A unified expert consensus now clarifies the best practices for diagnosing and managing rare presacral tumors, essential for improving surgical outcomes.

• High-resolution MRI is critical for risk stratification.
• Image-guided biopsies are recommended for high-risk lesions that could change management.

Complete surgical resection is the primary goal, with approaches tailored to tumor characteristics, while minimally invasive techniques may be suitable in select cases.

• Non-operative surveillance is endorsed for specific low-risk cystic lesions.