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Ilio-Sacral & Pelvic Nerves Tumors


TUMORS OF THE PELVIC BONES & NERVES
LAPAROSCOPIC-ASSISTED ORTHOPEDIC SURGER

Tumor of the pelvic nerves (schwannomas…)

Schwannomas are benign nerve sheath tumors that arise from Schwann cells. Schwannomas do not necessarily impair nerve function, but deformation and compression of nerve fiber bundles induced by the tumor generally result in neuropathic pelvic pain such as sciatica, vulvar pain, coccyx pain, and pubic pain. Surgical exploration and removal of schwannomas are absolutely essential and must be performed, at least, to histologically confirm that the tumor is benign. Malignant degeneration of schwannomas is extremely rare, but possible.

Surgical removal of schwannomas is challenging because their anatomical location makes them difficult to access. Such surgery is associated with a high risk of intra- and post-operative bleeding due to the extremely good blood supply to the pelvis. Moreover, surgical resection poses a high risk of nerve damage.

The laparoscopic exploration provides a minimally invasive approach to achieving both complete excision and histological confirmation of the tumor. Moreover, laparoscopic visualization and monitoring of the blood supply to these tumors makes it possible to substantially reduce intra-operative blood loss. Visual identification of the rectum, ureters and pelvic nerves makes laparoscopic surgery safer and much simpler than the conventional neurosurgical approach. Furthermore, there is a lower risk of postoperative functional deficits. Laparoscopic surgery results in improvement of symptoms in most patients with sacral nerve root schwannomas. Post-operative worsening does not occur because the sacral nerve roots are spared.

Tumors of the pelvic bone (teratoma, osteochondrosarcom…)

Primary treatment of sacral tumors consists of complete surgical resection (removal) with wide tumor-free margins and functional reconstruction. This is a big challenge, especially if the tumor is located in the high part of the sacrum. Sacral tumor surgery is very demanding because it is difficult to gain access to the surgical site.

In addition, there is a high risk of massive intra- and post-operative bleeding (bleeding during and after surgery) due to the increased blood supply to the tumor. Moreover, surgical resection (removal) of sacral tumors poses a risk of damage to the adjacent nerves and organs, such as the ureters and rectum.

There is no standard surgical treatment for these specific pathologies.

The treatment of sacrococcygeal tumors (tumors involving the sacrum and coccyx) consists of excision of the affected parts of the sacrum and coccyx. This type of surgery is performed by orthopedic oncologists. Primary laparoscopic access to the tumor focuses on visually identifying the ureters, rectum and pelvic nerves in order to protect them from surgical damage. This makes it possible to remove all blood vessels that feed the tumor and occlude the internal iliac artery in order to reduce blood loss.

The Possover International Medical Center is the only medical center in the world that performs laparoscopic-assisted orthopedic surgery for pelvic bone & nerves tumor.