Percutaneous Computer-Assisted Transiliac Approach to Sacral Tumors

Abstract

Summary The aim of this article is to present a new, minimally invasive percutaneous image-guided technique for surgery of tumorous malformation of the sacrum. Using one of the available computer-assisted surgery systems, we developed a navigable working tube through which various surgical tools can be introduced very precisely into the tumorous malformation. The tube allows us to obtain histologic samples and to perform tumor resections as well. For sacral procedures, the working tube is introduced percutaneously into the affected area of the sacrum through the sacroiliac joint with computer assistance. For successful matching, small titanium screws are inserted into the sacrum and the pelvis percutaneously before computed tomographic examination to give us precise landmark points. We have used this method in 24 cases. The aim of the surgery in biopsy cases was to obtain samples for histologic diagnoses of unknown tumors. In the cases of tumor resection (all were metastatic), the goal was to obtain neurologic decompression and decreased local pain. The pain response was very effective in all cases. The transiliac percutaneous approach to the sacrum has proven to be a safe and well-designed procedure. It can be performed even under local anesthesia, thus making it a very effective minimally invasive tool for obtaining pain relief in cases of sacral metastasis involving the first, second, and third segments.