Skip to main content
SpringerLink
Log in

Resection of giant invasive sacral schwannoma using image-based customized osteotomy tools

  • Ideas and Technical Innovations
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Background

Giant invasive sacral schwannomas are rare tumors. Surgical excision is the standard treatment and total resection is performed if feasible. Advances in three-dimensional (3D) imaging technology have facilitated treatment designs of complex surgical procedures.

Objective

Our aim was to evaluate virtual surgical planning, computer-aided design (CAD), and manufacturing with 3D printing technology of the customized osteotomy guiding device in giant invasive sacral schwannoma resection.

Methods

A digital 3D model of the sacrum, including the giant invasive sacral schwannoma, was rendered from patient computer tomography (CT) images. The surgeon chose excision margins of the tumor. Based on the virtual surgical planning, the customized guiding tool for osteotomy was designed and manufactured using the CAD and 3D printing.

Results

We used the guiding block to successfully excise a giant sacral schwannoma using only a posterior approach to achieve gross total resection. No augmented spinal instrumentation was used to prevent iatrogenic spinal instability. Clinical symptoms resolved dramatically after operation. No spinal instability occurred during follow-up.

Conclusion

With the assistance of an image-based customized osteotomy guiding device, we achieved both goals of tumor resection and bone preservation in giant sacral schwannoma resection. With thorough surgical planning, this technology can be applied to the complex surgical procedures easily and reliably.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Togral G, Arikan M, Hasturk AE, Gungor S (2014) Incidentally diagnosed giant invasive sacral schwannoma. Its clinical features and surgical management without stability. Neurosciences (Riyadh) 19:224–228

    Google Scholar 

  2. Yu NH, Lee SE, Jahng TA, Chung CK (2012) Giant invasive spinal schwannoma: its clinical features and surgical management. Neurosurgery 71:58–66. doi:10.1227/NEU.0b013e31824f4f96

    Article  PubMed  Google Scholar 

  3. Sridhar K, Ramamurthi R, Vasudevan MC, Ramamurthi B (2001) Giant invasive spinal schwannomas: definition and surgical management. J Neurosurg 94:210–215

    CAS  PubMed  Google Scholar 

  4. Ozdemir N, Bezircioglu H, Akar O (2010) Giant erosive spinal schwannomas: surgical management. Br J Neurosurg 24:526–531. doi:10.3109/02688697.2010.487129

    Article  PubMed  Google Scholar 

  5. Leon BR, Carrillo FJ, Gonzalez HM, Franco JL (1999) Mandibular reconstruction with the free vascularized fibular flap: utility of three-dimensional computerized tomography. J Reconstr Microsurg 15:91–97. doi:10.1055/s-2007-1000076 (discussion 97–99)

  6. Su L, Dong Q, Zhang H, Zhou X, Chen Y, Hao X, Li X (2016) Clinical application of a three-dimensional imaging technique in infants and young children with complex liver tumors. Pediatr Surg Int 32:387–395. doi:10.1007/s00383-016-3864-7

    Article  PubMed  Google Scholar 

  7. Spetzger U, Frasca M, Konig SA (2016) Surgical planning, manufacturing and implantation of an individualized cervical fusion titanium cage using patient-specific data. Eur Spine J. doi:10.1007/s00586-016-4473-9

    PubMed  Google Scholar 

  8. Lorensen WEC, Harvey E (1987) Marching cubes: a high resolution 3D surface construction algorithm. ACM Comput Graph 21:163–169. doi:10.1145/37402.37422

    Article  Google Scholar 

  9. Noh K, Pae A, Lee JW, Kwon YD (2016) Fabricating a tooth- and implant-supported maxillary obturator for a patient after maxillectomy with computer-guided surgery and CAD/CAM technology: a clinical report. J Prosthet Dent 115:637–642. doi:10.1016/j.prosdent.2015.10.015

    Article  PubMed  Google Scholar 

  10. Farrell BB, Franco PB, Tucker MR (2014) Virtual surgical planning in orthognathic surgery. Oral Maxillofac Surg Clin N Am 26:459–473. doi:10.1016/j.coms.2014.08.011

    Article  Google Scholar 

  11. Bobek S, Farrell B, Choi C, Farrell B, Weimer K, Tucker M (2015) Virtual surgical planning for orthognathic surgery using digital data transfer and an intraoral fiducial marker: the charlotte method. J Oral Maxillofac Surg 73:1143–1158. doi:10.1016/j.joms.2014.12.008

    Article  PubMed  Google Scholar 

  12. Bui MM, Smith P, Agresta SV, Cheong D, Letson GD (2008) Practical issues of intraoperative frozen section diagnosis of bone and soft tissue lesions. Cancer Control 15:7–12

    PubMed  Google Scholar 

  13. Potamianos P, Amis AA, Forester AJ, McGurk M, Bircher M (1998) Rapid prototyping for orthopaedic surgery. Proc Inst Mech Eng H 212:383–393

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Institute of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan, R.O.C.

      Cheng-Li Lin

    2. Department of Orthopaedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, R.O.C.

      Cheng-Li Lin

    3. Department of Mechanical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan, R.O.C.

      Jing-Jing Fang

    4. Department of Orthopedics, Tainan Municipal An-Nan Hospital, China Medical University, No. 66, Sec. 2, Changhe Rd., Annan Dist., Tainan, 709, Taiwan, R.O.C.

      Ruey-Mo Lin

    Authors
    1. Cheng-Li Lin
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Jing-Jing Fang
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Ruey-Mo Lin
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Ruey-Mo Lin.

    Ethics declarations

    Conflict of interest

    The authors have no personal financial or institutional interests in any of the materials, or devices described in this article.

    Additional information

    C.-L. Lin and J.-J. Fang contributed equally to this research.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Lin, CL., Fang, JJ. & Lin, RM. Resection of giant invasive sacral schwannoma using image-based customized osteotomy tools. Eur Spine J 25, 4103–4107 (2016). https://doi.org/10.1007/s00586-016-4782-z

    Download citation

    • Received:

    • Revised:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00586-016-4782-z

    Keywords

    Search

    Navigation