Use of Navigated Ultrasonic Bone Cutting Tool for En Bloc Resection of Thoracic Chondrosarcoma: Technical Report

2020 ◽  
Vol 19 (5) ◽  
pp. 551-556
Author(s):  
Aditya Vedantam ◽  
Krishanthan Vigneswaran ◽  
Ganesh Rao ◽  
Garrett L Walsh ◽  
Laurence D Rhines ◽  
...  
Keyword(s):  
New York ◽  
Real Time ◽  
Image Guidance ◽  
Cutting Tool ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Intraoperative Computed Tomography ◽  
Tumor Margins ◽  
Vertebral Bodies

Abstract BACKGROUND En bloc surgical resection with wide margins offers the best local control rates for chondrosarcoma of the spine. OBJECTIVE To describe the surgical technique for en bloc resection of a large thoracic chondrosarcoma using image guidance for a complex osteotomy with an ultrasonic bone cutting device (Misonix, Farmingdale, New York). METHODS A 2-stage procedure was performed for resection of a thoracic chondrosarcoma involving the T3-T7 vertebral bodies. During the first stage, a posterior approach, the ultrasonic bone cutter was precisely navigated to perform an intralaminar osteotomy as well as a multilevel split sagittal osteotomy through the vertebral bodies. In the second stage, a transthoracic approach was used to complete the en bloc resection of the specimen. Intraoperative frozen sections from the surgical margins were negative for tumor. RESULTS The ultrasonic bone cutting device was navigated based on coregistration of the intraoperative computed tomography (CT) images and preoperative magnetic resonance imaging (MRI). Real-time navigation using coregistered images enabled identification of tumor margins within the bone and adjacent soft tissue allowing precise execution of the intralaminar and multilevel split sagittal vertebral osteotomies. Surgical video demonstrates the utility of real-time navigation to properly identify the tumor margins and guide the ultrasonic bone cutting tool during the osteotomies. CONCLUSION We describe the use of image guidance to navigate an ultrasonic bone cutting tool for a complex en bloc resection of a multilevel thoracic spine chondrosarcoma.

En Bloc Resection of Sacral Chordomas Aided by Frameless Stereotactic Image Guidance: A Technical Note

2011 ◽  
Vol 70 (suppl_1) ◽  
pp. ons82-ons88 ◽  
Author(s):  
Hormuzdiyar H. Dasenbrock ◽  
Michelle J. Clarke ◽  
Ali Bydon ◽  
Matthew J. McGirt ◽  
Timothy F. Witham ◽  
...  
Keyword(s):  
Image Guidance ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Surrounding Tissue ◽  
Preoperative Imaging ◽  
Frameless Stereotaxy ◽  
En Bloc ◽  
Bony Landmarks ◽  
Adjacent Structures ◽  
Stereotactic Navigation

Abstract BACKGROUND: The most important predictor of survival for patients with sacral chordomas is an initial en bloc resection with negative margins. However, obtaining negative margins can be technically challenging. Intraoperative navigation may be helpful in attempting an excision with negative margins. OBJECTIVE: This is the first report of partial sacrectomy guided by frameless stereotactic navigation. METHODS: Three patients with a mean age of 58.7 years underwent en bloc resection of sacral chordomas aided by image guidance. Intraoperatively, the reference arc was clamped to the spinous process of L5 and the bony landmarks of S1 were used for registration. Subsequently, the drill was registered, allowing the osteotomy trajectory to be visualized in real time with reference to the patients' anatomy and tumor location. RESULTS: None of the patients had any intraoperative or postoperative complications. Two patients with smaller tumors (5 cm) had negative margins, whereas the third patient with an 11.5 cm tumor had marginal margins. With an average follow-up of 44 months, none of the patients have had a recurrence of the tumor. CONCLUSION: The use of frameless stereotaxy during the en bloc resection of sacral tumors is safe and feasible. Frameless stereotactic navigation was a useful adjunct to preoperative imaging and to the surgeon's anatomic knowledge. Image guidance was used during the osteotomies to decrease the likelihood of injury to vital adjacent structures or violation of the tumor capsule and to increase the likelihood that the appropriate surrounding tissue was resected to attempt a wide or marginal resection.

Clear-Cell Chondrosarcoma of the Lumbar Spine: Case Report and Review of the Literature

Neurosurgery ◽  
2011 ◽  
Vol 68 (4) ◽  
pp. E1160-E1164 ◽  
Author(s):  
Wesley Hsu ◽  
Edward McCarthy ◽  
Ziya L. Gokaslan ◽  
Jean-Paul Wolinsky
Keyword(s):  
Clear Cell ◽  
Thoracolumbar Spine ◽  
Compression Fracture ◽  
Pedicle Screws ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Clear Cell Chondrosarcoma ◽  
Vertebral Bodies ◽  
L1 And L2

Abstract BACKGROUND AND IMPORTANCE: Clear-cell chondrosarcoma is a rare subtype of chondrosarcoma. These osseous tumors are most commonly found in the end of long bones. We report a rare case of clear-cell chondrosarcoma of the osseous spine. CLINICAL PRESENTATION: A 52-year-old man presented to another institution with a pathologic L1 compression fracture. Intraoperatively, this fracture was discovered to be secondary to a chondrosarcoma involving T12, L1, and L2. He was then referred to our institution for further evaluation and treatment. A 2-stage operation was performed with successful en bloc resection of residual chondrosarcoma with negative margins. The first stage using a posterior approach resulted in placement of pedicle screws from T9 to L4, laminectomies from T12 to L2, and placement of Tomita saws between the thecal sac and the vertebral body at both the T11-12 and L2-3 disc levels. The second stage of the procedure involved a transthoracic, retroperitoneal approach to the thoracolumbar spine. Osteotomies between T11-12 and L2-3 were completed, and the vertebral bodies of T12, L1, and L2 were delivered as an en bloc specimen. The final pathology of the specimen was clear-cell chondrosarcoma with negative margins. CONCLUSION: This report discusses a rare occurrence of clear-cell chondrosarcoma in the osseous spine. Aggressive surgical intervention with the goal of en bloc resection of tumor is recommended to promote tumor-free survival.

Three-Level En Bloc Spondylectomy for Chordoma

2011 ◽  
Vol 68 (suppl_2) ◽  
pp. ons325-ons333 ◽  
Author(s):  
Michelle J. Clarke ◽  
Wesley Hsu ◽  
Ian Suk ◽  
Edward McCarthy ◽  
James H. Black ◽  
...  
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
En Bloc Spondylectomy ◽  
Tumor Margins ◽  
Bloc Spondylectomy ◽  
Negative Tumor ◽  
Neurologically Intact ◽  
Neurovascular Structures

Abstract Background: En bloc resection of spinal and sacral chordomas may convey a survival benefit. However, these procedures often are complex and require the surgeon to plan a procedure that results in negative tumor margins, protects vital neurovascular structures, and concludes with a viable biomechanical reconstruction. Objective: We present a case of a 3-level en bloc lumbar spondylectomy and reconstruction. Methods: A case of a 45-year-old woman with biopsy-proven exophytic L4 chordoma is presented. The patient underwent successful L3-L5 en bloc spondylectomy and reconstruction over 3 stages. Results: The patient did well following the procedure, and was neurologically intact at 6-week follow-up. Conclusion: Three-level en bloc spondylectomy with lumbopelvic reconstruction is a challenging yet feasible procedure.

The Use of Anterior Lumbosacral Interbody Fusion in Spinopelvic Stabilization After High Partial Sacrectomy

2019 ◽  
Vol 17 (4) ◽  
pp. E173-E176
Author(s):  
Osama N Kashlan ◽  
David K Monson ◽  
Daniel Refai
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
Leg Pain ◽  
Bony Defect ◽  
Nerve Roots ◽  
En Bloc ◽  
Tumor Margins ◽  
Sacral Tumor ◽  
Superior Portion ◽  
Total Sacrectomy

Abstract BACKGROUND AND IMPORTANCE Traditionally, when a patient presents with a midline chordoma with extension to the mid-S1 body where neither S1 nerve roots can be spared, the recommendation would be to perform a total sacrectomy for en bloc resection. This procedure, however, results in a large bony defect that makes it difficult to achieve fusion across the lumbosacral and sacroiliac junction (SIJ). To help prevent this challenge in the situation described above, we propose performing a high sacrectomy for en bloc resection with placement of an anterior L5-S1 graft instead in specific situations where the tumor extends to the mid-S1 body leaving the superior aspect of S1 unaffected. CLINICAL PRESENTATION A 56-yr-old female presented to our clinic with back pain, leg pain, urinary incontinence, and perineal numbness. She was found to have a chordoma that extended to the mid-S1 body superiorly. Her S1 nerve roots were involved extraforaminally. We performed the operation described above with no signs of hardware malfunction or tumor recurrence at 5 mo. CONCLUSION In patients where the sacral tumor that involves the S1 nerve roots but does not involve the superior portion of the S1 body, there continues to be unaffected SIJ to allow for arthrodesis, and an anterior approach is necessary for other indications, we recommend performing a high partial sacrectomy with placement of an anterior L5-S1 graft rather than a total sacrectomy as long as the bony resection offers ability to obtain tumor margins.

scholarly journals Underwater endoscopic mucosal resection for en bloc resection of a neuroendocrine tumor in the duodenal bulb

Endoscopy ◽  
2021 ◽  
Author(s):  
Hugo Uchima ◽  
Alberto Diez-Caballero ◽  
Jaume Capdevila ◽  
Mercé Rosinach ◽  
Alfredo Mata ◽  
...  
Keyword(s):  
Neuroendocrine Tumor ◽  
Endoscopic Mucosal Resection ◽  
Duodenal Bulb ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Mucosal Resection

scholarly journals Fibrin glue: Novel submucosal injection agent for endoscopic submucosal dissection

2021 ◽  
Vol 09 (03) ◽  
pp. E319-E323
Author(s):  
Madoka Takao ◽  
Yoshitaka Takegawa ◽  
Toshitatsu Takao ◽  
Hiroya Sakaguchi ◽  
Yoshiko Nakano ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Fibrin Glue ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Submucosal Injection ◽  
Submucosal Dissection ◽  
Vitro Model ◽  
Histopathologic Findings

Abstract Background and study aims Adequate mucosal elevation by submucosal injection is crucial for patient safety and efficiency during endoscopic submucosal dissection (ESD). This study aimed to evaluate the efficacy of fibrin glue (FG) as a long-lasting submucosal injection agent and to evaluate the technical feasibility of FG injection for ESD. Materials and methods To compare the capabilities of different agents in maintaining submucosal evaluation, we injected FG, hyaluronic acid solution, and normal saline into the porcine gastric specimen that was incised into approximately 5 × 5 cm squares. Then, we measured the height of submucosal elevations over time. Moreover, three hypothetical lesions from the resected porcine stomach underwent ESD with FG injection. Thereafter, we conducted macroscopic and histopathologic analyses. Results FG maintained the greatest submucosal elevation among all the injection agents. Three ESD procedures were performed with en bloc resection. Both macroscopic and histopathologic findings showed a thick FG clot on the ulcers. Conclusions The FG solution can be potentially used as an ESD submucosal injection agent in an in vitro model.

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