Detaillierte Beitrags-Information
| Beitragstitel | Giant Pendulum WDLS Through Sciatic Notch: Transient Iliac Osteotomy For Complete Tumor Resection |
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| Beitragscode | P106 |
| Autoren | |
| Präsentationsform | Poster |
| Themengebiete |
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| Abstract |
Purpose Pendulum tumors around the pelvis are infrequent, occur per definition intra- and extrapelvically, and pass either through the sciatic notch or the foramen obturatorium. Most often, there is a large discrepancy between the two parts of the tumor such, that the entirety of the mass can be approached from one compartment. However, if both the intra- and extrapelvic parts are so large that this is not possible, the question remains how to approach. Specifically, when the tumor should be removed completely for oncologic purposes. Method A 45 year old man noticed some unspecific abdominal pain for years, as well as right gluteal swelling for some months, but when a foot drop occurred, he sought medical attention. A large lipomatous tumor mass of 38cm was found on imaging both intra- and extrapelvically, communicating through the sciatic notch, and involving all the sacral nerve roots looped within the tumor mass. Ultrasound-guided tru-cut biopsy revealed a well differentiated liposarcoma, whereas some dedifferentiated parts with this large mass were still possible. To potentially improve the intrapelvic resection margins, preoperative radiotherapy with 50Gy was conducted. Results Using a triradiate incision, both intra- and extrapelvic masses were dissected, and to remove the mass in its entirety, we elected to osteotomize the ilium starting from the posterior aspect of the notch, slightly anteriorly tilted. The roof of the notch was separately removed with some 2x3cm, rendering an iliac opening (together with moving the leg) of up to 6cm, thereby allowing to lift the entire tumor in one piece. The sacro-spinal and –tuberal ligaments were preserved, as well as the femoral and obturator nerves, while all the sacral nerve roots were sacrificed. The pelvis was osteosynthesized using three threaded screws. Conclusion An intra- and extrapelvic tumor mass -which for oncologic reasons has to be completely removed- is safely approached through an iliac osteotomy, allowing to open up wide enough to mobilize it en bloc. Anatomic reduction is followed by screw osteosnythesis, and no additional morbidity is expected. |