Sakralni gigantocelularni tumor lečen kompletnom sakrektomijom i spinopelvičnom fiksacijom. (Croatian).

Sacral gigantocellular tumor treated with total sacrectomy and spinal-pelvic fixation. (English)

SACRUM diseases; TREATMENT effectiveness; NEUROSURGERY; OPERATIVE surgery; PAIN; SPHINCTERS; TUMORS

Background. Total sacrectomy with spinal-pelvic fixation is considered to be a successful approach to the radical surgical treatment of extensive sacral tumors, however, technically very demanding, thus only rarely reported in the literature. We presented a patient with sacral gigantocellular tumor managed successfully using this method but with certain standard operative techniques improvements. Case report. A 30-year old patient with a pronounced painful syndrome and sphincter disorders was confirmed to have sacral gigantocellular tumor affecting a greater part of the sacrum. Tumor resection was performed in the first act out off retroperitoneal organs (colon and blood vesels), sacroiliac joints were open by the ventral side, the L5 discus removed, the S2-S5 roots cut off. In the second act, performed three weeks later, sacrectomy was completed by the reconstruction of pelvic ring and spinal-pelvic fixation. Then, the standard technique was modified to provide additional spinal fixation. The results of the operation (duration, blood loss, postoperative deficit) were quite comparable with, and in some aspects even better than the results published in the literature. Conclusion. Total sacrectomy with spinal-pelvic fixation can be a therapy of choice in patients with extensive sacral tumors requaring, however, the multidisciplinary approach and a considerable experience with instrumental spinal stabilization. [ABSTRACT FROM AUTHOR]

Uvod. Kompletna sakrektomija sa spinopelvičnom fiksacijom uspešan je način radikalnog hirurškog lečenja velikih sakralnih tumora, ali je tehnički veoma zahtevan, te se retko objavljuje u literaturi. Prikazan je bolesnik sa gigantocelularnim tumorom sakruma, uspešno lečen ovom metodom, kod koga su primenjena izvesna poboljšanja standardne operativne tehnike. Prikaz bolesnika. Bolesniku starom 30 godina, sa izrazitim bolnim sindromom i sfinkternim smetnjama, dokazan je gigantocelularni tumor koji je zahvatio veći deo sakruma. Operisan je u dva akta. U prvom aktu učinjena je disekcija tumora od retroperitonelanih organa (kolona i krvnih sudova), otvoreni su sakroilijačni zglobovi sa ventralne strane, uklonjen diskus L5 i presečeni korenovi S2-S5. U drugom aktu, učinjenom nakon tri nedelje, dovršena je sakrektomija i učinjena rekonstrukcija karličnog prstena i spinopelvična fiksacija. Tom prilikom modifikovana je standardna tehnika u cilju obezbeđivanja dodatne spinalne fiksacije. Rezultati operacije (trajanje, gubitak krvi, postoperativni deficit) sasvim su komparabilni, a u nekim aspektima i bolji, nego rezultati publikovani u literaturni. Zaključak. Sakrektomija sa spinopelvičnom fiksacijojm može biti terapija izbora za bolesnike sa ekstenzivnim sakralnim tumorom, ali zahteva multidisciplinarni pristup i značajno iskustvo u instrumentalnoj spinalnoj stabilizaciji. [ABSTRACT FROM AUTHOR]

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