• Constantine Karakousis
  • Paul Sugarbaker


Sacrectomy is used for the removal of pelvic tumors with sacral attachments or for chordoma. It may be a satisfying dissection with clear margins or a difficult procedure with positive margins on nerve roots and considerable residual disability because of loss of nerve supply to anal and urethral sphincters. The tumors that involve the sacrum above the inferior border of the sacroiliac joints may require dissection or sacrifice of the S3, S2, or even S1 nerve roots. Tumors with an anterior component are approached through a combined abdominolateral approach in a lateral position or sequential abdominosacral positions. Tumors with a large posterior component are approached with the patient in a prone position. Tumors may require en-bloc resection of the rectum or anal canal plus rectum. Following division of the origin of the gluteus maximus muscle from the sacral edge, the pudendal nerve must be spared, because it courses posterior to the ischial spine and then on the surface of the obturator internus in the ischiorectal fossa. The dural sac ends at the S2–3 junction. If the dura is entered, it must be meticulously repaired to prevent a CSF leak. The fused sacral laminae are transected proximally with fine rongeurs. Sacral nerve roots are displaced laterally and the dura superiorly. The fused sacral bodies anteriorly may be divided with an osteotome. Closure is over generous closed-suction drainage.


Nerve Root Pudendal Nerve Sacrospinous Ligament Obturator Internus Ischiorectal Fossa 
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© Kluwer Academic Publishers 2004

Authors and Affiliations

  • Constantine Karakousis
  • Paul Sugarbaker

There are no affiliations available

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