Diagnosis and management of sacral tumors

A review

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Sacral tumors pose significant challenges to the managing physician from diagnostic and therapeutic perspectives. Although these tumors are often diagnosed at an advanced stage, patients may benefit from good clinical outcomes if an aggressive multidisciplinary approach is used. In this review, the epidemiology, clinical presentation, imaging characteristics, treatment options, and published outcomes are discussed. Special attention is given to the specific anatomical constraints that make tumors in this region of the spine more difficult to effectively manage than those in the mobile portions of the spine.

Article Information

Address correspondence to: Daniel M. Sciubba, M.D., Department of Neurosurgery, Johns Hopkins University, 600 North Wolfe Street, Meyer Building 8-161, Baltimore, Maryland 21287. email: dsciubb1@jhmi.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    A: Sagittal STIR MR image showing a hyperintense lesion of the sacrum that proved to be chordoma on biopsy. B and C: Photographs (anterior [B] and posterior [C] views) of a specimen obtained by en bloc resection showing wide soft-tissue margins. D: Intraoperative photograph following resection shows posterior aspect of rectum visible in operative field and preservation of bilateral S-3 nerve roots.

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    Sagittal T1-weighted MR image showing large sacral mass, consistent with giant cell tumor.

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    Sagittal T2-weighted (A), sagittal Gd T1-weighted (B), and axial Gd T1-weighted (C) MR images obtained in a patient with a large, cystic schwannoma of the sacrum.

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    Plain anteroposterior radiograph showing loss of sacral ala projection on the patient's right side, suggesting a lytic, sacral tumor.

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