• Gabriel Y F Lee and Eric M Massicotte.
• Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada.
• Neurosurgery. 2005 Oct 1; 57 (4 Suppl): E412; discussion E412.

Objective And ImportanceThe utility of image guidance in fashioning a posterior transsacral operative corridor for approaching small presacral neural lesions has not previously been reported.Clinical PresentationA 61-year-old woman presented with unilateral sciatica and worsening leg weakness. Subsequent investigations disclosed a well-defined, 1.4-cm lesion in continuity with the S1 nerve root distal to the anterior sacral foramen.TechniqueA minimally invasive approach was undertaken with use of the StealthStation (Medtronic Sofamor Danek, Inc., Memphis, TN). The amount of sacral bone resection was preplanned to ensure the most direct posterior access route. Intraoperative navigation was used to guide the trajectory of bone drilling. After adequate exposure was achieved, the lesion was resected using standard microsurgical techniques under continuous intraoperative electrophysiological monitoring.ConclusionAn image-guided transsacral approach is a viable option for accessing small to moderately sized lesions of nerve root origin located within the presacral space.

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