Surgical workflow for fully navigated high sacral amputation in sacral chordoma

  • Johannes Goldberg
  • Simon Heinrich Bayerl
  • Christian Witzel
  • Felix Aigner
  • Christopher P. Ames
  • Peter VajkoczyEmail author
Technical Note


The method of choice for treatment of sacral chordomas is en bloc tumor removal via sacrectomy or sacral amputation in varying degrees depending on the initial tumor extent. Besides local tumor control, the preservation of neurological function is equally important to minimize postoperative bladder and bowel dysfunction. Removal of sacral tumors is complicated by the complex regional anatomy of the pelvis and the surrounding visceral and retroperitoneal structures. We aim to describe the surgical workflow for a fully navigated high sacral amputation facilitated by integration of an intraoperative computed tomography (iCT)-based spinal navigation system. An iCT-based spinal navigation system (AIRO® CT scanner, Brainlab AG, Feldkirchen, Germany) was used to perform intraoperative navigation with an image-guidance system and infrared tracking camera (BrainLab CurveTM, Brainlab AG, Feldkirchen, Germany) in combination with the spinal navigation set by Brainlab (Brainlab AG, Feldkirchen, Germany) to perform a fully navigated high sacral amputation. We demonstrate the successful implementation of iCT-based spinal navigation during high sacral amputation and the key advantages of this technique throughout the surgery. iCT-based spinal navigation is a useful complementing technique for en bloc high sacral amputations that renders the surgery safer and more accurate.


Chordoma Sacral tumor Sacral amputation Intraoperative computed tomography Computed tomography Spinal navigation 


Funding information

This study was funded by the Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Berlin, Germany.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict(s) of interest.

Ethical approval and informed consent

The nature of this article is a case presentation in the context of a technical note with completely anonymized patient data, which is why ethics committee approval and patient consent were neither required nor sought.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryCharité – Universitätsmedizin BerlinBerlinGermany
  2. 2.Division of Plastic and Reconstructive Surgery, Department of Surgery, Campus Charité Mitte–Campus Virchow-KlinikumCharité – Universitätsmedizin BerlinBerlinGermany
  3. 3.Department of Surgery, Campus Charité Mitte–Campus Virchow-KlinikumCharité – Universitätsmedizin BerlinBerlinGermany
  4. 4.Department of NeurosurgeryUniversity of CaliforniaSan FranciscoUSA

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