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Case Reports in Surgery
Volume 2014, Article ID 834537, 10 pages
http://dx.doi.org/10.1155/2014/834537
Case Report

Modified Kraske Procedure with Mid-Sacrectomy and Coccygectomy for En Bloc Excision of Sacral Giant Cell Tumors

1Neurosurgery Department, Garcia de Orta Hospital, Avenida Torrado da Silva, 2801-951 Almada, Portugal
2Orthopedic Department, Beatriz Ângelo Hospital, Avenida Carlos Teixeira, 2674-514 Loures, Portugal
3General Surgery Department, CUF Infante Santo Hospital, Travessa do Castro, 1350-070 Lisbon, Portugal
4General Surgery Department, Garcia de Orta Hospital, Avenida Torrado da Silva, 2801-951 Almada, Portugal
5Plastic and Reconstructive Surgery Department, Garcia de Orta Hospital, Avenida Torrado da Silva, 2801-951 Almada, Portugal

Received 14 July 2014; Accepted 5 October 2014; Published 16 October 2014

Academic Editor: Yoshiharu Kawaguchi

Copyright © 2014 Vítor M. Gonçalves et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Sacral giant cell tumors are rare neoplasms, histologically benign but potentially very aggressive due to the difficulty in achieving a complete resection, their high recurrence rate, and metastization capability. Although many treatment options have been proposed, en bloc excision with tumor-free margins seems to be the most effective, being associated with long term tumor control, improved outcome, and potential cure. An exemplifying case of a 29-year-old female with progressive complaints of pain and paresthesias in the sacral and perianal regions, constipation, and weight loss for 6 months is presented. The surgical technique for en bloc excision of a large sacral giant cell tumor through a modified Kraske procedure with mid-sacrectomy and coccygectomy is described. Complete resection with wide tumor-free margins was achieved. At 5 years of follow-up the patient is neurologically intact, without evidence of local recurrence on imaging studies. A multidisciplinary surgical procedure is mandatory to completely remove sacral tumors. In the particular case of giant cell tumors, it allows minimizing local recurrence preserving neurovascular function, through a single dorsal and definitive approach.