En bloc resection of middle-lower sacral chordomas under the microscope: a clinical study

Abstract

Objective To investigate the application value of microneurosurgery in combination with en-bloc idea in the resection of middle-lower sacral chordomas. Methods The chordomas only involving under S3 (including S3) are known as the middle-lower sacral chordomas. Eleven patients with middle-lower sacral chordoma were treated surgically from October 2007 to December 2012. The en-bloc resection concept was used as a guiding principle during the operation; osteotomy, nerve anatomy, and tumor separation were performed by using microneurosurgical technique in the specific removal process. The effect of operation and complications were observed. Results In the case of keeping the capsule intact, the sacral chordomas were totally removed. The mean time of operation was 141 min, and the mean blood loss was 420 ml. The nerves were clearly identified under the microscope. The anterior nerve roots above bilateral S3 were retained completely in 9 cases, and the anterior nerve roots of the unilateral S3 were retained completely in 2 cases. The bowel and bladder functions were preserved completely in 10 cases at 6 months after procedure, and partially preserved in one case. The patients were followed up for a mean of 3.7 years. Two patients had local recurrence. Conclusions In the middle-lower sacral chordoma surgery, en-bloc resection in combination with microneurosurgery technique is conducive to en-bloc resection of sacral chordomas and protection of neurological function, and reduction of introperative blood loss. The recurrence rate is low. Key words: Chordoma; Sacrococcygeal region; Microsurgery; En bloc resection