.…”

“…However, some surgeons prefer not to perform bony reconstructions after sacrectomy because some patients can ambulate and to avoid the risk of implant-related complications [11,19,21,22]. We began using sacrectomy without spinopelvic reconstruction as the preferred method at our institute after treating a patient with an infected wound after spinopelvic resection; the patient was able to walk with minimal pain after we removed all implants [17].…”

Risk Factors Associated with Reconstructive Complications Following Sacrectomy

“…En bloc sacrectomy can be an effective treatment for sacral tumors, metastatic lesions, and conditions such as osteomyelitis. 1–5 However, partial or total removal of the sacrum results in extensive injury to surrounding bone and soft tissue, often requiring hardware for bony reconstruction and soft-tissue coverage via pedicled or free flaps. 6–9 Plastic surgeons face particularly challenging decisions in this setting, as wound closure is frequently complicated by radiation, compromised local vasculature, and inherent stress to the sacral region.…”