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Computer Navigation-aided Resection of Sacral Chordomas

Chinese Medical Journal 2016年第2期129卷 162-168页

作者： Yong-Kun Yang Chung-Ming Chan Qing Zhang Hai-Rong Xu Xiao-Hui Niu Department of Orthopedic Oncology Surgery Beijing Ji Shui Tan Hospital Peking University Beijing 100035 China Department of Orthopaedics and Rehabilitation Division of Musculoskeletal Oncology University of Florida Gainesville Florida 32611 USA

Background： Resection of Sacral chordomas is challenging. The anatomy is complex, and there are often no bony landmarks to guide the resection. Achieving adequate surgical margins is, therefore, difficult, and the recurrence rate is high. Use of computer navigation may allow optimal preoperative planning and improve precision in tumor resection. The purpose of this study was to evaluate the safety and feasibility of computer navigation-aided resection of Sacral chordomas. Methods： Between 2007 and 2013, a total of 26 patients with Sacral chordoma underwent computer navigation-aided surgery were included and followed for a minimum of 18 months. There were 21 primary cases and 5 recurrent cases, with a mean age of 55.8 years old （range： 35 84 years old）. Tumors were located above the level of the $3 neural foramen in 23 patients and below the level of the $3 neural foramen in 3 patients. Three-dimensional images were reconstructed with a computed tomography-based navigation system combined with the magnetic resonance images using the navigation software. Tumors were resected via a posterior approach assisted by the computer navigation. Mean follow-up was 38.6 months （range： 18-84 months）. Results： Mean operative time was 307 min. Mean intraoperative blood loss was 3065 ml. For computer navigation, the mean registration deviation during surgery was 1.7 ram. There were 18 wide resections, 4 marginal resections, and 4 intralesional resections. All patients were alive at the final follow-up, with 2 （7.7%） exhibiting tumor recurrence. The other 24 patients were tumor-free. The mean Musculoskeletal Tumor Society Score was 27.3 （range： 19-30）. Conclusions： Computer-assisted navigation can be safely applied to the resection of the Sacral chordomas, allowing execution of preoperative plans, and achieving good oncological outcomes. Nevertheless, this needs to be accomplished by surgeons with adequate experience and skill.

关键词： Chordoma Computer-assisted Navigation Resection Sacral

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Surgical treatment of Sacral fractures following lumboSacral arthrodesis: Case report and literature review

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World Journal of Orthopedics 2016年第1期7卷 69-73页

作者： Yu Wang Xian-Yi Liu Chun-De Li Xiao-Dong Yi Zheng-Rong Yu Department of Orthopaedics Peking University First Hospital

Sacral fractures following posterior lumboSacral fusion are an uncommon complication. Only a few case series and case reports have been published so far. This article presents a case of totally displaced Sacral fracture following posterior L4-S1 fusion in a 65-yearold patient with a 15-year history of corticosteroid use who underwent open reduction and internal fixation using iliac screws. The patient was followed for 2 years. A thorough review of the literature was conducted using the Medline database between 1994 and 2014. Immediately after the revision surgery, the patient's pain in the buttock and left leg resolved significantly. The patient was followed for 2 years. The weakness in the left lower extremity improved gradually from 3/5 to 5/5. In conclusion, the incidence of postoperative Sacral fractures could have been underestimated, because most of these fractures are not visible on a plain radiograph. Computed tomography has been proved to be able to detect most such fractures and should probably be performed routinely when patients complain of renewed buttock pain within 3 mo after lumboSacral fusion. The majority of the patients responded well to conservative treatments, and extending the fusion construct to the iliac wings using iliac screws may be needed when there is concurrent fracture displacement, sagittal imbalance, neurologic symptoms, or painful nonunion.

关键词： Sacral fracture Insufficiency fracture Surgical treatment Complication LumboSacral fusion Revision surgery

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Adverse events of Sacral neuromodulation for fecal incontinence reported to the federal drug administration

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2016年第2期7卷 294-305页

作者： Klaus Bielefeldt Division of Gastroenterology University of Pittsburgh Medical Center

AIM:To investigate the nature and severity of AE related to Sacral neurostimulation(SNS).METHODS:Based on Pubmed and Embase searches,we identified published trials and case series of SNS for fecal incontinence(FI)and extracted data on adverse events,requiring an active intervention.Those problems were operationally defined as infection,device removal explant or need for lead and/or generator replacement.In addition,we analyzed the Manufacturer and User Device Experience registry of the Federal Drug Administration for the months of August-October of2015.Events were included if the report specifically mentioned gastrointestinal(GI),bowel and FI as indication and if the narrative did not focus on bladder symptoms.The classification,reporter,the date of the recorded complaint,time between initial implant and report,the type of AE,steps taken and outcome were extracted from the report.In cases of device removal or replacement,we looked for confirmatory comments by healthcare providers or the manufacturer.RESULTS:Published studies reported adverse events and reoperation rates for 1954 patients,followed for 27(1-117)mo.Reoperation rates were 18.6%(14.2-23.9)with device explants accounting for 10.0%(7.8-12.7)of secondary surgeries;rates of device replacement or explant or pocket site and electrode revisions increased with longer follow up.During the period examined,the FDA received 1684 reports of AE related to SNS with FI or GI listed as indication.A total of 652 reports met the inclusion criteria,with 52.7%specifically listing FI.Lack or loss of benefit(48.9%),pain or dysesthesia(27.8%)and complication at the generator implantation site(8.7%)were most commonly listed.Complaints led to secondary surgeries in 29.7%of the AE.Reoperations were performed to explant(38.2%)or replace(46.5%)the device or a lead,or revise the generator pocket(14.6%).Conservative management changes mostly involved changes in stimulation parameters(44.5%),which successfully addressed concerns in 35.2%of cases that included information about treat

关键词： Sacral nerve stimulation Implanted medical devices Treatment complications Defecation disorders Device registry

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Isolated Sacral injuries: Postoperative length of stay, complications, and readmission

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World Journal of Orthopedics 2015年第8期6卷 629-635页

作者： Vasanth Sathiyakumar Hanyuan Shi Rachel V Thakore Young M Lee David Joyce Jesse Ehrenfeld William T Obremskey Manish K Sethi the Vanderbilt Orthopaedic Institute Center for Health Policy Medical Center East

AIM: To investigate inpatient length of stay(LOS), complication rates, and readmission rates for Sacral fracture patients based on operative approach.METHODS: All patients who presented to a large tertiary care center with isolated Sacral fractures in an 11-year period were included in a retrospective chart review. Operative approach(open reduction internal fixation vs percutaneous) was noted, as well as age, gender, race, and American Society of Anesthesiologists' score. Complications included infection, nonunion and malunion, deep venous thrombosis, and hardware problems; 90-d readmissions were broken down into infection, surgical revision of the Sacral fracture, and medical complications. LOS was collected for the initial admission and readmission visits if applicable. Fisher's exact and non-parametric t-tests(Mann-Whitney U tests) were employed to compare LOS, complications, and readmissions between open and percutaneous approaches.RESULTS: Ninety-four patients with isolated Sacral fractures were identified: 31(30.4%) who underwentopen reduction and internal fixation(ORIF) vs 63(67.0%) who underwent percutaneous fixation. There was a significant difference in LOS based on operative approach: 9.1 d for ORIF patients vs 6.1 d for percutaneous patients(P = 0.043), amounting to a difference in cost of $13590. Ten patients in the study developed complications, with no significant difference in complication rates or reasons for complications between the two groups(19.4% for ORIF patients vs 6.3% for percutaneous patients). Eight patients were readmitted, with no significant difference in readmission rates or reasons for readmission between the two groups(9.5% percutaneous vs 6.5% ORIF).CONCLUSION: There is a significant difference in LOS based on operative approach for Sacral fracture patients. Given similar complications and readmission rates, we recommend a percutaneous approach.

关键词： Sacral fractures Open reduction and internal fixation Percutaneous complications Readmissions Length of stay

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Combined Sacral Nerve Roots Stimulation and Low Thoracic Spinal Cord Stimulation for the Treatment of Chronic Pelvic Pain

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Pain Studies and Treatment 2014年第2期2卷 86-90页

作者： Samer Abdel-Aziz Ahmed Ghaleb Department of Anesthesiology and Pain Medicine University of Arkansas for Medical Sciences Little Rock USA

Some pelvic pain syndromes are very resistant to medical treatment. Several studies have demonstrated that Sacral neuromodulation, which has been successfully used for the treatment of bladder dysfunction, incontinence, urinary retention and urinary frequency [1]-[3], can be successfully used for the treatment of chronic pelvic pain [4]-[7]. Several studies have also demonstrated significant involvement of dorsal column pathways in the transmission of visceral pelvic pain [8] and the successful use of spinal cord stimulation for the treatment of chronic pelvic pain [9]. We report three cases of severe chronic pelvic pain that failed conservative treatment modalities. Placement of a combined Sacral nerve roots stimulator and a low thoracic spinal cord stimulator resulted in a significant pain relief and improvement in daily life activities. We believe that this combination may help patients suffering from chronic pelvic pain resistant to medical management.

关键词： Chronic Pelvic Pain Sacral Nerve Roots Stimulation Thoracic Spinal Cord Stimulation

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Sacral neuromodulation therapy of the lower urinary tract: A review of the literature and unanswered questions

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Open Journal of Obstetrics and Gynecology 2013年第4期3卷 1-6页

作者： Golnaz Alemi Vani Dandolu Department of Obstetrics and Gynecology University of Nevada School of Medicine Las Vegas USA

Objective: To review the evidence surrounding Sacral Neuromodulation therapy and delineate areas that will need more research. Methods: An extensive search was performed on the available literature on SNM for lower urinary tract dysfunction. Based on the results of the search, the mechanisms of action, indications, technique, and patient characteristics of therapy failures and success are presented and discussed. Results: SNM is accepted by the FDA since 1997 for the treatment of lower urinary tract dysfunction. As it is a relatively new procedure, there are variations in the technique of lead placement, generator choice, testing interval, patient selection, time to explantation, and definitions of therapy failures and successes. Conclusions: SNM is a safe and therapeutic option for the treatment of urgencyfrequency syndrome, urge incontinence, and idiopathic urinary retention. However, there are multiple unanswered questions that require extensive research.

关键词： Sacral Neuromodulation SNM Peripheral Nerve Evaluation PNE InterStim Tined Lead Electrode Implantable Pulse Generator Lower Urinary Tract Dysfunction Explantation Urgency Frequency Syndrome Urinary Retention Incontinence

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A Rare Case of Anterior Sacral Meningocele (ASM) in a Young Patient

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Open Journal of Modern Neurosurgery 2016年第1期6卷 16-19页

作者： Shanu Gambhir Mark Winder Gareth Owen Department of Neurosurgery St. Vincent’s Hospital Darlinghurst Australia

We report a 24-year-old male who presented with abdominal distension, constipation and left sided groin pain. CT and MRI of the abdomen/spine were performed which showed a large anterior Sacral meningocele occupying most of the pelvic and abdominal cavity and displacement of their respective contents. Initially a posterior approach with lumboSacral laminectomy (L5 - S4) was performed. The ostium of the meningocele was identified with several nerve roots identified passing through, adjacent and into the defect. As nerve roots traversed the ostium, watertight closure was not feasible without sacrificing nerve roots. Subsequent MRI demonstrated recurrence of approximately 60% of the anterior Sacral meningocele. We therefore opted to approach the ASM anteriorly via an anterior approach with the help of colorectal surgical colleague. The ASM was completely embedded within the sigmoid and upper to mid rectal mesentry, with its own vascular supply to the thick walled capsule. This case highlights the need for a combined approach due to the incorporation of the pseudomeningocele into the omentum with the development of its own blood supply.

关键词： Spina Bifida Sacral Meningocele Abdominal Distension

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Impact of Therapeutic Electrical Stimulation of Sacral Surface Considering Individual Anatomical Sacral Variations on Early Recovery Urinary Continence after Radical Prostatectomy

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Forensic Medicine and Anatomy Research 2017年第1期5卷 1-13页

作者： Naser A. ElSawy Hesham G. Mahran Abdullah G. Alkushi Department of Laboratory Medicine Faculty of Applied Medical Sciences Umm al Qura University Makkah KSA Department of Anatomy and Embryology Faculty of Medicine Zagazig University Zagazig Egypt Department of Physical Therapy for Surgery Faculty of Physical Therapy Cairo University Cairo Egypt Department of Anatomy Faculty of Medicine Umm Al-Qura University Makkah KSA

Objectives: To investigate the effect of electrical stimulation of different anatomical variations of Sacral surface on early recovery of urinary continence after radical prostatectomy. Methods: Twenty of 53 consecutive patients who underwent prostatectomy by a single surgeon were enrolled in this study. Ten patients were prospectively randomized to two groups;five patients in Sacral foramena stimulation group received postoperative surface electrical stimulation of Sacral foramina area while five patients in control group did not received any electrical stimulation. Selection of remaining ten patients depended on Sacral hiatus anatomical variations, assessed by plan X-rays. Of the ten patients, five patients with Sacral hiatus subtotals were grouped under SHS1 while 5 patients with Sacral hiatus totals were grouped as SHS2. Electrical stimulation for each group began 7 days after catheter removal, thrice a week for 8 weeks. Each of the 24 treatment sessions for each group composed of 20 minutes for Sacral electrical stimulation. Continence was evaluated at baseline, 4 and 8 weeks using the 24-hour pad test and according to the incontinence section of the International Continence Society questionnaire. Results: After 2 weeks of treatment, the mean leakage weight was comparable between SFS group and SHS1 group while it was significantly lowered in SHS2 as compared to SFS and SHS1 groups. Comparing mean leakage weight at 8 weeks revealed further significant reduction in SHS2 group than in SFS and SHS1 groups. Moreover, percentage of continent patients was highest in SHS2 group after 8 weeks of treatment followed by SHS1, SFS and control respectively. Conclusions: Electrical stimulation of Sacral hiatus surface area may provide better stimulation for Sacral nerve than Sacral foramena surface area and appears to be effective treatment for early recovery of urinary continence after radical prostatectomy.

关键词： Urinary Incontinence Electrical Stimulation Sacral Foramina Sacral Hiatus Area Radical Prostatectomy

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Neuromodulation for fecal incontinence: An effective surgical intervention

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World Journal of Gastroenterology 2013年第41期19卷 7048-7054页

作者： Giuseppe Chiarioni Olafur S Palsson Corrado R Asteria William E Whitehead Division of Gastroenterology of the University of Verona Valeggio s/M HospitalAzienda Ospedaliera Universitaria Integrata di Verona37067 Valeggio sul MincioVeronaItaly Division of Gastroenterology and Hepatology and Center for Functional Gastrointestinal and Motility Disorders University of North Carolina at Chapel HillChapel HillNC 27516United States Department of Surgery and Orthopedics General Surgery UnitAzienda Ospedaliera Carlo Poma di MantovaAsola General Hospital46041 AsolaMantovaItaly

Fecal incontinence is a disabling symptom with medical and social implications,including fear,embarrassment,isolation and even depression.Most patients live in seclusion and have to plan their life around the symptom,with secondary impairment of their quality of life.Conservative management and biofeedback therapy are reported to benefit a good percentage of those affected.However,surgery must be considered in the nonresponder population.Recently,Sacral nerve electrostimulation,lately named neuromodulation,has been reported to benefit patients with fecal incontinence in randomized controlled trials more than placebo stimulation and conservative management,by some unknown mechanism.Neuromodulation is a minimally invasive procedure with a low rate of adverse events and apparently favorable cost-efficacy profile.This review is intended to expand knowledge about this effective intervention among the non-surgically skilled community who deals with this disabled group of patients.

关键词： Fecal incontinence Neuromodulation Sacral nerve stimulation Biofeedback Anal sphincter

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AbdominoSacral resection for locally recurring rectal cancer

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World Journal of Gastrointestinal Surgery 2016年第12期8卷 770-778页

作者： Filiberto Belli Alessandro Gronchi Carlo Corbellini Massimo Milione Ermanno Leo Colorectal Surgery Unit National Cancer Institute Sarcoma-Melanoma Surgery Unit National Cancer Institute Department of Pathology National Cancer Institute

AIM To investigate feasibility and outcome of abdominalSacral resection for treatment of locally recurrent rectal adenocarcinoma.METHODS A population of patients who underwent an abdominalSacral resection for posterior recurrent adenocarcinoma of the rectum at the National Cancer Institute of Milano, between 2005 and 2013, is considered. Retrospectively collected data includes patient characteristics, treatment and pathology details regarding the primary and the recurrent rectal tumor surgical resection. A clinical and instrumental follow-up was performed. Surgical and oncological outcome were investigated. Furthermore an analytical review of literature was conducted in order to compare our case series with other reported experiences.RESULTS At the time of abdomino-Sacral resection, the mean age of patients was 55(range, 38-64). The median operating time was 380 min(range, 270-480). Sacral resection was performed at S2/S3 level in 3 patients, S3/S4 in 3 patients and S4/S5 in 4 patients. The median operating time was 380 ± 58 min. Mean intraoperative blood loss was 1750 m L(range, 200-680). The median hospital stay was 22 d. Overall morbidity was 80%, mainly type Ⅱ complication according to the ClavienDindo classification. Microscopically negative margins(R0) is obtained in all patients. Overall 5-year survival after first surgical procedure is 60%, with a mediansurvival from the first surgery of 88 ± 56 mo. The most common site of re-recurrence was intrapelvic.CONCLUSION Sacral resection represents a feasible approach to posterior rectal cancer recurrence without evidence of distant spreading. An accurate staging is essential for planning the best therapy.

关键词： Rectal cancer recurrence Local recurrence Sacral resection AbdominoSacral resection Recurrent rectal cancer

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