Combined Surgical Oncology and Neurosurgery Approach for Resection of Sacral Chordoma

Racheal Wolfson, MD, Richard Menger, MD, MPA, Ouyen Dinh Chu, MD, MBA, Anthony Sin, MD

Sacral chordomas are rare neoplasms of the sacral spine arising from remnants of the notochord. They are poorly responsive to chemotherapy and radiation therapy. The recommended treatment of sacral chordomas is en bloc resection with wide margins.

We present a case of a 46-year-old man with a sacral chordoma who underwent surgical resection of the mass. A combined anterior-posterior approach was used, with a surgical oncologist freeing the pelvic cavity through an abdominal laparotomy followed by a neurosurgeon resecting the mass and fusing the lumbar spine to the pelvis posteriorly. The patient underwent a laparotomy the second day for exploration of the pelvis and final closure. The procedure was well tolerated the the patient retained ambulation postoperatively.

Complete resection of sacral chordomas with wide margins offers the best prognosis for patients. Sacral chordomas should be referred to a tertiary care center with experience treating these lesions. Our center recommends a combined surgery-neurosurgery approach for safe resection of sacral chordomas.

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