scholarly journals Sacroplasty Augmentation of Instrumented Pelvic Reconstruction After High Sacrectomy: A Technical Case Report

2021 ◽  
Author(s):  
Amanda N Sacino ◽  
Sutipat Pairojboriboon ◽  
Ian Suk ◽  
Daniel Lubelski ◽  
Robin Yang ◽  
...  
Keyword(s):  
Mechanical Stability ◽  
Pelvic Ring ◽  
Surgical Techniques ◽  
Extent Of Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Mobile Spine ◽  
Sacral Tumors ◽  
Fibrous Tumor

Abstract BACKGROUND AND IMPORTANCE En bloc resection of sacral tumors is the most effective treatment to help prevent recurrence. Sacrectomy, however, can be destabilizing, depending on the extent of resection. Various surgical techniques for improving stability and enabling early ambulation have been proposed. CLINICAL PRESENTATION Here, we report a case in which we use PMMA (poly[methyl methacrylate]) to augment pelvic instrumentation to improve mechanical stability after sacrectomy for en bloc resection of a solitary fibrous tumor. CONCLUSION We highlight the use of sacroplasty augmentation of pelvic ring reconstruction to provide biomechanical stability without the need for fusion of any mobile spine segments, which allowed for early patient ambulation and no appreciable loss of range of motion or mobility.

scholarly journals Mobile spine chordoma: results of 166 patients from the AOSpine Knowledge Forum Tumor database

2016 ◽  
Vol 24 (4) ◽  
pp. 644-651 ◽  
Author(s):  
Ziya L. Gokaslan ◽  
Patricia L. Zadnik ◽  
Daniel M. Sciubba ◽  
Niccole Germscheid ◽  
C. Rory Goodwin ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Survival Data ◽  
Large Scale ◽  
Surgical Techniques ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Increased Risk ◽  
Significant Difference ◽  
Mobile Spine

OBJECT A chordoma is an indolent primary spinal tumor that has devastating effects on the patient's life. These lesions are chemoresistant, resistant to conventional radiotherapy, and moderately sensitive to proton therapy; however, en bloc resection remains the preferred treatment for optimizing patient outcomes. While multiple small and largely retrospective studies have investigated the outcomes following en bloc resection of chordomas in the sacrum, there have been few large-scale studies on patients with chordomas of the mobile spine. The goal of this study was to review the outcomes of surgically treated patients with mobile spine chordomas at multiple international centers with respect to local recurrence and survival. This multiinstitutional retrospective study collected data between 1988 and 2012 about prognosis-predicting factors, including various clinical characteristics and surgical techniques for mobile spine chordoma. Tumors were classified according to the Enneking principles and analyzed in 2 treatment cohorts: Enneking-appropriate (EA) and Enneking-inappropriate (EI) cohorts. Patients were categorized as EA when the final pathological assessment of the margin matched the Enneking recommendation; otherwise, they were categorized as EI. METHODS Descriptive statistics were used to summarize the data (Student t-test, chi-square, and Fisher exact tests). Recurrence and survival data were analyzed using Kaplan-Meier survival curves, log-rank tests, and multivariate Cox proportional hazard modeling. RESULTS A total of 166 patients (55 female and 111 male patients) with mobile spine chordoma were included. The median patient follow-up was 2.6 years (range 1 day to 22.5 years). Fifty-eight (41%) patients were EA and 84 (59%) patients were EI. The type of biopsy (p < 0.001), spinal location (p = 0.018), and if the patient received adjuvant therapy (p < 0.001) were significantly different between the 2 cohorts. Overall, 58 (35%) patients developed local recurrence and 57 (34%) patients died. Median survival was 7.0 years postoperative: 8.4 years postoperative for EA patients and 6.4 years postoperative for EI patients (p = 0.023). The multivariate analysis showed that the EI cohort was significantly associated with an increased risk of local recurrence in comparison with the EA cohort (HR 7.02; 95% CI 2.96–16.6; p < 0.001), although no significant difference in survival was observed. CONCLUSIONS EA resection plays a major role in decreasing the risk for local recurrence in patients with chordoma of the mobile spine.

scholarly journals Long-Term Outcomes of High-Dose Single-Fraction Radiosurgery for Chordomas of the Spine and Sacrum

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Jenny Jin ◽  
John Berry-Candelabra ◽  
Y Josh Yamada ◽  
Daniel Higginson ◽  
Adam Schmitt ◽  
...  
Keyword(s):  
Local Recurrence ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
High Dose ◽  
En Bloc ◽  
Intralesional Resection ◽  
Single Fraction ◽  
Mobile Spine ◽  
Symptom Response

Abstract INTRODUCTION To evaluate outcomes of patients with primary chordomas treated with spine stereotactic radiosurgery (SRS) alone or in combination with surgery, drawing from a single-institution database to elucidate treatment options associated with durable radiographic control of these conventionally radioresistant tumors. Chordomas result in significant morbidity, with a high rate of local recurrence and potential for metastases. SRS as a primary treatment could save patients from extensive surgery. Spine SRS outcomes support exploration of its role in the durable control of these conventionally radioresistant tumors. METHODS Clinical records were reviewed for outcomes of patients with primary chordoma of the mobile spine and sacrum who underwent single-fraction SRS between 2006 and 2017. Radiographic local recurrence-free survival (LRFS), overall survival (OS), symptom response, and toxicity were assessed in relation to extent of surgery. RESULTS In total, 35 patients with de novo chordoma of the mobile spine (49%) and sacrum (51%) received SRS with a median post-SRS follow-up of 38.8 mo (range: 2.0-122.9). The median PTV dose was 24Gy (range: 18–24Gy). Overall, 12 patients (33%) underwent definitive SRS and 23 patients (66%) underwent surgery followed by adjuvant SRS. Surgical strategies included separation surgery prior to SRS, curettage/intralesional resection, and en bloc resection in 7, 6, and 10 patients, respectively. The 3- and 5-yr LRFS rates were 86.2% and 80.5% respectively. Among 32 patients receiving 24 Gy (91%), the 3- and 5-yr LRFS were 96.3% and 89.9%. The 3- and 5-yr OS rates were 90.0% and 84.3%. The symptom response rate to treatment was 88% for pain and radiculopathy. Extent or type of surgery was not associated with LRFS, OS, or symptom response rates (P > .05), but en bloc resection was associated with higher CTCAE v. 5.0 surgical toxicity compared to epidural decompression and curettage/intralesional resection (P = .03). The long-term = grade 2 SRS toxicity rate was 31%, including 17% grade 3 tissue necrosis, recurrent laryngeal nerve palsy, fracture, and secondary malignancy. CONCLUSION High-dose spine SRS offers the chance of durable radiographic control and effective symptom relief with acceptable toxicity for primary chordomas as either definitive or adjuvant therapy.

scholarly journals Parathyroid Carcinoma: An Up-to-Date Retrospective Multicentric Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-5 ◽  
Author(s):  
Francesco Quaglino ◽  
Luca Manfrino ◽  
Luca Cestino ◽  
Massimo Giusti ◽  
Enrico Mazza ◽  
...  
Keyword(s):  
Serum Calcium ◽  
Parathyroid Carcinoma ◽  
Surgical Techniques ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Region Data ◽  
Males And Females ◽  
Cancer Network ◽  
Multiple Symptoms

Parathyroid carcinoma (PC) is a rare disease responsible for about 1% of primary hyperparathyroidism (PHPT) cases. PC usually has an indolent course, tough to differentiate from the benign causes of PHPT, and the only certain diagnosis is histologic. The gold standard surgical treatment is the en bloc resection associated with the homolateral thyroid loboistmectomy. The aim of this study was to underline the main differences between PC and benign PHPT, along with gathering epidemiological knowledge relative to PC in our region. Data from the regional cancer network (Rete Oncologica del Piemonte e della Valle d’Aosta) since 2007 have been reported, including 21 patients from three hospitals (AO S. Croce e Carle of Cuneo, AOU Città della Salute of Turin, and ASL Città di Torino). The incidence of the disease, gender, age at time of diagnosis, presence of renal and bone symptoms, serum calcium and PTH levels, surgical technique performed, and percentage of recurrence were analysed. PC data were than compared with a series of patients affected by benign PHPT, referred to ASL Città di Torino, Maria Vittoria Hospital, from 2007 to 2019. A PC incidence of 0.05 cases per 100,000 inhabitants was found in our region. Benign forms occurred more frequently in females (p=0.0002), while PC equally occurred in males and females and affected younger patients (p=0.026). Serum calcium and PTH levels were significantly higher in PC patients; accordingly, typical PHPT symptoms were more frequently reported in PC than in benign PHPT. In the PC group, the en bloc resection shows a 13 times lower risk for relapse compared with all the other surgical techniques. PC is equally gender distributed, and the average patients’ age is in the fifth decade of life. It is usually functioning, with greater biochemical activity and multiple symptoms. A not-radical surgical resection is associated with a higher recurrence rate. A meticulous presurgical evaluation of PHPT patients showing PC’s evocative features is mandatory to obtain a complete disease extirpation.

Quality of life after en bloc resection of tumors in the mobile spine

2015 ◽  
Vol 15 (8) ◽  
pp. 1728-1737 ◽  
Author(s):  
Matthew W. Colman ◽  
Syed M. Karim ◽  
Santiago A. Lozano-Calderon ◽  
Frank X. Pedlow ◽  
Kevin A. Raskin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Mobile Spine

Outcomes following attempted en bloc resection of cervical chordomas in the C-1 and C-2 region versus the subaxial region: a multiinstitutional experience

2014 ◽  
Vol 21 (3) ◽  
pp. 348-356 ◽  
Author(s):  
Camilo A. Molina ◽  
Christopher P. Ames ◽  
Dean Chou ◽  
Laurence D. Rhines ◽  
Patrick C. Hsieh ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Median Survival ◽  
Tumor Recurrence ◽  
Demographic Data ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Upper Cervical Spine ◽  
En Bloc ◽  
Significant Difference ◽  
Mobile Spine

Object Chordomas involving the mobile spine are ideally managed via en bloc resection with reconstruction to optimize local control and possibly offer cure. In the cervical spine, local anatomy poses unique challenges, limiting the feasibility of aggressive resection. The authors present a multi-institutional series of 16 cases of cervical chordomas removed en bloc. Particular attention was paid to clinical outcome, complications, and recurrence. In addition, outcomes were assessed according to position of tumor at the C1–2 level versus the subaxial (SA) spine (C3–7). Methods The authors reviewed cases involving patients who underwent en bloc resection of cervical chordoma at 4 large spine centers. Patients were included if the lesion epicenter involved the C-1 to C-7 vertebral bodies. Demographic data and details of surgery, follow-up course, exposure to adjuvant therapy, and complications were obtained. Outcome was correlated with presence of tumor in C1–2 versus subaxial spine via a Student t-test. Results Sixteen patients were identified (mean age at presentation 55 ± 14 years). Seven cases (44%) cases involved C1–2, and 16 involved the subaxial spine. Median survival did not differ significantly different between the C1–2 (72 months) and SA (60 months) groups (p = 0.65). A combined (staged anteroposterior) approach was used in 81% of the cases. Use of the combined approach was significantly more common in treatment of subaxial than C1–2 tumors (100% vs 57%, p = 0.04). En bloc resection was attempted via an anterior approach in 6% of cases (C1–2: 14.3%; SA: 0%; p = 0.17) and a posterior approach in 13% of cases (C1–2: 29%; SA: 0%; p = 0.09). The most commonly reported margin classification was marginal (56% of cases), followed by violated (25%) and wide (19%). En bloc excision of subaxial tumors was significantly more likely to result in marginal margins than excision of C1–2 tumors (C1–2: 29%; SA: 78%; p = 0.03). C1–2 tumors were associated with significantly higher rates of postoperative complications (C1–2: 71%; SA: 22%; p = 0.03). Both local and distant tumor recurrence was greatest for C1–2 tumors (local C1–2: 29%; local SA: 11%; distant C1–2: 14%; distant SA: 0%). Statistical analysis of tumor recurrence based on tumor location was not possible due to the small number of cases. There was no between-groups difference in exposure to postoperative adjuvant radiotherapy. There was no difference in median survival between groups receiving proton beam radiotherapy or intensity-modulated radiotherapy versus no radiation therapy (p = 0.8). Conclusions Compared with en bloc resection of chordomas involving the subaxial cervical spine, en bloc resection of chordomas involving the upper cervical spine (C1–2) is associated with poorer outcomes, such as less favorable margins, higher rates of complications, and increased tumor recurrence. Data from this cohort do not support a statistically significant difference in survival for patients with C1–2 versus subaxial disease, but larger studies are needed to further study survival differences.

scholarly journals En Bloc Resection and Pelvic Ring Reconstruction for Primary Malignant Bone Tumors Involving Sacroiliac Joint

2019 ◽  
Vol 11 (6) ◽  
pp. 1120-1126 ◽  
Author(s):  
Ming Xu ◽  
Kai Zheng ◽  
Jie Zhao ◽  
Wen‐zhe Bai ◽  
Xiu‐chun Yu
Keyword(s):  
Sacroiliac Joint ◽  
Bone Tumors ◽  
Pelvic Ring ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Malignant Bone Tumors ◽  
En Bloc

Reconstruction of the anterior craniocervical junction using an expandable cage after resection of a C1 chordoma in a 5-year-old child: case report

2019 ◽  
Vol 24 (1) ◽  
pp. 62-65
Author(s):  
Lourdes C. Eco ◽  
Alison Brayton ◽  
William E. Whitehead ◽  
Andrew Jea
Keyword(s):  
Spinal Instrumentation ◽  
En Bloc Resection ◽  
Craniocervical Junction ◽  
Lateral Approach ◽  
Bloc Resection ◽  
Benign Tumors ◽  
En Bloc ◽  
Expandable Cage ◽  
Far Lateral Approach ◽  
Mobile Spine

Chordomas are histologically benign tumors with local aggressive behavior. They arise from embryological remnants of the notochord at the clivus, mobile spine, and sacrum. Chordomas are rare tumors in the pediatric age group. Their surgical management is difficult, given their propensity for inaccessible anatomical regions, and proximity to critical neurovascular structures. While en bloc resection with surgical margins has been advocated as the preferred approach for chordomas, tumor characteristics and violation of adjacent anatomical boundaries may not allow for safe en bloc resection of the tumor. Here, the authors present the case of a C1 chordoma in a 5-year-old boy with epidural and prevertebral extension. The patient’s treatment consisted of a far-lateral approach for resection of the tumor and C1 arch, followed by circumferential reconstruction of the craniocervical junction with an expandable cage spanning the skull base to C2, and posterior occipitocervical spinal instrumentation. At 42 months after surgery, the patient remains neurologically intact with stable oncological status, and no evidence of craniocervical junction instrumentation failure.

The long term surgical outcome of spinal giant cell tumor.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e22510-e22510
Author(s):  
Joonho Yoon ◽  
Chun Kee Chung ◽  
Sunho Lee ◽  
Chiheon Kim
Keyword(s):  
Local Recurrence ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Rank Test ◽  
Radical Excision ◽  
Total Removal ◽  
En Bloc ◽  
Additional Surgery ◽  
Significant Difference ◽  
Mobile Spine

e22510 Background: GCT is a benign and locally aggressive tumor that occur infrequently in the mobile spine. The radical excision is generally agreed for treatment of GCTs. Methods: We performed retrospective analysis of 20 GCTs in the mobile spine from 2005 to 2013. Verteberal involvement was classified with Weinstein-Boriani-Biagini grading system. Surgery types were classified into 3 groups; partial excision, gross total removal (GTR), and en-bloc resection. We analysis by GTR versus non-GTR group, and enbloc versus non-enbloc group in GTR group. The log rank test was used for comparison of factors, and a P value of less than 0.05 was deemed significant. Results: After first surgery of the 20 patients, 17 additional surgery performed for 10 (50%) patients. There were 7 (35%) local recurrences and 3 (15%) distant metastasis. The time to recurrence or progression of tumor ranged from 5 months to 39 months. Two (10%) patients had additional surgery for instrument failure. One (5%) patient died from the complication of the surgery. The follow up duration ranged from 24 months to 141 months. The local recurrence was associated with partial resection (P < 0.01) and history of recurrence (P = 0.39). There was no significant difference between non-en bloc GTR and en bloc GTR in local recurrence (p = 0.101). Conclusions: Gross total resection should be considered for GCTs of the mobile spine. The choice of en bloc resection must be balanced with risks of the procedure. En bloc resection or radical excision could be challenging in many cases. In that cases, the gross total removal by intralesional resection is considerable for local control.

Interest of Laparoscopy for “En Bloc” Resection of Primary Malignant Sacral Tumors by Combined Approach

Spine ◽  
2015 ◽  
Vol 40 (19) ◽  
pp. 1542-1552 ◽  
Author(s):  
Arnaud Dubory ◽  
Gilles Missenard ◽  
Benoît Lambert ◽  
Charles Court
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
Combined Approach ◽  
En Bloc ◽  
Sacral Tumors

En bloc resection of primary sacral tumors: classification of surgical approaches and outcome

2005 ◽  
Vol 3 (2) ◽  
pp. 111-122 ◽  
Author(s):  
Daryl R. Fourney ◽  
Laurence D. Rhines ◽  
Stephen J. Hentschel ◽  
John M. Skibber ◽  
Jean-Paul Wolinsky ◽  
...  
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
Surgical Approaches ◽  
En Bloc ◽  
Sacral Tumors ◽  
Tumors Classification
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