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Paediatric Anaesthesia Jan 2022A sacrococcygeal teratoma and a sacral agenesis represent a contraindication to a caudal block. We report two cases where the optimal use of ultrasound helped place a...
A sacrococcygeal teratoma and a sacral agenesis represent a contraindication to a caudal block. We report two cases where the optimal use of ultrasound helped place a sacral intervertebral catheter in two neonates. Radiological and ultrasound studies of the sacrum and spine should be available before performing the procedure.
Topics: Analgesia; Humans; Infant, Newborn; Sacrococcygeal Region; Sacrum; Ultrasonography; Ultrasonography, Interventional
PubMed: 34618993
DOI: 10.1111/pan.14305 -
The British Journal of Dermatology Aug 2000
Topics: Carcinoma, Verrucous; Humans; Male; Middle Aged; Sacrococcygeal Region; Skin Neoplasms
PubMed: 10951172
DOI: 10.1046/j.1365-2133.2000.03689.x -
The Surgeon : Journal of the Royal... Feb 2007Presacral tumours represent a heterogeneous group of predominantly benign and occasionally malignant neoplasms. Due to the rarity of these tumours, their management is... (Review)
Review
Presacral tumours represent a heterogeneous group of predominantly benign and occasionally malignant neoplasms. Due to the rarity of these tumours, their management is often performed in an ad hoc fashion and an algorithm for optimal treatment remains undefined. This review aims to present an overview of presacral tumours, focusing on their presentation, pathology, investigation and management.
Topics: Adult; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Pelvic Neoplasms; Sacrococcygeal Region; Tomography, X-Ray Computed
PubMed: 17313126
DOI: 10.1016/s1479-666x(07)80109-0 -
British Journal of Urology Jun 1984
Topics: Animals; Female; Humans; Infant, Newborn; Male; Penis; Sacrococcygeal Region; Tail
PubMed: 6549571
DOI: 10.1111/j.1464-410x.1984.tb05410.x -
Turkish Neurosurgery 2016Sacrococcygeal region giant tumors are a challenge for neurosurgeons. The purpose of this paper was to retrospectively analyze the clinical records of sacrococcygeal...
AIM
Sacrococcygeal region giant tumors are a challenge for neurosurgeons. The purpose of this paper was to retrospectively analyze the clinical records of sacrococcygeal region giant tumors treated surgically by balloon occlusion of the abdominal aorta.
MATERIAL AND METHODS
A total of 130 patients of sacral region tumors underwent surgery in our department from February 2009 to February 2013. Among these patients, 35 giant tumors were treated by balloon catheter occlusion of the abdominal aorta and electrophysiological monitoring. Thirty patients returned for follow-up evaluations and their clinical and imaging records were analyzed.
RESULTS
Thirty patients underwent surgery via a posterior approach; these cases included 21 chordomas, 5 schwannomas, and 4 giant cell tumors of bone. Wide resections were performed in 26 patients (86.7%) and margin resections were performed in 4 (13.3%) patients. Most patients' symptoms were relieved through surgery and only nine patients (30%) experienced recurrence of the tumors during follow-up.
CONCLUSION
Sacrococcygeal region giant tumors are still difficult to treat, especially for malignant tumors. Balloon catheter occlusions of the lower abdominal aorta can notably decreased intraoperative hemorrhage, shorten operation time, and decrease postoperative complications. This method is a good choice for neurosurgeons to manage these giant tumors in the sacral region.
Topics: Adult; Aged; Aorta, Abdominal; Balloon Occlusion; Blood Loss, Surgical; Female; Giant Cell Tumors; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Retrospective Studies; Sacrococcygeal Region
PubMed: 27476915
DOI: 10.5137/1019-5149.JTN.13606-14.1 -
The Journal of Neuroscience : the... Feb 2017The ability to improve motor function in spinal cord injury patients by reactivating spinal central pattern generators (CPGs) requires the elucidation of neurons and...
UNLABELLED
The ability to improve motor function in spinal cord injury patients by reactivating spinal central pattern generators (CPGs) requires the elucidation of neurons and pathways involved in activation and modulation of spinal networks in accessible experimental models. Previously we reported on adrenoceptor-dependent sacral control of lumbar flexor motoneuron firing in newborn rats. The current work focuses on clarification of the circuitry and connectivity involved in this unique modulation and its potential use. Using surgical manipulations of the spinal gray and white matter, electrophysiological recordings, and confocal microscopy mapping, we found that methoxamine (METH) activation of sacral networks within the ventral aspect of S2 segments was sufficient to produce alternating rhythmic bursting (0.15-1 Hz) in lumbar flexor motoneurons. This lumbar rhythm depended on continuity of the ventral funiculus (VF) along the S2-L2 segments. Interrupting the VF abolished the rhythm and replaced it by slow unstable bursting. Calcium imaging of S1-S2 neurons, back-labeled via the VF, revealed that ∼40% responded to METH, mostly by rhythmic firing. All uncrossed projecting METH responders and ∼70% of crossed projecting METH responders fired with the concurrent ipsilateral motor output, while the rest (∼30%) fired with the contralateral motor output. We suggest that METH-activated sacral CPGs excite ventral clusters of sacral VF neurons to deliver the ascending drive required for direct rhythmic activation of lumbar flexor motoneurons. The capacity of noradrenergic-activated sacral CPGs to modulate the activity of lumbar networks via sacral VF neurons provides a novel way to recruit rostral lumbar motoneurons and modulate the output required to execute various motor behaviors.
SIGNIFICANCE STATEMENT
Spinal central pattern generators (CPGs) produce the rhythmic output required for coordinating stepping and stabilizing the body axis during movements. Electrical stimulation and exogenous drugs can reactivate the spinal CPGs and improve the motor function in the absence of descending supraspinal control. Since the body-stabilizing sacral networks can activate and modulate the limb-moving lumbar circuitry, it is important to clarify the functional organization of sacral and lumbar networks and their linking pathways. Here we decipher the ascending circuitry linking adrenoceptor-activated sacral CPGs and lumbar flexor motoneurons, thereby providing novel insights into mechanisms by which sacral circuitry recruits lumbar flexors, and enhances the motor output during lumbar afferent-induced locomotor rhythms. Moreover, our findings might help to improve drug/electrical stimulation-based therapy to accelerate locomotor-based rehabilitation.
Topics: Adrenergic alpha-1 Receptor Agonists; Animals; Brain Mapping; Electrophysiological Phenomena; Gray Matter; Lumbosacral Region; Methoxamine; Motor Neurons; Nerve Net; Rats; Rats, Sprague-Dawley; Sacrococcygeal Region; Spinal Cord; Sympathetic Nervous System; White Matter
PubMed: 28025254
DOI: 10.1523/JNEUROSCI.2213-16.2016 -
Journal of Pediatric Urology Jun 2016Sacral agenesis (SA) is a rare congenital condition that refers to the absence of part or all of two or more lower sacral vertebral bodies. It can be associated with... (Comparative Study)
Comparative Study
BACKGROUND
Sacral agenesis (SA) is a rare congenital condition that refers to the absence of part or all of two or more lower sacral vertebral bodies. It can be associated with neurogenic bladder dysfunction that does not necessarily correlate with the level of spinal or skeletal defect. Patients with SA should undergo urodynamic studies (UDS) to guide lower urinary tract (LUT) management.
OBJECTIVE
This review aimed to update the present institutional experience since 1981 of this rare patient population with detailed, long-term follow-up of bladder and kidney function.
STUDY DESIGN
A single institution, retrospective, IRB-approved review was performed on patients born after January 1, 1981 with an isolated diagnosis of sacral agenesis without spina bifida, and followed with urologic involvement at Boston Children's Hospital. Records were reviewed for demographics, radiologic imaging, UDS including cystometrogram (CMG) and electromyography (EMG), surgery, and blood chemistries. Comparisons were made between groups of patients based on age at diagnosis, with specific focus on renal function and stability of neurogenic bladder lesion.
RESULTS
Forty-three patients were identified: 23 female and 20 male. Thirty-seven children (86%) had a known age of diagnosis. Nineteen were diagnosed before 2 months old, including five who were diagnosed prenatally, 11 were diagnosed between 2 and 18 months, and seven were diagnosed after 18 months. All 43 had UDS, with 24 (55.8%) studied at the time of diagnosis (Summary Table). Twenty had serial full UDS, with 30% demonstrating neurourologic instability. None developed end-stage renal disease (ESRD) or required spinal cord detethering.
DISCUSSION
Many children with SA appeared to be diagnosed prenatally or early in life; SA was mostly identified during evaluation of associated anomalies. Though UDS aid in urologic management, testing was not routinely utilized at the time of diagnosis.
CONCLUSIONS
This review of long-term follow-up in SA patients showed stable LUT and renal function, with minimal risk of progression to ESRD.
Topics: Abnormalities, Multiple; Female; Humans; Infant; Kidney; Male; Meningocele; Retrospective Studies; Sacrococcygeal Region; Time Factors; Treatment Outcome; Urinary Bladder; Urinary Bladder, Neurogenic
PubMed: 26897325
DOI: 10.1016/j.jpurol.2015.12.008 -
Proceedings of the Royal Society of... Nov 1959
Topics: Abnormalities, Multiple; Child; Humans; Infant; Meningocele; Nervous System Malformations; Sacrococcygeal Region; Sacrum; Syndrome; Urination; Urination Disorders
PubMed: 14426059
DOI: No ID Found -
Wounds : a Compendium of Clinical... Jan 2018Fournier's gangrene (FG) is a type of necrotizing fasciitis of the perineum and scrotum that is characterized by very rapid progression. Sacral pressure ulcers are one...
INTRODUCTION
Fournier's gangrene (FG) is a type of necrotizing fasciitis of the perineum and scrotum that is characterized by very rapid progression. Sacral pressure ulcers are one of the causes of FG.
CASE REPORT
An 85-year-old man was referred to the National Hospital Organization Nagasaki Medical Center (Ohmura City, Japan) with a diagnosis of FG extending to the retroperitoneum caused by a sacral pressure ulcer. Immediate debridement was performed; however, it was not possible to remove all necrotic tissue from the pelvis. The wound was cleansed with continuous irrigation combined with negative pressure wound therapy, which brought the infection under control. The exposed rectum was resurfaced with a gracilis musculocutaneous flap, and the remaining wound in the sacral region was covered with a gluteal artery perforator flap.
CONCLUSIONS
The authors consider continuous irrigation combined with negative pressure wound therapy as extremely useful for patients with FG in whom sufficient debridement cannot be performed.
Topics: Aged, 80 and over; Debridement; Fournier Gangrene; Humans; Negative-Pressure Wound Therapy; Perforator Flap; Pressure Ulcer; Retroperitoneal Space; Sacrococcygeal Region; Therapeutic Irrigation; Treatment Outcome
PubMed: 29406297
DOI: No ID Found -
Clinical Anatomy (New York, N.Y.) Apr 2021A standard lumbar puncture may be impossible for many anatomic or technical reasons. Previous accounts of caudal epidural anesthesia and other procedures via the sacral...
A standard lumbar puncture may be impossible for many anatomic or technical reasons. Previous accounts of caudal epidural anesthesia and other procedures via the sacral hiatus prompted us to test if image-guided percutaneous trans-sacral hiatus access to the lumbosacral subarachnoid cistern would be anatomically feasible. To study vertebral canal morphometry and curvature, we analyzed midsagittal computed tomography-myelogram images of 40 normal subjects and digitally measured sacral curvatures between S1 to S5 and S2 to S4 using two methods whereby a lower angle signifies a straighter sacrum. We measured midsagittal vertebral canal area, hiatus width, dural sac termination levels, and distance from sacral hiatus to the dural sac tip (needle distance). Subjects were F:M = 25:15, with a mean age of 44.9 years. The two S1-S5 full sacral curvature mean angles were 57.3° and 60.4°. Almost all sacral hiatuses were at S4, and dural sac terminations were at S1-S2. The mean S2-S4 sacral curvature was 25.1°, and the mean needle distance was 57.7 mm. Using two-way analysis of variance, there were significant sex differences for needle distances (p = .001), and full and limited sacral curvatures (p = .02, and p = .046, respectively). There were no significant linear regression correlations between age and sacral curvature, needle distance, canal area, or hiatus width. Therefore, despite a frequently prominent full sacral curvature, the combination of S1-S2 dural sac termination plus a relatively straight trajectory of the lower vertebral canal between S2 and S4 support the theoretical feasibility of percutaneous trans-sacral hiatus and vertebral canal access to the lumbosacral cistern using a standard spinal needle.
Topics: Adult; Aged; Anatomic Landmarks; Anesthesia, Caudal; Female; Humans; Male; Middle Aged; Myelography; Retrospective Studies; Sacrococcygeal Region; Sacrum; Spinal Canal; Subarachnoid Space
PubMed: 32323367
DOI: 10.1002/ca.23612