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Patient-Specific Three-Dimensional Model for a Safe Surgical Pathway in Sacral Chondrosarcoma

  • Anil Murat Ozturk
  • Mehmet Asim Ozer
  • Onur Suer
  • Okan Derin
  • Figen Govsa
  • Burcin Kececi
  • Dundar Sabah
Original Article
  • 4 Downloads

Abstract

Sacral tumors are amongst the most challenging procedures to treat because of the complex anatomy. This study determined whether patient-specific models change preoperative planning decisions made in preparation for en bloc resection of complex sacral mass surgical procedures. Imaging showed a big encapsulated mass at the S2–3 level involving the neural foramina and obscuring the nerve roots. High-resolution images were acquired and utilized to generate a patient-specific 3D tumor model. The visual and tactile inspection of 3D models allowed the best anatomical understanding, with faster and clearer comprehension of the surgical anatomy. The 3D sacral model was for observation of previously unapparent anatomical details; with this new technology, surgeon can observe their planned surgical intervention, explore the patient-specific anatomy and extension of the tumor, and sharpen their procedure choices. Moreover, multiple planes showed how far the angles on the plane would extend for osteotomy of the sacrum. Another result was identifying correct guides and safe venture landmarks. The study helped to establish safe osteotomy line wherever the nerve roots were retained and enabled osteotomy by preserving bilaterally the S1 and S2 nerve roots for wide excision of wide excision of primary sacral tumor to get adequate bowel and bladder functions. Finally, it helped to determine whether or not the remaining bone in the sacrum is sufficient for spinopelvic stability and needed fixation. It was decided spinopelvic fixation was not necessary for this case. Surgical intervention of sacral tumors varies depending on the tumor, its size, extension, and location. Surgery can have profound risks including unnecessary nerve root resection spinopelvic instability and suboptimal oncological resection. 3D models help to transfer complex anatomical information to clinicians and provide guidance in the preoperative planning stage, for intraoperative navigation and for surgical training purposes.

Keywords

Sacral nerves 3D printing model Surgical planning Sacral osteotomy Chondrosarcoma 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Indian Association of Surgical Oncology 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, Faculty of MedicineEge UniversityIzmirTurkey
  2. 2.Digital Imaging and 3D Modelling Laboratory Department of Anatomy, Faculty of MedicineEge UniversityIzmirTurkey
  3. 3.Ege Üniversitesi Tıp Fakültesi Anatomi Anabilim DalıIzmirTurkey

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