Trattamento demolitivo e ricostruttivo in un case di voluminoso cordoma del sacro

Chordomas are rare tumors which mostly are locally invasive; they are seen in the vertebral column and probably originate from embryonal rests of the chorda dorsalis. Those in the sacral region have a slow growth and can sometimes become very large and produce symptoms mainly due to local compression. The Authors discuss the case of a 67 yrs old man they have treated. After a description of the clinical features and of the protocol to follow to diagnose and evaluate this tumor, they describe the surgical treatment consisting of the resection of the sacral metameres involved and of the perisacral soft tissue as far as the rectal posterior wall. The reconstruction of the defect was obtained with a dural layer to protect the rectum and a polyester mesh. A gluteus maximus myocutaneous flap was then rotated to provide both adequate coverage to the underlying mesh and sacrum, and good quality tissue in view of the additional x-ray therapy. The patient is being followed-up and a year later there is no evidence of recurrence and the tissues are perfectly viable.