Spinal Tumor - Sacrum Resection

I'm awaiting the biopsy results, but both my CT scan and MRI point to me having a tumor on my sacrum (covering most of S1 and S2). The belief is that it is a Chordoma or a Giant Cell Tumor. It is roughly 6 x 7 cms.

Several Questions"
* What nerves are most likely to be damaged if my S1 and S2 are removed?
* Could radiation treatment cause greater damage than a poorly done surgical procedure?
* Can anyone suggest a hospital/medical team that has a lot of experience performing these sacral resections?
* Could Cyberknife, freezing the tumor or one of these other newer approaches be a solid alternative?

I'm hoping to schedule this treatment within the next 2-3 weeks.

Thanks.

[Dr Sharma]

Hi there. For confirming the diagnosis, a staged biopsy procedure is appropriate and will reveal large number of osteoclastic giant cells, admixed with mononuclear cells the standard treatment for GCT is curettage and placement of a bone graft or bone cement. Recurrence rates are high as 50% when intralesional resection is not carefully performed. Current choice of therapy by surgeons is aggressive curettage, followed by adjuvant phenol, hydrogen peroxide, liquid nitrogen, or argon beam therapy. Cementation may serve as a local adjuvant while restoring mechanical integrity to a compromised region facilitating spinal and pelvic fixation. It is important to use adjuvants carefully in sacrum, to reduce inflicting trauma on sacral nerve roots. Nerve root monitoring is appropriate and required. sacrectomy is valuable to effect local tumor control and overall patient survival, despite potential complications and neurological and sexual dysfunction. Preoperative embolisation may be undertaken since these are vascular tumors. Your surgeon is the best judge in the choice of surgery. Hope this helps. Take care.