High sacral resections may best be performed with the use of fine rongeurs to divide the fused sacral laminae at the proposed line of transection of the bone posteriorly. Thus, the sacral canal is opened, and with gentle dissection, the dural sac and sacral roots at this level are displaced superiorly and laterally. At this level, the fused sacral bodies may then be divided with an osteotome. For large chordomas extending into the soft tissues, wider resection becomes necessary and the sciatic and pudendal nerves may be exposed. Dissection along the pudendal nerve and the ipsilateral sacral root or roots will secure their continuity if they are not found to be involved with tumor and, thus, continence will be assured.