DOI QR코드

DOI QR Code

Computer-Assisted Modified Mid-Sacrectomy for En Bloc Resection of Chordoma and Preservation of Bladder Function

  • Han, In-Ho (Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Seo, Young-Jun (Department of Neurosurgery, Dongnam Institute of Radiological & Medical Sciences) ;
  • Cho, Won-Ho (Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Choi, Byung-Kwan (Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine)
  • Received : 2011.01.28
  • Accepted : 2011.11.29
  • Published : 2011.12.28

Abstract

A 67-year-old woman presented for evaluation of severe coccygeal pain. The computed tomography scans and magnetic resonance imaging showed an asymmetric midline sacral tumor invading the right lower portion of S2. To preserve both S2 nerve roots and to obtain negative surgical margins, a modified mid-sacrectomy with an aid of a computed navigation system was performed. The sacral tumor was excised en bloc with negative tumor margins. Both S2 nerve roots were preserved and additional reconstruction was not necessary because of minimal resection of the sacroiliac joint. We report a case of a sacral chordoma which was excised en bloc with adequate surgical margins by a computer-assisted modified mid-sacrectomy. The computed navigation system may be a useful tool for tumor targeting and safe osteotomies in sacral tumor surgery via the posterior only approach.

Keywords

References

  1. Assaker R, Reyns N, Pertruzon B, Lejeune JP : Image-guided endoscopic spine surgery : Part II : clinical applications. Spine (Phila Pa 1976) 26 : 1711-1718, 2001 https://doi.org/10.1097/00007632-200108010-00016
  2. Benevento BT, Sipski ML : Neurogenic bladder, neurogenic bowel, and sexual dysfunction in people with spinal cord injury. Phys Ther 82 : 601-612, 2002
  3. Cho HS, Kang HG, Kim HS, Han I : Computer-assisted sacral tumor resection. A case report. J Bone Joint Surg Am 90 : 1561-1566, 2008 https://doi.org/10.2106/JBJS.G.00928
  4. Fourney DR, Rhines LD, Hentschel SJ, Skibber JM, Wolinsky JP, Weber KL, et al. : En bloc resection of primary sacral tumors : classification of surgical approaches and outcome. J Neurosurg Spine 3 : 111-122, 2005 https://doi.org/10.3171/spi.2005.3.2.0111
  5. Hsieh PC, Xu R, Sciubba DM, McGirt MJ, Nelson C, Witham TF, et al. : Long-term clinical outcomes following en bloc resections for sacral chordomas and chondrosarcomas : a series of twenty consecutive patients. Spine (Phila Pa 1976) 34 : 2233-2239, 2009 https://doi.org/10.1097/BRS.0b013e3181b61b90
  6. Marshman LA, Friesem T, Rampersaud YR, Le Huec JC, Krishna M, Reddy GR : Significantly improved lumbar arthroplasty placement using image guidance : technical note. Spine (Phila Pa 1976) 32 : 2027-2030, 2007 https://doi.org/10.1097/BRS.0b013e3181316292
  7. McLoughlin GS, Sciubba DM, Suk I, Witham T, Bydon A, Gokaslan ZL, et al. : En bloc total sacrectomy performed in a single stage through a posterior approach. Neurosurgery 63 : ONS115-ONS120; discussion ONS120, 2008
  8. Nolte LP, Visarius H, Arm E, Langlotz F, Schwarzenbach O, Zamorano L : Computer-aided fixation of spinal implants. J Image Guid Surg 1 : 88-93, 1995 https://doi.org/10.1002/(SICI)1522-712X(1995)1:2<88::AID-IGS3>3.0.CO;2-H
  9. Onaitis M, Ludwig K, Perez-Tamayo A, Gottfried M, Russell L, Shadduck P, et al. : The Kraske procedure : a critical analysis of a surgical approach for mid-rectal lesions. J Surg Oncol 94 : 194-202, 2006 https://doi.org/10.1002/jso.20591
  10. Rajasekaran S, Kamath V, Shetty AP : Intraoperative Iso-C three-dimensional navigation in excision of spinal osteoid osteomas. Spine (Phila Pa 1976) 33 : E25-E29, 2008 https://doi.org/10.1097/BRS.0b013e31815e6308
  11. Ramamurthy R, Bose JC, Muthusamy V, Natarajan M, Kunjithapatham D : Staged sacrectomy--an adaptive approach. J Neurosurg Spine 11 : 285-294, 2009 https://doi.org/10.3171/2009.3.SPINE08824
  12. Rao G, Chang GJ, Suk I, Gokaslan Z, Rhines LD : Midsacral amputation for en bloc resection of chordoma. Neurosurgery 66 : 41-44, 2010
  13. Schwab JH, Healey JH, Rose P, Casas-Ganem J, Boland PJ : The surgical management of sacral chordomas. Spine (Phila Pa 1976) 34 : 2700-2704, 2009 https://doi.org/10.1097/BRS.0b013e3181bad11d
  14. Tjardes T, Shafizadeh S, Rixen D, Paffrath T, Bouillon B, Steinhausen ES, et al. : Image-guided spine surgery : state of the art and future directions. Eur Spine J 19 : 25-45, 2010 https://doi.org/10.1007/s00586-009-1091-9
  15. Van Royen BJ, Baayen JC, Pijpers R, Noske DP, Schakenraad D, Wuisman PI : Osteoid osteoma of the spine : a novel technique using combined computer-assisted and gamma probe-guided high-speed intralesional drill excision. Spine (Phila Pa 1976) 30 : 369-373, 2005 https://doi.org/10.1097/01.brs.0000152531.49095.34

Cited by

  1. Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes vol.100, pp.8, 2011, https://doi.org/10.1002/bjs.9192_1
  2. Anterior-only Partial Sacrectomy for en bloc Resection of Locally Advanced Rectal Cancer vol.4, pp.4, 2014, https://doi.org/10.1055/s-0034-1375562
  3. Resection of a sacral chordoma aided by neuronavigation: A case report vol.23, pp.None, 2011, https://doi.org/10.1016/j.inat.2020.100985