Novel approach using transoral robotic surgery for resection of cervical spine chordoma

McCann, Adam; Berger, Connor; Mahmoud, Ahmad F.; Kuan, Edward C.; Malhotra, Neil R.; O’Malley, Bert W.

doi:10.1002/lary.27489

Cited by 6 publications

(6 citation statements)

References 23 publications

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“…16,17 The use of TORS to treat patients with cervical spine lesions was described by Molteni et al 18 in 2017. McCann et al 19 also described using TORS for the resection of a C2 chordoma. However, these approaches employed a midline incision, and issues with wound infection and dehiscence were encountered, resulting in prolonged tube feeding and antibiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Robotic-Assisted Tubular Transoral Parapharyngeal Approach to the Ventral Craniovertebral Junction

Basma¹,

Rangarajan²,

Michael³

et al. 2021

Operative Surg.

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BACKGROUND Transoral robotic surgery (TORS) has become a routine technique for treating benign and malignant lesions of the oropharynx with the advantage of reducing morbidity compared to open surgical techniques. However, TORS has not been used routinely for accessing lesions of the spine. OBJECTIVE To describe how TORS can be used to access spinal lesions. METHODS We describe our technique of accessing the parapharyngeal space using the robotic technique, and then dissecting the prevertebral muscles to expose the ventral craniovertebral junction. Tubular retraction with endoscopic visualization is then employed for surgical resection. We then report a case of a 14-yr-old competitive athlete who presented with an osseous lesion of C1, which underwent resection using this novel TORS approach. RESULTS Our patient underwent successful resection of a lateral C1 osteoid osteoma utilizing a combined TORS/endoscopic approach. She tolerated soft diet immediately and was discharged on postoperative day 2. Postoperative imaging revealed complete resection of the lesion, and she returned to competitive athletics within 6 wk. CONCLUSION Utilizing this novel, robotic-assisted approach can definitively treat osseous cervical spine lesions while reducing morbidity, allowing for early return to normal diet and minimizing overall length of hospital stay.

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Section: Discussionmentioning

confidence: 99%

Robotic-Assisted Tubular Transoral Parapharyngeal Approach to the Ventral Craniovertebral Junction

Basma¹,

Rangarajan²,

Michael³

et al. 2021

Operative Surg.

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“…The use of transoral robotic surgery is emerging technology and technical case reports are starting to appear in the literature. 9…”

Section: Future Developmentsmentioning

confidence: 99%

Time to Modify Rather than Discard the Transoral Approach to Selected Cases of Clival Chordomas at the Craniocervical Junction

Kirollos

Pillay

2023

Indian Journal of Neurosurgery

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Maintaining the transoral approach in the armamentarium of surgical approaches to clival chordomas mainly as a complimentary procedure to endonasal endoscopic approach in selected cases is advantageous. Lateral extension of the disease is a limitation to both approaches and is addressed by transcranial approaches. Especially for extensive lesions the simultaneous combination of approaches is based upon the predicted blind spots for each approach and certain technical nuances need to be considered.

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“…Otolaryngologists are often engaged for tumors requiring high anterior cervical approaches due to tumor extension into the retropharyngeal space from between the carotid sheath and pharyngeal constrictors 10,11 . Transoral robotic approaches for superior cervical spine chordomas have also been described for retropharyngeal masses with some success, provided tumor anatomy allows for access through the oral cavity 13,14 . While chordomas in the head and neck are commonly managed with open surgical approaches, endonasal endoscopic and contralateral transmaxillary approaches have also been proposed for clival and superior cervical tumors due to advantages in surgical exposure 13–15 …”

Section: Introductionmentioning

confidence: 99%

“…10,11 Transoral robotic approaches for superior cervical spine chordomas have also been described for retropharyngeal masses with some success, provided tumor anatomy allows for access through the oral cavity. 13,14 While chordomas in the head and neck are commonly managed with open surgical approaches, endonasal endoscopic and contralateral transmaxillary approaches have also been proposed for clival and superior cervical tumors due to advantages in surgical exposure. [13][14][15] Chordomas are indolent tumors that often remain silent until the later stages of the disease.…”

Section: Introductionmentioning

confidence: 99%

Speech and Swallowing Outcomes of Surgically Managed Cervical Chordoma: A Case Series

Yu,

Ko,

Han

et al. 2024

The Laryngoscope

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ObjectivesCervical chordoma is a rare, low‐grade primary bone tumor occurring in the axial skeleton. Due to challenges in surgical exposure caused by anatomic location, patients may experience dysfunction in speech and swallowing. The objective of this study was to characterize speech and swallowing outcomes for patients undergoing surgical resection of cervical chordoma. Moreover, we detail in‐depth two cases with similar initial presentations to compare prognostic factors and management strategies.MethodsEleven patients with histologically confirmed cervical chordoma treated between 1993 and 2020 were included in this retrospective case series. Outcomes measured included overall survival, disease‐free survival, need for enteral feeds, as well as results of modified barium swallow study (MBSS) and fiberoptic laryngoscopy.ResultsThe mean age at diagnosis was 55.9 years. The patient population was 81.8% male. Mean survival after diagnosis was 96 months. Four (36.4%) patients required post‐operative MBSS and demonstrated aspiration. All four of these patients presented with tumors in the superior cervical spine and received surgeries utilizing anterior approaches. Of the four, 2 required enteral feeds long‐term. Four (36.4%) patients endorsed dysphonia. One patient developed post‐operative right vocal fold paresis. The remaining three patients experienced stable dysphonia pre‐ and post‐operatively. Additionally, three (27%) patients required tracheostomy placement, two of which remained in place long‐term.ConclusionsDysphagia is a common side effect of cervical chordoma resection. It is associated with the use of an anterior approach during resection and with tumors located in the superior cervical spine. Patients with postoperative dysphagia should receive early multidisciplinary swallow rehabilitation.Level of Evidence4 Laryngoscope, 2024

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Novel approach using transoral robotic surgery for resection of cervical spine chordoma

Cited by 6 publications

References 23 publications

Robotic-Assisted Tubular Transoral Parapharyngeal Approach to the Ventral Craniovertebral Junction

Robotic-Assisted Tubular Transoral Parapharyngeal Approach to the Ventral Craniovertebral Junction

Time to Modify Rather than Discard the Transoral Approach to Selected Cases of Clival Chordomas at the Craniocervical Junction

Speech and Swallowing Outcomes of Surgically Managed Cervical Chordoma: A Case Series

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