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Surgical Strategy of Pediatric Benign Sacral Tumors
Jun Wang1, Zhiye Du, Rongli Yang
1Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China.
Insights
This study presents a novel surgical strategy for rare pediatric sacral tumors, demonstrating effective outcomes and improved patient safety during operations. The approach utilizes preoperative selective arterial embolization (SAE) and intraoperative aortic balloon occlusion (ABO) to manage high-vascularity tumors.
Area of Science:
- Pediatric oncology
- Surgical oncology
- Spine surgery
Background:
- Benign osseous tumors and tumor-like lesions of the sacrum are rare in children.
- Optimal surgical strategies for these pediatric cases remain unclear.
Purpose of the Study:
- To evaluate the outcomes of a proposed surgical strategy and classification for pediatric sacral benign tumors and tumor-like lesions.
- To assess the safety and efficacy of preoperative selective arterial embolization (SAE) and intraoperative aortic balloon occlusion (ABO).
Main Methods:
- Analysis of 49 pediatric patients (aged ≤18 years) treated between 2005 and 2018.
- Inclusion of various tumor types, including giant cell tumors (GCTs) and aneurysmal bone cysts.
- Classification of surgical excision into three types based on tumor location, with SAE and ABO utilized for high-vascularity tumors.
Main Results:
- Giant cell tumors (39%) and aneurysmal bone cysts (18%) were the most common diagnoses.
- A 16% local recurrence rate was observed, with GCTs and neurogenic tumors showing recurrence.
- Neurological dysfunction occurred in 12% of patients, including incontinence and bowel obstruction.
- SAE and ABO showed no significant influence on oncological or non-oncological complications.
Conclusions:
- The proposed surgical strategy offers excellent therapeutic effects for pediatric sacral benign tumors.
- Preoperative SAE and intraoperative ABO enhance safety for patients with highly vascular sacral tumors.
- The classification system aids in surgical planning for these rare pediatric conditions.
Background:
Primary benign osseous tumors and tumor-like lesions at the sacrum are rare in the pediatric population and exact surgical strategy is still unclear. In this study, we evaluate the outcome for pediatric patients with benign tumors and tumor-like lesions at the sacrum who were receiving surgical treatment according to our proposed surgical strategy and classification.
Methods:
We analyzed 49 pediatric patients with sacral benign tumors or tumor-like lesions aged 18 years and below from 2005 to 2018. There were 23 men and 26 women with a mean age of 14.0±3.8 years. Nineteen patients had giant cell tumors (GCTs), 9 aneurysmal bone cysts, 5 osteoblastomas, 5 neurogenic tumors, 3 hemangiomas, 3 teratomas, 2 Langerhans cell histiocytosis, 1 chondroblastoma, 1 fibrous dysplasia, and 1 GCT of tendon sheath. We proposed our surgical plan and surgical classification for pediatric patients with sacral benign tumors or tumor-like lesions.
Results:
The mean follow-up duration was 6.2 years (range, 1.0 to 18.9 y). GCTs (39%, 19/49) and primary aneurysmal bone cysts (18%, 9/49) are the top 2 common histologic types. Preoperative selective arterial embolization (SAE) was performed in 12 cases and 24 patients received intraoperative aortic balloon occlusion (ABO) as the preoperative surgical plan. Furthermore, according to tumor location at the sacrum, we classified surgical excision of sacral benign tumors and tumor-like lesions into 3 types. Fourteen cases were classified as type I, 27 as type II, 3 as type III, and 5 patients with neurogenic tumors cannot be classified into this surgical classification. Ten patients had wound complications. Two had femoral artery thrombosis because of ABO application. One had mechanical failure. Rate of local recurrence was 16%. Seven patients with GCTs and 1 with neurogenic tumor had local recurrence. No patient died of disease at the last follow-up. For the assessment of neurological function, the rate of neurological dysfunction was 12% (6/49). Four cases had urinary incontinence, 3 fecal incontinence, and 3 had bowel obstruction. Next, univariate analysis for influence of preoperative SAE and intraoperative ABO on complications demonstrated that both of them exerted no significant influence on the occurrence of oncological and nononcological complications.
Conclusions:
The proposed surgical strategy can provide an excellent therapeutic effect for pediatric benign tumors and tumor-like lesions at the sacrum. Preoperative SAE and intraoperative ABO can safeguard pediatric patients with high vascularity of benign tumor at the sacrum during the operation.
Level Of Evidence:
Level IV.
