Inomed Stockert Neuro N50. A versatile
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Multigen RF lesion generator .
21-MAY-2017 MUNIF MLEHAN AL-SHAMARI 40 YEARS
HUGE CHORDOMA WITH DESTRUCTION OF THE LOWER SACROCOCCYGEAL REGION BELOW THE LEFT
S2 ROOT WITH EXTRA AND INTRAPELVIC EXPANSION.
The patient came to the clinic 15-May-2017 complaining of
left sciatica for 3 months. The patient was
operated for "anal fissure" 6 months ago without
improvement. MRI bad quality done
06-December-2016 showing chordoma at the lower
half of the sacrum. Biopsy was done, confirmed
chordoma nature of the lesion. The patient has
difficult micturition the last 2 months.
On examination, the patient is limping with
exaggerated scoliotic stance. SLRS
was 40 degrees with pain in left side. There is weak
dorsi and planterflexion left foot -4/5, and
weak adduction of the knee 4/5. There is
analgesia in the left perianal region with weak
sphincter ani left side.
The patient was sent for investigations and
neuro MRI of the pelvis with TWIST and
spectroscopy of the lesion was performed showing
complete destruction of the coccygeum and left
side of the sacral bone up to the emergence of
the left S2 root. The SIJs are anatomically
preserved. The rectum is pushed anterior without
involvement. No arterial feeders were noted. The
left S2,3,4 are involved in the mass. The mass
is growing behind the sacrococcygeal structures
under the skin and fulfilling the pelvic cavity.
Spectroscopy of the mass showed moderate
elevation of Choline, NAA, lipid 1.3 and 0.9
Skeletonization of the
sacrococcygeal area. The tumor is destroying the S3
down to the coccygeum more the left side. Step wise
resection was performed until the rectum was seen
and the left S3 and S2 were preserved and the motor
response was adequate. The tumor is highly
vascularised that the patient was in need for 4
units of blood and 2 units FFP. The resected tumor
was sent for histologic study. Check MRI showed that
there is huge fragment in the right lower pole. This
part was resected with the tumorous coccygeum. Parts
of the tumor were severely adherent to the rectum,
that it was impossible to remove them without
violating the posterior wall of the rectum.
Coagulation of these fragments and another check MRI
was performed and these parts were seen. Routine
closure of the wound.
Smooth postoperative recovery. The power of
the left normalized and he was sciatica free.
He was sent to the ward.
The final histologic result was low-grade myxoid
chondrosarcoma with CD99 and Vimentin
positive and negative for S100 and E-Cadherin.
The patient has several problems, which
require surgical correction, stenosis at 2 levels and
This is the 118th case using the MultiGen. This procedure regained routine acceptance.
It became a usual part of the spine and peripheral nerves
surgery. Click here for
It is better not to perforate the rectum
by leaving 5% of the mass, since it is benign. Time will
tell the speed of the recurrence.