GIANT LUMBO-SACRAL TUMORS

Abstract

Objectives Despite comprising just 8% of all spinal tumors, sacral tumors present a long list of issues that should be taken in consideration when neurosurgical approach is tempted. Their unique anatomic location, close relation with neural structures and pelvic organs and high-vascularity are just a few nuances of these type of conditions. This paper outline the importance of a good preoperative and intraoperative management in order to facilitate the maximum recovery of the patients. Material and Methods This paper analyses retrospectively a series of 2 cases of giant sacral tumors (>100 cm3) that were operated in our clinic in 2024 by a multidisciplinary team (neurosurgeons and general surgeons). Follow-up data were obtained from the charts and medical records. All the lesions were localised under L4 vertebra with invasion of sacrum. Results Our first case was a 47-years old man who accused diffuse mild lumbar pain for more than 2 years, but acutely aggravated in the last months with lumbosacral radicular pain, palsy of the inferior lumbar nerves, urinary incontinence and paraesthesia. MRI showed a giant L5-S2 mass and biopsy diagnostic was myxopapillary ependymoma. Second case was of a young woman with lumbosacral radicular pain debuted a few months ago, whose clinical state worsened rapidly becoming paralytic of lower limbs. MRI showed a giant sacral mass with invasion of the pelvic musculature and surrounding the iliac vessels (intraoperative aspect: sarcoma). Both patients ameliorated postoperatively, and are currently enrolled in a recovery program. Sub-total resection and near-total resection were obtained. Conclusions Sacral tumors exhibit a challenge in the field of spine surgery being clinical silence over a period of months and years, and then followed by gross deficit. We diagnosed sacral tumors based on clinical, radiographic and laboratory aspects. Prognostic factors were preoperative clinical status and gross-total resection.