Pertsch Nathan J, Leary Owen P, Camara-Quintana Joaquin Q, Liu David D, Niu Tianyi, Woo Albert S, Ng Thomas T, Oyelese Adetokunbo A, Fridley Jared S, Gokaslan Ziya L
The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and.
Departments of Neurosurgery.
J Neurosurg Case Lessons. 2021 Feb 8;1(6):CASE2023. doi: 10.3171/CASE2023.
Cervicothoracic junction chordomas are uncommon primary spinal tumors optimally treated with en bloc resection. Although en bloc resection is the gold standard for treatment of mobile spinal chordoma, tumor location, size, and extent of involvement frequently complicate the achievement of negative margins. In particular, chordoma involving the thoracic region can require a challenging anterior access, and en bloc resection can lead to a highly destabilized spine.
Modern technological advances make en bloc resection more technically feasible than ever before. In this case, the successful en bloc resection of a particularly complex cervicothoracic junction chordoma was facilitated by a multidisciplinary surgical approach that maximized the use of intraoperative computed tomography-guided spinal navigation and patient-specific three-dimensional-printed modeling.
The authors review the surgical planning and specific techniques that facilitated the successful en bloc resection of this right-sided chordoma via image-guided parasagittal osteotomy across 2 stages. The integration of emerging visualization technologies into complex spinal column tumor management may help to provide optimal oncological care for patients with challenging primary tumors of the mobile spine.
颈胸段脊索瘤是罕见的原发性脊柱肿瘤，最佳治疗方法是整块切除。尽管整块切除是可活动脊柱脊索瘤治疗的金标准，但肿瘤位置、大小及受累范围常常使切缘阴性的实现变得复杂。特别是累及胸段的脊索瘤可能需要具有挑战性的前路入路，整块切除可能导致脊柱高度失稳。
现代技术进步使整块切除在技术上比以往任何时候都更可行。在此病例中，一种多学科手术方法促进了对一个特别复杂的颈胸段脊索瘤的成功整块切除，该方法最大限度地利用了术中计算机断层扫描引导的脊柱导航和患者特异性三维打印模型。
作者回顾了通过影像引导下经矢状旁截骨分两阶段成功整块切除该右侧脊索瘤的手术规划和具体技术。将新兴可视化技术整合到复杂脊柱肿瘤的管理中，可能有助于为可活动脊柱原发性挑战性肿瘤患者提供最佳肿瘤治疗。
