Single staged en-bloc sacrectomy in giant cell tumor of sacrum using pre-operative embolization: A case report

BACKGROUND: Giant cell tumor (GCT) is a benign tumor with progressive and destructive characteristics involving metaphysis, with extension to the epiphyseal tissue, en-bloc resection surgery is the main choice for surgical treatment. IMPORTANCE: Our case report will discuss en bloc resection with pre-operative embolization for treating GCT in the sacrum to reduce the incidence of intraoperative bleeding. CASE PRESENTATION: A 33-year-old woman complained of low back pain radiating to the left leg that had been present for one year. Lumbosacral X-ray examination revealed a destructive osteolytic lesion involving the sacrum I-III and left iliac bones surrounded by soft tissue mass. The surgery on the patient 24 h later included installing posterior pedicle screw instrumentation on the 3rd and 4th lumbar, iliac screw, and using bone cement. After that, we performed a curettage on the mass and filled it with a bone graft. DISCUSSION: Non-surgical GCT management is effective but has a high local recurrence rate when used alongside curettage. Intralesional resection and en bloc resection are the most common surgical treatments. GCT with pathological fractures requires more invasive procedures, such as en-bloc resection, but excision can be performed to minimize surgical complications. Arterial embolization is a curative therapy for GCT sacral tumors. CONCLUSION: En-bloc resection with pre-operative arterial embolization for treating GCT can reduce the incidence of intraoperative bleeding.