Yudistira Andhika, Aslam Achmad Bayhaqi Nasir, Asmiragani Syaifullah, Satriawan Ery, Airlangga Gilang
Spine Division of Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya - Saiful Anwar General Hospital, Malang, East Java, Indonesia.
Radiologic Intervention Division of Radiologic Department, Faculty of Medicine, Universitas Brawijaya - Saiful Anwar General Hospital, Malang, East Java, Indonesia.
Int J Surg Case Rep. 2023 Jun;107:108324. doi: 10.1016/j.ijscr.2023.108324. Epub 2023 May 13.
Giant cell tumor (GCT) is a benign tumor with progressive and destructive characteristics involving metaphysis, with extension to the epiphyseal tissue, en-bloc resection surgery is the main choice for surgical treatment.
Our case report will discuss en bloc resection with pre-operative embolization for treating GCT in the sacrum to reduce the incidence of intraoperative bleeding.
A 33-year-old woman complained of low back pain radiating to the left leg that had been present for one year. Lumbosacral X-ray examination revealed a destructive osteolytic lesion involving the sacrum I-III and left iliac bones surrounded by soft tissue mass. The surgery on the patient 24 h later included installing posterior pedicle screw instrumentation on the 3rd and 4th lumbar, iliac screw, and using bone cement. After that, we performed a curettage on the mass and filled it with a bone graft.
Non-surgical GCT management is effective but has a high local recurrence rate when used alongside curettage. Intralesional resection and en bloc resection are the most common surgical treatments. GCT with pathological fractures requires more invasive procedures, such as en-bloc resection, but excision can be performed to minimize surgical complications. Arterial embolization is a curative therapy for GCT sacral tumors.
En-bloc resection with pre-operative arterial embolization for treating GCT can reduce the incidence of intraoperative bleeding.
骨巨细胞瘤（GCT）是一种具有进行性和破坏性特征的良性肿瘤，累及干骺端，并延伸至骨骺组织，整块切除手术是主要的手术治疗选择。
我们的病例报告将讨论术前栓塞后整块切除治疗骶骨骨巨细胞瘤，以降低术中出血的发生率。
一名33岁女性主诉腰痛并向左下肢放射，症状已持续一年。腰骶部X线检查显示，骶骨I-III及左侧髂骨有一溶骨性破坏病变，周围有软组织肿块。24小时后对该患者进行的手术包括在第3和第4腰椎安装后路椎弓根螺钉内固定、髂骨螺钉，并使用骨水泥。之后，我们对肿块进行了刮除并植骨。
非手术治疗骨巨细胞瘤是有效的，但与刮除术联合使用时局部复发率较高。病灶内切除和整块切除是最常见的手术治疗方法。伴有病理性骨折的骨巨细胞瘤需要更具侵入性的手术，如整块切除，但可以进行切除以尽量减少手术并发症。动脉栓塞是骶骨骨巨细胞瘤的一种治疗方法。
术前动脉栓塞后整块切除治疗骨巨细胞瘤可降低术中出血的发生率。
