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Chirurgia 2019 April;32(2):88-94

DOI: 10.23736/S0394-9508.18.04792-7


lingua: Inglese

Giant intrasacral schwannoma: removal and innovative posterior fixation system. Technical note and literature review

Delia CANNIZZARO 1, 2 , Cristina MANCARELLA 1, 2, Massimo TOMEI 1, Alessandro ORTOLINA 1, Andrea CARDIA 1, Maurizio FORNARI 1

1 Department of Neurosurgery, Humanitas Clinical and Research Center, Rozzano, Milan Italy; 2 Department of Neurology, Psychiatry and Neurosurgery, “Sapienza” University, Rome, Italy

Schwannoma is a rare benign tumor. The management of sacrum tumors remains one of the most demanding challenges in terms of partial or gross total removal and of long spinal fusion and instrumentation. The recently described sacral alar iliac screw fixation is an attractive alternative. The presentation, diagnosis, and management of intrasacral schwannomas are reviewed, as exemplified in a case presentation and literature review, with particular attention in technical procedures. we described a 71-year-old woman affected by a giant sacral(S1-S2) intraosseous lesion with involvement of spinal canal. A subtotal removal of the lesion and sacral alar iliac fixation was performed using intraoperative O-Arm images. Trans peduncle screws were placed in L4 and L5. A sacral screw was inserted in the right S1 and bilateral alar iliac fixation was performed. A posterolateral interbody fusion was performed in L4 L5. Positioned and tightened lordotic rods previously shaped in vertical axe, while a horizontal rod was positioned as cross link between L5 and S1, to replace bone architecture of the sacrum subverted by the tumor. Lumbo-sacral fixation for long fusion to the sacrum represents a debated issue. The development of more rigid bio-mechanically stable posterior fixation as evidenced by the use of iliac screws, trans sacral bars and trans iliac bars has resulted in a significant decrease in pseudoarthrosis rates. The use of single posterior fixation strengthened by the horizontal rod is valid option in the treatment of complex sacrum destroying lesion.

KEY WORDS: Sacrum - Neoplasms - Neurilemmoma - Arthrodesis

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