Advertisement

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
  • 35 Downloads

Abstract

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.

Keywords

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

Notes

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.

References

  1. 1.
    Bederman SS, Shah KN, Hassan JM, Hoang BH, Kiester PD, Bhatia NN (2014) Surgical techniques for spinopelvic reconstruction following total sacrectomy: a systematic review. Eur Spine J 23:305–319.  https://doi.org/10.1007/s00586-013-3075-z CrossRefGoogle Scholar
  2. 2.
    Bergh P, Gunterberg B, Meis-Kindblom JM, Kindblom LG (2001) Prognostic factors and outcome of pelvic, sacral, and spinal chondrosarcomas: a center-based study of 69 cases. Cancer 91:1201–1212CrossRefGoogle Scholar
  3. 3.
    Bergh P, Kindblom LG, Gunterberg B, Remotti F, Ryd W, Meis-Kindblom JM (2000) Prognostic factors in chordoma of the sacrum and mobile spine: a study of 39 patients. Cancer: Interdisciplinary International Journal of the American Cancer Society 88:2122–2134CrossRefGoogle Scholar
  4. 4.
    Chambers KJ, Lin DT, Meier J, Remenschneider A, Herr M, Gray ST (2014) Incidence and survival patterns of cranial chordoma in the United States. Laryngoscope 124:1097–1102CrossRefGoogle Scholar
  5. 5.
    Cheng EY, Özerdemoglu RA, Transfeldt EE, Thompson RC Jr (1999) Lumbosacral chordoma: prognostic factors and treatment. Spine 24:1639CrossRefGoogle Scholar
  6. 6.
    Dickey ID, Hugate Jr RR, Fuchs B, Yaszemski MJ, Sim FH (2005) Reconstruction after total sacrectomy: early experience with a new surgical technique. Clin Orthop Relat Res (1976-2007) 438:42-50Google Scholar
  7. 7.
    Doita M, Harada T, Iguchi T, Sumi M, Sha H, Yoshiya S, Kurosaka M (2003) Total sacrectomy and reconstruction for sacral tumors. Spine 28:E296–E301PubMedGoogle Scholar
  8. 8.
    Fourney DR, Rhines LD, Hentschel SJ, Skibber JM, Wolinsky J-P, Weber KL, Suki D, Gallia GL, Garonzik I, Gokaslan ZL (2005) En bloc resection of primary sacral tumors: classification of surgical approaches and outcome. J Neurosurg Spine 3:111–122CrossRefGoogle Scholar
  9. 9.
    Guo Y, Yadav R (2002) Improving function after total sacrectomy by using a lumbar-sacral corset. Am J Phys Med Rehabil 81:72–76CrossRefGoogle Scholar
  10. 10.
    Härtl R, Lam KS, Wang J, Korge A, Kandziora F, Audigé L (2013) Worldwide survey on the use of navigation in spine surgery. World Neurosurg 79:162–172.  https://doi.org/10.1016/j.wneu.2012.03.011 CrossRefGoogle Scholar
  11. 11.
    Hecht N, Kamphuis M, Czabanka M, Hamm B, König S, Woitzik J, Synowitz M, Vajkoczy P (2016) Accuracy and workflow of navigated spinal instrumentation with the mobile AIRO® CT scanner. Eur Spine J 25:716–723.  https://doi.org/10.1007/s00586-015-3814-4 CrossRefPubMedGoogle Scholar
  12. 12.
    Khanna AR, Yanamadala V, Coumans J-V (2016) Effect of intraoperative navigation on operative time in 1-level lumbar fusion surgery. J Clin Neurosci 32:72–76.  https://doi.org/10.1016/j.jocn.2016.02.033 CrossRefPubMedGoogle Scholar
  13. 13.
    McLoughlin GS, Sciubba DM, Suk I, Witham T, Bydon A, Gokaslan ZL, Wolinsky J-P (2008) En bloc total sacrectomy performed in a single stage through a posterior approach. Oper Neurosurg (Hagerstown) 63:ONS115–ONS120CrossRefGoogle Scholar
  14. 14.
    McMaster ML, Goldstein AM, Bromley CM, Ishibe N, Parry DM (2001) Chordoma: incidence and survival patterns in the United States, 1973–1995. Cancer Causes Control 12:1–11CrossRefGoogle Scholar
  15. 15.
    Navarro-Ramirez R, Lang G, Lian X, Berlin C, Janssen I, Jada A, Alimi M, Hartl R (2017) Total navigation in spine surgery; a concise guide to eliminate fluoroscopy using a portable intraoperative computed tomography 3-dimensional navigation system. World Neurosurg 100:325–335.  https://doi.org/10.1016/j.wneu.2017.01.025 CrossRefGoogle Scholar
  16. 16.
    O'Neill P, Bell BA, Miller JD, Jacobson I, Guthrie W (1985) Fifty years of experience with chordomas in southeast Scotland. Neurosurgery 16:166–170.  https://doi.org/10.1227/00006123-198502000-00007 CrossRefPubMedGoogle Scholar
  17. 17.
    Osaka S, Kodoh O, Sugita H, Osaka E, Yoshida Y, Ryu J (2006) Clinical significance of a wide excision policy for sacrococcygeal chordoma. J Cancer Res Clin Oncol 132:213–218CrossRefGoogle Scholar
  18. 18.
    Park L, DeLaney TF, Liebsch NJ, Hornicek FJ, Goldberg S, Mankin H, Rosenberg AE, Rosenthal DI, Suit HD (2006) Sacral chordomas: impact of high-dose proton/photon-beam radiation therapy combined with or without surgery for primary versus recurrent tumor. Int. J. Radiat. Oncol. Biol. Phys. 65:1514–1521.  https://doi.org/10.1016/j.ijrobp.2006.02.059 CrossRefGoogle Scholar
  19. 19.
    Rao G, Chang GJ, Suk I, Gokaslan Z, Rhines LD (2010) Midsacral amputation for en bloc resection of chordoma. Oper Neurosurg (Hagerstown) 66:ons-41-ons-44.  https://doi.org/10.1227/01.neu.0000365799.21610.c4 CrossRefGoogle Scholar
  20. 20.
    Ruggieri P, Angelini A, Ussia G, Montalti M, Mercuri M (2010) Surgical margins and local control in resection of sacral chordomas. Clin Orthop Relat Res 468:2939–2947CrossRefGoogle Scholar
  21. 21.
    Samson IR, Springfield DS, Suit HD, Mankin HJ (1993) Operative treatment of sacrococcygeal chordoma. A review of twenty-one cases. JBJS 75:1476–1484CrossRefGoogle Scholar
  22. 22.
    Schwab JH, Healey JH, Rose P, Casas-Ganem J, Boland PJ (2009) The surgical management of sacral chordomas. Spine 34:2700–2704.  https://doi.org/10.1097/brs.0b013e3181bad11d CrossRefPubMedGoogle Scholar
  23. 23.
    Shen FH, Harper M, Foster WC, Marks I, Arlet V (2006) A novel “four-rod technique” for lumbo-pelvic reconstruction: theory and technical considerations. Spine 31:1395–1401CrossRefGoogle Scholar
  24. 24.
    Simpson AH, Porter A, Davis A, Griffin A, McLeod RS, Bell RS (1995) Cephalad sacral resection with a combined extended ilioinguinal and posterior approach. JBJS 77:405–411CrossRefGoogle Scholar
  25. 25.
    Stephens M, Gunasekaran A, Elswick C, Laryea JA, Pait TG, Kazemi N (2018) Neurosurgical management of sacral tumors: review of the literature and operative nuances. World Neurosurg 116:362–369.  https://doi.org/10.1016/j.wneu.2018.05.212 CrossRefGoogle Scholar
  26. 26.
    Van de Kelft E, Costa F, Van der Planken D, Schils F (2012) A prospective multicenter registry on the accuracy of pedicle screw placement in the thoracic, lumbar, and sacral levels with the use of the O-arm imaging system and StealthStation Navigation. Spine 37:E1580–E1587CrossRefGoogle Scholar
  27. 27.
    Yonemoto T, Si T, Takenouchi T, Ishii T, Satoh T, Moriya H (1999) The surgical management of sacrococcygeal chordoma. Cancer 85:878–883CrossRefGoogle Scholar
  28. 28.
    York JE, Kaczaraj A, Abi-Said D, Fuller GN, Skibber JM, Janjan NA, Gokaslan ZL (1999) Sacral chordoma: 40-year experience at a major cancer center. Neurosurgery 44:74–79CrossRefGoogle Scholar
  29. 29.
    Zang J, Guo W, Yang R, Tang X, Li D (2015) Is total en bloc sacrectomy using a posterior-only approach feasible and safe for patients with malignant sacral tumors? 22:563. doi: https://doi.org/10.3171/2015.1.spine14237 PubMedGoogle Scholar
  30. 30.
    Zhou J, Sun J, Bai HX, Huang X, Zou Y, Tan X, Zhang Z, Tang X, Tao Y, Xiao B, Zhang PJ, Yang L (2017) Prognostic factors in patients with spinal chordoma: an integrative analysis of 682 patients. Neurosurgery 81:812–823.  https://doi.org/10.1093/neuros/nyx081 CrossRefPubMedGoogle Scholar

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

Personalised recommendations