A modern multidisciplinary approach to a large cervicothoracic chordoma using staged en bloc resection with intraoperative image-guided navigation and 3D-printed modeling: illustrative case

Pertsch, Nathan J.; Leary, Owen P.; Camara-Quintana, Joaquin; Liu, David D.; Niu, Tianyi; Woo, Albert S.; Ng, Tony; Oyelese, Adetokunbo A.; Fridley, Jared; Gokaslan, Ziya L.

doi:10.3171/case2023

Cited by 4 publications

(1 citation statement)

References 40 publications

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“…1 and 6). 54 As these novel imaging modalities rapidly advance, it is likely even more sophisticated intraoperative localization methods that leverage these techniques in combination will continue to emerge.…”

Section: Advances In Intraoperative Imaging and Navigationmentioning

confidence: 99%

Multidisciplinary surgical considerations for en bloc resection of sacral chordoma: review of recent advances and a contemporary single-center series

Schroeder,

de Lomba,

Leary

et al. 2024

Neurosurgical Focus

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OBJECTIVE Contemporary management of sacral chordomas requires maximizing the potential for recurrence-free and overall survival while minimizing treatment morbidity. En bloc resection can be performed at various levels of the sacrum, with tumor location and volume ultimately dictating the necessary extent of resection and subsequent tissue reconstruction. Because tumor resection involving the upper sacrum may be quite destabilizing, other pertinent considerations relate to instrumentation and subsequent tissue reconstruction. The primary aim of this study was to survey the surgical approaches used for managing primary sacral chordoma according to location of lumbosacral spine involvement, including a narrative review of the literature and examination of the authors’ institutional case series. METHODS The authors performed a narrative review of pertinent literature regarding reconstruction and complication avoidance techniques following en bloc resection of primary sacral tumors, supplemented by a contemporary series of 11 cases from their cohort. Relevant surgical anatomy, advances in instrumentation and reconstruction techniques, intraoperative imaging and navigation, soft-tissue reconstruction, and wound complication avoidance are also discussed. RESULTS The review of the literature identified several surgical approaches used for management of primary sacral chordoma localized to low sacral levels (mid-S2 and below), high sacral levels (involving upper S2 and above), and high sacral levels with lumbar involvement. In the contemporary case series, the majority of cases (8/11) presented as low sacral tumors that did not require instrumentation. A minority required more extensive instrumentation and reconstruction, with 2 tumors involving upper S2 and/or S1 levels and 1 tumor extending into the lower lumbar spine. En bloc resection was successfully achieved in 10 of 11 cases, with a colostomy required in 2 cases due to rectal involvement. All 11 cases underwent musculocutaneous flap wound closure by plastic surgery, with none experiencing wound complications requiring revision. CONCLUSIONS The modern management of sacral chordoma involves a multidisciplinary team of surgeons and intraoperative technologies to minimize surgical morbidity while optimizing oncological outcomes through en bloc resection. Most cases present with lower sacral tumors not requiring instrumentation, but stabilizing instrumentation and lumbosacral reconstruction are often required in upper sacral and lumbosacral cases. Among efforts to minimize wound-related complications, musculocutaneous flap closure stands out as an evidence-based measure that may mitigate risk.

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Section: Advances In Intraoperative Imaging and Navigationmentioning

confidence: 99%

Multidisciplinary surgical considerations for en bloc resection of sacral chordoma: review of recent advances and a contemporary single-center series

Schroeder,

de Lomba,

Leary

et al. 2024

Neurosurgical Focus

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Utility of 3D-Printed Models in the Surgical Planning for Primary Spine Tumors: A Survey of International Spinal Oncology Experts

Mikula,

Rhines,

Patel

et al. 2024

Global Spine Journal

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Study Design Survey study. Objectives The purpose of this study was to characterize the utility of 3D printed patient specific anatomic models for the planning of complex primary spine tumor surgeries. Methods A survey of individual members of an international study group of spinal oncology surgeons was performed. Participants were provided a clinical vignette, pathologic diagnosis, and pre-operative imaging for three primary spinal oncology cases. Study participants provided a free text surgical plan for resection and were then presented an associated 3D printed model for each case and asked to re-evaluate their surgical plan. Results Ten spinal oncology surgeons participated in the study, representing nine institutions across five countries. Four of the surgeons (40%) made significant changes to their surgical plan after reviewing the 3D models, including sacrifice of an additional nerve root to obtain negative margins, sparing an SI joint that was originally planned for inclusion in the en bloc resection, adjusting the location of osteotomy cuts, changes to the number of surgical stages and/or staging order, and preservation of neurology that was originally planned for sacrifice. The overall impression of the 3D models was positive, with 90% of the participants stating they found the 3D model useful in developing a surgical plan. Conclusions Surgical planning for resection of primary spinal column tumors is challenging and time intensive. 3D printed patient specific surgical models may be an additional tool that can augment surgical planning and execution by improving the chance of accomplishing surgical resection goals and minimizing morbidity.

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Frameworks for Total Ear Reconstruction: Past, Present and Future Directions

et al. 2022

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Total ear reconstruction describes surgical approaches aimed toward restoring the external ear to correct acquired or congenital deformities. Frameworks for auricular reconstruction have undergone substantial evolution over the past century and are broadly categorized as either autologous or alloplastic in nature. Recently, advances in tissue engineering, regenerative medicine and materials science have opened new avenues for recreating the cartilaginous and soft tissue structures of the ear through development of cutting-edge 3D constructs derived from a patient's own cells in a process known as bioprinting. This review outlines the historical approaches to frameworks for ear reconstruction and provides an updated synopsis and appraisal of current bioprinting efforts.

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A modern multidisciplinary approach to a large cervicothoracic chordoma using staged en bloc resection with intraoperative image-guided navigation and 3D-printed modeling: illustrative case

Cited by 4 publications

References 40 publications

Multidisciplinary surgical considerations for en bloc resection of sacral chordoma: review of recent advances and a contemporary single-center series

Multidisciplinary surgical considerations for en bloc resection of sacral chordoma: review of recent advances and a contemporary single-center series

Utility of 3D-Printed Models in the Surgical Planning for Primary Spine Tumors: A Survey of International Spinal Oncology Experts

Frameworks for Total Ear Reconstruction: Past, Present and Future Directions

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