Strategy of surgical treatment of sacral neurogenic tumors

Assessment of different surgical approaches and procedures to remove different types of neurogenic tumors (Types I-IV).

To aid surgeons faced with operating on a sacral neurogenic tumor by providing guidelines for determining the best surgical approach to use based on the way a neurogenic tumor presents.

It is often difficult to determine the best surgical approach to use when operating on sacral neurogenic tumors. This retrospective study reports on the outcomes of patients with sacral neurogenic tumors and the surgical approach used in each case in order to better assess the most appropriate surgical approach and procedure to use with each tumor type.

Between July 1998 and July 2006, 48 cases (18 males) with sacral neurogenic tumors were admitted and treated. Average age was 47 years old (range, 17-75). The average period of follow-up was 47 months. There were 41 cases with benign tumors and 7 cases of malignant tumors. Depending on how the tumor presented, 1 of 3 surgical approaches was used, an anterior approach (7 patients), a posterior approach (22 patients), or a combined anterior-posterior approach (19 patients).

For the cases of Type I and the cases of Type II and III in which tumors grew forward but were lower than S1 level, surgical resection of tumors required a simple posterior approach. The cases of Type II and III in which tumors grew forward and expanded higher than S1 level required a combined anterior-posterior approach. For cases of Type IV, a simple anterior approach for resection of tumors was used.

In surgical resection of sacral neurogenic tumors, surgical approach depends on the location and size of the tumors. Intraspinal tumors should be excised from a posterior approach. For giant neurogenic tumors that arise from the sacrum and involve the spinal canal, surgical resection should be done by a combined anterior-posterior approach. Giant presacral neurogenic tumors located below the S1 level can be removed by a posterior approach. The anterior surgical approach should be used for giant presacral neurogenic tumors that are located above S1 and do not involve the spinal canal.