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Pairojboriboon S, Sacino A, Pennington Z, Lubelski D, Yang R, Morris CD, Suk I, Sciubba DM, Lo SFL. Nerve Root Sparing En Bloc Resection of Sacral Chondrosarcoma: Technical Note and Review of the Literature. Oper Neurosurg (Hagerstown) 2021; 21:497-506. [PMID: 34791405 DOI: 10.1093/ons/opab333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/18/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Total en bloc sacrectomy provides the best long-term local control for large primary bony sacral tumors, but often requires lumbosacral nerve root sacrifice leading to loss of ambulation and/or bowel, bladder, and/or sexual dysfunction. Nerve-sparing techniques may be an option for some patients that avoid these outcomes and accordingly improve postoperative quality of life. OBJECTIVE To describe the technique for a posterior-only en bloc hemisacrectomy with maximal nerve root preservation and to summarize the available literature. METHODS A 38-yr-old woman with a 7.7 × 5.4 × 4.5 cm biopsy-proven grade 2 chondrosarcoma involving the left L5-S2 posterior elements underwent a posterior-only left hemisacrectomy tri-rod L3-pelvis fusion. A systematic review of the English literature was also conducted to identify other descriptions of high sacrectomy with distal sacral nerve root preservation. RESULTS Computer-aided navigation facilitated an extracapsular resection that allowed preservation of the left-sided L5 and S3-Co roots. Negative margins were achieved and postoperatively the patient retained ambulation and good bowel/bladder function. Imaging at 9-mo follow-up showed no evidence of recurrence. The systematic review identified 4 prior publications describing 6 total patients who underwent nerve-sparing sacral resection. Enneking-appropriate resection was only obtained in 1 case though. CONCLUSION Here we describe a technique for distal sacral nerve root preservation during en bloc hemisacrectomy for a primary sacral tumor. Few prior descriptions exist, and the present technique may help to reduce the neurological morbidity of sacral tumor surgery.
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Affiliation(s)
- Sutipat Pairojboriboon
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Department of Orthopaedic Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Amanda Sacino
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Zach Pennington
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Robin Yang
- Department of Plastic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Carol D Morris
- Department of Orthopedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ian Suk
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, New York, USA
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, New York, USA
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Trecartin AC, Peña A, Lovell M, Bruny J, Mueller C, Urquidi M, Bischoff A. Anal duplication: is surgery indicated? A report of three cases and review of the literature. Pediatr Surg Int 2019; 35:971-978. [PMID: 31256296 DOI: 10.1007/s00383-019-04509-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2019] [Indexed: 11/28/2022]
Abstract
AIM OF THE STUDY Anal canal duplications (ACDs) are extremely rare with only approximately 90 cases described in the literature. We report on three additional patients. METHODS Cases were analyzed to evaluate presenting symptoms, physical exam and MRI findings. A comprehensive literature review was performed to compare our patients to previously described cases. IRB approval was obtained for this study (19-0394). MAIN RESULTS The first female patient presented with an asymptomatic ACD at 2 years old. The second patient was a 13-year-old female with perianal drainage that was initially mistaken for a fistula-in-ano and ultimately found to have an ACD associated with a dermoid cyst. Both posterior midline duplications shared a common wall with the rectum, but did not communicate with it. The ACDs and dermoid cyst were successfully excised through a posterior sagittal approach with no postoperative complications. Histology demonstrated the presence of both squamous epithelium and transitional anal epithelium in each case. The third patient was 8 months old and had a tethered cord, hemisacrum, presacral mass, and anal duplication that was initially undiagnosed. These results corroborate patterns identified in other reports of ACDs with over 90% being female and in the posterior midline. The majority are asymptomatic, but may present with symptoms of local or even systemic infection. CONCLUSION An opening in the midline posterior to the anus should raise clinical suspicion for anal canal duplication. An associated presacral mass must be ruled out. Complete excision through a posterior sagittal approach is recommended upon diagnosis to avoid symptomatic presentations. The key part of the operation is the separation of the ACD from the posterior rectal wall.
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Affiliation(s)
- A C Trecartin
- International Center for Colorectal and Urogenital Care, Department of Pediatric Surgery, Children's Hospital Colorado, 13123 East 16th Avenue, Box 323, Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - A Peña
- International Center for Colorectal and Urogenital Care, Department of Pediatric Surgery, Children's Hospital Colorado, 13123 East 16th Avenue, Box 323, Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - M Lovell
- Department of Pathology, Children's Hospital Colorado, Aurora, CO, USA
| | - J Bruny
- International Center for Colorectal and Urogenital Care, Department of Pediatric Surgery, Children's Hospital Colorado, 13123 East 16th Avenue, Box 323, Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - C Mueller
- Department of Pediatric Surgery, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - M Urquidi
- Department of Pediatric Surgery, Clinica Olivos, Cochabamba, Bolivia
| | - Andrea Bischoff
- International Center for Colorectal and Urogenital Care, Department of Pediatric Surgery, Children's Hospital Colorado, 13123 East 16th Avenue, Box 323, Anschutz Medical Campus, Aurora, CO, 80045, USA.
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