Total resection of sacral giant cell tumor with en bloc resection, sacral nerve reconstruction, and custom 3D-printed implant: a case report with long-term follow-up.

INTRODUCTION: Giant cell tumor (GCT) of the sacrum is a rare, locally aggressive bone tumor. Surgical resection is the primary treatment, but preserving sacral nerve function remains challenging. We present a case of sacral GCT treated with a novel nerve-preserving en bloc resection technique, resulting in long-term tumor control and functional recovery.

CASE PRESENTATION: A 33-year-old male presented with progressive sacral pain and neurological symptoms. Imaging revealed a sacral GCT involving the S1 vertebral body and nerve root canal. The patient underwent en bloc resection with sacral nerve preservation and reconstruction, along with custom 3D-printed prosthesis implantation. Postoperative recovery was uncomplicated, with preserved bowel, bladder, and lower limb function. There was no evidence of recurrence during the 8-year follow-up period.

CLINICAL DISCUSSION: Sacral GCTs present substantial surgical challenges due to their proximity to critical neurovascular structures. While en bloc resection effectively reduces recurrence rates, it often compromises sacral nerve function. Our technique successfully preserved key sacral nerve roots, leading to superior postoperative functional outcomes compared to conventional approaches. A review of relevant literature supports the advantages of nerve-sparing strategies in sacral tumor surgery.

CONCLUSION: This case highlights the feasibility and benefits of sacral nerve-preserving en bloc resection for GCT. The long-term follow-up confirms durable tumor control and robust functional recovery, suggesting its potential as a preferred surgical approach for carefully select cases.