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The pre-operative embolization of hypervascular spinal tumors is often performed to decrease intraoperative blood loss and facilitate tumor resection; however, few studies have been published on its effectiveness in giant cell tumors (GCT) of the sacrum and spine. The purpose of the present study was to investigate the value of surgical excision with pre-operative transarterial embolization for GCTs of the sacrum and spine, and to evaluate the follow-up outcomes. A retrospective study was performed on 28 patients with GCTs of the sacrum and spine, who underwent surgical treatment combined with pre-operative transarterial embolization between June 1995 and August 2011. The intraoperative blood loss, transfusion, duration of surgery, treatment, local recurrence, complications, follow-up status and functional outcome were reviewed. The average follow-up period was 86.3 months (range, 12-193 months). All the patients were treated with intralesional resection without any intraoperative shock or fatalities. The average intraoperative level of blood loss was 1,528.6 ml (range, 400-5,800 ml), the average transfusion volume was 1,514.3 ml (range, 400-6,000 ml) and the average duration of surgery was 225.4 min (range, 120-470 min). In total, eight (28.6%) patients developed recurrence and two patients succumbed. A total of eight (28.6%) patients experienced complications and 24 (85.7%) retained normal neurological function. Pre-operative embolization significantly decreases intraoperative blood loss and facilitates the maximal removal of the tumor. Pre-operative embolization followed by intralesional resection is able to achieve satisfactory local control and clinical outcomes. It is an effective technique for excising GCTs of the sacrum and spine.

The present study aimed to assess a posterior approach for the surgical resection of giant sacral neurogenic tumors, and to evaluate the oncological and functional outcomes. A total of 16 patients with giant sacral neurogenic tumors underwent pre-operative embolization and subsequent posterior sacral resection between January 2000 and June 2010. Benign tumors were identified in 12 cases, while four cases exhibited malignant peripheral nerve sheath tumors (MPNSTs). An evaluation of the operative techniques used, the level of blood loss, any complications and the functional and oncological outcomes was performed. All tumor masses were removed completely without intra-operative shock or fatalities. The mean tumor size was 17.5 cm (range, 11.5-28 cm) at the greatest diameter. The average level of intra-operative blood loss was 1,293 ml (range, 400-4,500 ml). Wound complications occurred in four patients (25%), including three cases of cutaneous necrosis and one wound infection. The mean follow-up time was 59 months (range, 24-110 months). Tumor recurrence or patient mortality as a result of the disease did not occur in any of the patients with benign sacral neurogenic tumors. The survival rate of the patients with malignant lesions was 75% (3/4 patients) since 25 % (1/4 patients) had multiple local recurrences and succumbed to the disease. The patients with benign tumors scored an average of 92.8% on the Musculoskeletal Tumor Society (MSTS) score functional evaluation, while the patients with malignant tumors scored an average of 60.3%. A posterior approach for the surgical resection of giant sacral neurogenic tumors, combined with pre-operative embolization may be safely conducted with satisfactory oncological and functional outcomes.