Navigated Ultrasonic Osteotomy to Aid in En Bloc Chordoma Resection via Spondylectomy.
Adult
Chordoma
/ surgery
Humans
Incidental Findings
Kidney Transplantation
Laminectomy
Lumbar Vertebrae
/ surgery
Magnetic Resonance Imaging
Male
Multimodal Imaging
Neurosurgical Procedures
/ methods
Osteotomy
/ methods
Plastic Surgery Procedures
Spinal Neoplasms
/ surgery
Spondylosis
/ surgery
Surgery, Computer-Assisted
/ methods
Tomography, X-Ray Computed
Treatment Outcome
Ultrasonography
En bloc chordoma resection
Lumbar spine tumor
Navigated ultrasonic osteotomy
Spondylectomy
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
05
05
2020
revised:
02
08
2020
accepted:
03
08
2020
pubmed:
14
8
2020
medline:
27
4
2021
entrez:
14
8
2020
Statut:
ppublish
Résumé
Chordomas are rare, locally malignant tumors derived from remnants of the notochord that can manifest anywhere in the spine or base of the skull. Surgical treatment for chordomas of the lumbar spine often fails to achieve successful en bloc resection, which is critical to minimizing recurrence risk. In this case report, the authors describe total en bloc resection of a lumbar vertebral body chordoma via the first documented approach of navigated ultrasonic osteotomy for spondylectomy. The patient is a 43-year-old man with end-stage renal disease, requiring dialysis, secondary to diabetes mellitus. The lesion in question was incidentally discovered in the L5 vertebral body during full body scanning for evaluation for a renal transplant. The lesion was diagnosed as a chordoma via percutaneous coaxial needle biopsy. Allogeneic renal transplant was canceled pending treatment of this newly discovered lesion. A combined, staged approach of L3-pelvis posterior instrumented fusion, L5 laminectomy and spondylectomy, and anterior L5 cage reconstruction with L4-S1 fusion was planned. Intraoperative computed tomography scan was performed and stereotactic osteotomies were planned. Ultrasonic osteotome (SONOPET Ultrasonic Aspirator) was registered as a navigation tool and employed, after verification, to complete the posterior stereotactic osteotomies, with postoperative computed tomography, magnetic resonance imaging, and pathology demonstrating successful en bloc resection. The navigated osteotome provided a critical combination of surgical precision and efficiency intraoperatively. This approach offers a promising technological adjunct for the treatment of complex spine tumors requiring precise resection and reconstruction.
Sections du résumé
BACKGROUND
Chordomas are rare, locally malignant tumors derived from remnants of the notochord that can manifest anywhere in the spine or base of the skull. Surgical treatment for chordomas of the lumbar spine often fails to achieve successful en bloc resection, which is critical to minimizing recurrence risk.
CASE DESCRIPTION
In this case report, the authors describe total en bloc resection of a lumbar vertebral body chordoma via the first documented approach of navigated ultrasonic osteotomy for spondylectomy. The patient is a 43-year-old man with end-stage renal disease, requiring dialysis, secondary to diabetes mellitus. The lesion in question was incidentally discovered in the L5 vertebral body during full body scanning for evaluation for a renal transplant. The lesion was diagnosed as a chordoma via percutaneous coaxial needle biopsy. Allogeneic renal transplant was canceled pending treatment of this newly discovered lesion. A combined, staged approach of L3-pelvis posterior instrumented fusion, L5 laminectomy and spondylectomy, and anterior L5 cage reconstruction with L4-S1 fusion was planned. Intraoperative computed tomography scan was performed and stereotactic osteotomies were planned. Ultrasonic osteotome (SONOPET Ultrasonic Aspirator) was registered as a navigation tool and employed, after verification, to complete the posterior stereotactic osteotomies, with postoperative computed tomography, magnetic resonance imaging, and pathology demonstrating successful en bloc resection. The navigated osteotome provided a critical combination of surgical precision and efficiency intraoperatively.
CONCLUSIONS
This approach offers a promising technological adjunct for the treatment of complex spine tumors requiring precise resection and reconstruction.
Identifiants
pubmed: 32791231
pii: S1878-8750(20)31785-X
doi: 10.1016/j.wneu.2020.08.021
pii:
doi:
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
319-324Informations de copyright
Copyright © 2020. Published by Elsevier Inc.