Surgical treatment of sacral chordomas combined with transcatheter arterial embolization.

STUDY DESIGN

A retrospective study, analyzing midterm results of transcatheter arterial embolization (TAE) for removal of a sacral chordoma.

OBJECTIVE

To develop a suitable method to maximally remove the tumor.

SUMMARY OF BACKGROUND DATA

Although previous reports have reported the use of TAE for removal of tumors, there is currently no data available on using this method to treat sacral chordomas.

METHODS

Thirty patients with sacral chordomas, who underwent surgical treatment from January 1994 to September 2005, were selected. All 30 patients underwent the posterior approach after TAE of the main arteries that supplied the sacral chordoma. The average follow-up was 44.6 months after the operation. The blood lost during the operation, blood transfusion, and the blood drained from the patient after the operation was reviewed. In addition, the sphincter muscle function of the bladder and bowel was observed.

RESULTS

The intraoperative blood loss averaged 1200 mL during the removal of the tumor. The average blood drained from the patient after the operation was 650 mL. The average blood transfusion postoperatively was 1080 mL. Of the 30 patients, 12 had recurrence and 2 died of tumor metastasis. In the 17 patients whose sacral nerve roots had been bilaterally reserved at and above the S3 level, the sphincter muscle function of the bladder and bowel was good, whereas the function of the sphincter muscles was impaired in 2 patients with nerve roots reserved only at and above the S1 level. In 1 case, colostomy and ureterocutaneosomy were used.

CONCLUSIONS

In comparison with historical literature, preoperative TAE for excising the sacral tumor can significantly decrease intraoperative blood loss, make the surgical field clear, possibly eliminate the need for using an anterior approach, and facilitate the maximal removal of the sacral chordoma. It is an encouraging technique for excising the sacral chordomas.