{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:58:42Z","timestamp":1785286722870,"version":"3.55.0"},"reference-count":23,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,7,27]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Ambiguous destructive lumbosacral tumors with intractable pain and neurological compromise present a dilemma between timely decompression and oncological adequacy. The authors present a rare case of primary unclassified sarcoma of the sacrum to illustrate the implications of diagnostic uncertainty in surgical decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 59-year-old woman presented with excruciating low back pain and bilateral sciatica from a destructive lumbosacral mass spanning L5\u2013S4 with circumferential cauda equina compression. CT-guided biopsy demonstrated an atypical epithelioid and spindle cell neoplasm, not otherwise classified. Given rapid neurological decline and refractory pain, she underwent preoperative embolization and urgent posterior decompression with multilevel laminectomies (L4\u2013S4), transpedicular corpectomies (S1\u20133), and lumbopelvic fixation, followed by paraspinous flap closure. Frozen-section analysis favored a tenosynovial giant cell tumor (TGCT) to support a nerve root\u2013sparing resection. Postoperative MRI showed small residual enhancement at S1\u20132. Final pathological analysis revealed an intermediate-grade unclassified sarcoma, and she subsequently underwent adjuvant radiation therapy. Systemic staging is ongoing. At the 6-month follow-up, she reported durable analgesia and function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Destructive lumbosacral tumors should be approached with an oncological mindset even when histology is uncertain. In urgent cases, timely decompression and functional preservation may outweigh radical resection, underscoring the value of adaptable, multidisciplinary management.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE2646\">https:\/\/thejns.org\/doi\/10.3171\/CASE2646<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case2646","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:01:24Z","timestamp":1784678484000},"source":"Crossref","is-referenced-by-count":0,"title":["Lessons in balancing function with oncological control in a destructive lumbosacral tumor of uncertain pathology: illustrative case"],"prefix":"10.3171","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1687-3474","authenticated-orcid":true,"given":"Beatrice","family":"Campilan","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3220-0475","authenticated-orcid":true,"given":"Weston C.","family":"de Lomba","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6282-828X","authenticated-orcid":true,"given":"Owen P.","family":"Leary","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1780-7904","authenticated-orcid":true,"given":"Christian","family":"Schroeder","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Belinda","family":"Shao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franca S.","family":"Kraenzlin","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, Providence"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaroslaw T.","family":"Hepel","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, The Warren Alpert Medical School of Brown University, Providence"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled J.","family":"Alkhateeb","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krisztina","family":"Moldovan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziya L.","family":"Gokaslan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia L.","family":"Zadnik Sullivan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"bib1","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Multidisciplinary surgical considerations for en bloc resection of sacral chordoma: review of recent advances and a contemporary single-center series","volume":"56","author":"Schroeder","year":"2024","unstructured":"Schroeder CDe Lomba WCLeary OPMultidisciplinary surgical considerations for en bloc resection of sacral chordoma: review of recent advances and a contemporary single-center series. 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Spine (Phila Pa 1976). 2004;29(6):E123-E126. doi:10.1097\/01.brs.0000115140.19829.4b"},{"issue":"3","key":"bib8","series-title":"Perm J","first-page":"e146","article-title":"A novel use of foley catheters to prevent injury to the pelvic viscera during stereotactic radiosurgery for undifferentiated pleomorphic sarcoma of the sacrum","volume":"18","author":"Maa","year":"2014","unstructured":"Maa JWaterford SJahan TLarson DAChou D.A novel use of foley catheters to prevent injury to the pelvic viscera during stereotactic radiosurgery for undifferentiated pleomorphic sarcoma of the sacrum. 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Spine (Phila Pa 1976). 2018;43(18):1268-1274. doi:10.1097\/BRS.0000000000002635"},{"issue":"1","key":"bib18","series-title":"J Neurosurg Spine","first-page":"77","article-title":"Complex wound closure by plastic surgery following resection of spinal neoplasms minimizes postoperative wound complications in high-risk patients","volume":"33","author":"Leary","year":"2020","unstructured":"Leary OPLiu DDBoyajian MKComplex wound closure by plastic surgery following resection of spinal neoplasms minimizes postoperative wound complications in high-risk patients. J Neurosurg Spine. 2020;33(1):77-86. doi:10.3171\/2019.12.SPINE191238"},{"issue":"1 suppl","key":"bib19","series-title":"Global Spine J","first-page":"143S","article-title":"Prevention and management of posterior wound complications following oncologic spine surgery: narrative review of available evidence and proposed clinical \u00addecision-making algorithm","volume":"15","author":"Leary","year":"2025","unstructured":"Leary OPSetty AGong JHPrevention and management of posterior wound complications following oncologic spine surgery: narrative review of available evidence and proposed clinical \u00addecision-making algorithm. 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Medicina (Kaunas). 2025;61(2):289. doi:10.3390\/medicina61020289"},{"issue":"4","key":"bib23","series-title":"Oncologist","first-page":"512","article-title":"Epithelioid sarcoma and unclassified sarcoma with epithelioid features: clinicopathological variables, molecular markers, and a new experimental model","volume":"16","author":"Sakharpe","year":"2011","unstructured":"Sakharpe ALahat GGulamhusein TEpithelioid sarcoma and unclassified sarcoma with epithelioid features: clinicopathological variables, molecular markers, and a new experimental model. 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