Tumor lesions of the sacrum are relatively rare and account for 1-7% of all spinal tumors. Tumors of this localization are usually detected when the tumor reaches a significant size and causes gross neurologic disorders and impaired pelvic organs. Radicality of removal of tumors of the sacrum depends on the involvement of the cauda equina, pelvic organs and vascular structures in the process.
The study involved 13 pateintd TMA clinic on the basis of the Department of Traumatology, Orthopedics, Neurosurgery with GPH No2 from 2011 to 2016. There were 6 women, 7 men. Age category ranged from 17 to 50 years. 1-stage: Holographic selective angiography by Seldinger's method of small pelvic vessels with subsequent embolization of “feeding” tumor of vessels. In addition, the anatomical features of the arteries are determined taking into account the localization of the tumor process, which is important in the operation. 2-stage: After preoperative embolization, three patients underwent hemisakrumectomy with VS3-VS5, and three patients underwent VS1-VS3 sarcomectomy. In this case, patients were additionally stabilized by TPF systems by Lumbo-Pelviofixation.
In 2 cases during surgery, the tumor was intimately soldered to the roots of the horse tail and their isolation led to traumatization of the horse's tail, resulting in a postoperative delay in urine and stool. These violations were resolved within 2 months. In 4 patients with neurinoma S1, S2, S3 spine, an involuntary resection of these roots was performed. In these cases complications from the pelvic organs were not observed due to the presence of a cross innervation. In 2 patients, because of the duration of the operation, suppuration of the operating wound was noted with subsequent secondary healing. There were no lethal outcomes among 13 patients during follow-up.
The tactics of surgical treatment of sacral tumors, including the preliminary embolization of “feeding” arteries with subsequent radical removal of volume formation, reduces the risk of intraoperative complications, and also allows to remove the tumor totally, which in turn prevents its recurrence.
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All authors have declared no conflicts of interest.