Bydon Mohamad, De la Garza-Ramos Rafael, Bettegowda Chetan, Suk Ian, Wolinsky Jean-Paul, Gokaslan Ziya L
‡The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins University School of Medicine, Baltimore, Maryland; §Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Neurosurgery. 2015 Sep;11 Suppl 3(Suppl 3):E472-8. doi: 10.1227/NEU.0000000000000836.
Giant cell tumors (GCTs) are rare primary bone neoplasms. The best long-term prognosis is achieved via complete tumor excision, but this feat is challenging in the spine due to proximity of blood vessels and nervous tissue. When occurring in the sacrum, GCTs have been removed in an en bloc fashion via combined anterior/posterior approaches, oftentimes with nerve root sacrifice. The purpose of this article is to present a case of a single-staged, posterior-only approach for en bloc resection of a sacral GCT without nerve root sacrifice.
A 45-year-old female presented with intractable lower back and leg pain, saddle anesthesia, and lower extremity weakness. She underwent imaging studies, which revealed a lesion involving the S1 and S2 vertebral bodies. Computed tomography guided biopsy revealed the lesion to be a GCT. The patient underwent a posterior-only approach without nerve root sacrifice to achieve an en bloc resection, followed by lumbopelvic reconstruction.
Sacrectomy via a single-staged posterior approach with nerve root preservation is a challenging yet feasible procedure for the treatment of giant cell tumors in carefully selected patients.
骨巨细胞瘤（GCTs）是罕见的原发性骨肿瘤。通过完整切除肿瘤可实现最佳的长期预后，但由于血管和神经组织距离较近，在脊柱部位完成这一目标具有挑战性。当骨巨细胞瘤发生在骶骨时，常通过前后联合入路整块切除肿瘤，且往往需要牺牲神经根。本文旨在介绍一例采用单阶段、仅后路入路整块切除骶骨骨巨细胞瘤且不牺牲神经根的病例。
一名45岁女性出现顽固性腰腿痛、鞍区感觉缺失及下肢无力。她接受了影像学检查，结果显示一个累及S1和S2椎体的病变。计算机断层扫描引导下活检显示该病变为骨巨细胞瘤。患者接受了仅后路入路且不牺牲神经根的整块切除手术，随后进行了腰骶骨盆重建。
对于精心挑选的患者，采用单阶段后路入路并保留神经根的骶骨切除术是一种具有挑战性但可行的治疗骨巨细胞瘤的方法。
