Inferior gluteal artery detection at the greater sciatic notch with a computer-assisted navigation system during pelvic and sacral tumor resection

Figures & data

Table 1. Patient characteristics.

Case number	Age/sex	Pathological diagnosis	Location and surgical type^a	Tumor size (mm)
1	58/M	UPS of bone	P 2/3, IH	84 × 53 × 46
21st operation	60/F	Giant-cell tumor	Sacrum, intralesional resection and curettage	73 × 71 × 58
2nd operation	60/F	Giant-cell tumor	Same as 1st operation	38 × 28 × 28
3	66/M	Chondrosarcoma	P1, IH	50 × 34 × 38
4	63/M	Chondrosarcoma	P1/2/4, IH	130 × 86 × 120
5	63/M	Teratoma	Sacrum, sacrectomy below S2/3	103 × 74 × 66
6	66/F	Chondrosarcoma	P1/4, IH	90 × 100 × 58
7	78/M	Chordoma	Sacrum, sacrectomy below S2/3	65 × 21 × 41

UPS: undifferentiated pleomorphic sarcoma; IH: internal hemipelvectomy.

a Classification of tumor location and subsequent resection according to Enneking et al.[5,17] P1 = iliac wing; P2 = periacetabular region; P3 = superior and inferior pubic rami; P4 = hemisacrum.

Figure 1. Intraoperative navigation view of Case 4. The embolization coil is a bright point at the intersection of the red lines, indicated by the yellow circle. It was easily palpable and helpful as a reference point.

Figure 2. Intraoperative navigation view and postoperative CT 34 months after operation (Case 1). The inferior gluteal artery is indicated at the outlet of the greater sciatic notch with a dark blue line (a). The inferior gluteal artery (yellow arrows) on the operated side was preserved (b, c).

Figure 3. Intraoperative navigation view and postoperative CT 12 months after operation (Case 4). The inferior gluteal artery was detected on the pelvic cavity side of the greater sciatic notch (a). The patent inferior gluteal artery on the operated side (b, c).

Figure 4. Intraoperative navigation view of Case 2. Arrowhead indicates S2 root and arrow indicates S1 root encased by tumor.

Table 2. Outcomes.

Case number	Op time	Global error	Preparation time	Wound necrosis	Deep infection	Other postoperative complications	Follow-up (months)	Local recurrence
1	10 h 10 min	<1 mm	43 min	–	–	–	42	–
21st op	4 h 30 min	<1 mm	25 min	–	–	–	39	–
2nd op	6 h 12 min	<1 mm	30 min	–	–	–	39	–
3	5 h 38 min	<1 mm	25 min	–	–	–	29	–
4	5 h 50 min	<1 mm	33 min	–	–	–	27	–
5	4 h 25 min	<1 mm	22 min	–	–	Hematoma (POD 7)	16	–
6	6 h 58 min	<1 mm	27 min	+ (POD 14)	–	–	11	–
7	3 h 00 min	<1 mm	28 min	–	–	–	6	–
Mean	5 h 50 min	<1 mm	29 min	1/8 (12.5%)	0/8 (0%)	1/8 (12.5%)	24.3	0/7

POD: postoperative day.

Akiyama T, Clark JC, Miki Y, et al. The non-vascularised fibular graft: a simple and successful method of reconstruction of the pelvic ring after internal hemipelvectomy. J Bone Joint Surg Br. 2010;92:999–1005.

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Enneking WF, Dunham WK. Resection and reconstruction for primary neoplasms involving the innominate bone. J Bone Joint Surg Am. 1978;60:731–746.

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